Advocacy Update

• Who Will Lead House Health Care Committees in the 118th Congress
• CMS Increases Federal IDR Arbitration Fee
• COVID-19 Public Health Emergency Extended through Mid-April
• New Info on Digital Pathology Codes Now Available at CAP.org
• ONC Receptive to CAP’s Comments on Health Data Standard
• Can You Afford a 3% Payment Cut?
• Test Your Advocacy News Intelligence

As the 118th Congress took office in January, Republicans hold a slight majority in the House, making for a new speaker and committee leadership. House Speaker Kevin McCarthy (R-CA) was sworn in on January 7 along with the rest of Congress. Here is a list of key congressional House committees overseeing Medicare, Medicaid, and health care that will be pertinent to the CAP's advocacy strategy.

In the House Committee on Energy and Commerce, the chair is Rep. Cathy McMorris Rodgers (R-WA) and Rep. Frank Pallone, (D-NJ), will be the ranking member.

For the House Committee on Ways and Means, Rep. Jason Smith (R-MO) will serve as chair and Rep. Richie Neal (D-MA) will serve as ranking member.

Read our rundown of key Senate committees on health care.

The Centers for Medicare & Medicaid Services (CMS) recently announced that the nonrefundable administrative fee due from each party for participating in the federal independent dispute resolution (IDR) process under the No Surprises Act increased from $50 to $350. This change became effective January 1.

The change in the fee amount is an update to prior CMS guidance, which stated the administrative fee for the IDR process would remain $50 in 2023. The CMS explained that the change was needed due to “supplemental data analysis and increasing expenditures in carrying out the Federal IDR process.”

The CAP has been concerned with the significant backlog of disputes but opposes the fee change. Check out updates on our advocacy on surprise billing.

On January 11, the Department of Health, and Human Services (HHS) renewed the COVID-19 Public Health Emergency until April 15. By extending the emergency, states and Medicaid services will continue with affiliated waivers for various sectors of the US health care system for another 90 days.

This may be the last time HHS renews the health emergency. The next deadline for the pandemic will be in mid-February as the Biden administration has promised to give stakeholders 60 days’ notice before letting the health emergency expire.

The CAP curated resources for pathologists and their practices on the new Category III Digital Pathology codes. These resources include a website with all the codes, information, and frequently asked questions. The new codes are intended to capture and report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. Digitization of glass microscope slides enables remote examination by the pathologist and/or in conjunction with using artificial intelligence (AI) algorithms.

The CAP worked with the American Medical Association (AMA) CPT Editorial Panel to establish 13 new digital pathology add-on codes. As a result of CAP advocacy, the codes will help pathologists, pathology practices, and laboratories providing digital pathology digitization procedures appropriately report these services. The new digital pathology codes have been effective since January 1, 2023.

Check out the resources.

The Office of the National Coordinator for Health Information Technology (ONC) responded favorably to the CAP’s advocacy and has included the CAP’s advice in the next iteration of the United States Core Data for Interoperability (USCDI) standard.

The ONC created the USCDI standard, which it adopted in its implementation of the 21st Century Cures Act. The USCDI standard defines how health care data must be formatted to be exchanged electronically nationwide. The CAP asked the ONC how the USCDI standard could achieve its goal without overburdening pathologists and laboratories.

The CAP advocated to align the USCDI with the testing reporting requirements in the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Specifically, the CAP stated that CLIA requirements are required for clinical laboratories. Those elements will consequently achieve the USCDI’s goal of developing a foundation for the nationwide electronic sharing and reporting of laboratory information to support patient care. Moreover, aligning the USCDI with CLIA requirements will avoid contradictory or duplicative and burdensome reporting requirements for pathologists and laboratories. As a result of the CAP’s advocacy, the ONC agreed and will align the USCDI more with CLIA in future iterations.

Pathologists’ payments are being threatened to decline by 3% to offset a new G code designed to benefit primary care physicians. Advocacy works…but only if you are at the table.

Be an active advocate for pathology and plan to attend the Pathologists Leadership Summit where you will gain unparalleled access to the education and training to make an impact. Further your impact by joining us in-person on Capitol Hill to advocate and protect the future of our specialty. The Pathologists Leadership Summit takes place April 15-18 in Washington, DC.

Register now

Test your knowledge with the January Advocacy News Quiz. See how you compare against your fellow CAP members and brag about your score on social media!

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