Advocacy Update

• Cigna to Keep Paying the Professional Component of Clinical Pathology Services after CAP Expresses Concerns
• CAP Asks Congress for Laboratory Support in Upcoming Infrastructure Legislation
• Final White House Budget Confirms Increased Funding for CDC, New Health Care Agency
• Senate Confirms Brooks-LaSure as CMS Administrator
• CDC Updates COVID-19 Testing Requirements for Vaccinated Individuals
• Advocacy Win: Tennessee Passes Amended Lab Licensure Law Supported by TSP, CAP
• Advance Diversity in Pathology: Apply by June 18 
• 2021 Practice Leadership Survey is Open
• New Month, New Advocacy News Quiz

In response to the CAP’s engagement, Cigna informed the CAP on June 7 that the decision is imminent. The CAP learned health insurance payer Cigna plans to continue reimbursing pathologists for the professional component of clinical pathology services. A formal update regarding the policy to pay for the professional component of clinical pathology would be forthcoming soon.

The CAP had strongly urged the health insurer Cigna to rescind its policy to deny claims when the professional component (modifier 26) of clinical pathology is billed. In a CAP letter to Cigna on April 23, the CAP urged the insurer to continue paying for the professional component of clinical pathology services for all pathologists. The CAP further engaged with the presidents of state pathology societies and state issue advisors on the Cigna policy and gathered feedback on how the change will affect pathologists in their states. Several state pathology societies also sent letters to Cigna urging them to reverse course.

Cigna had announced the payment policy change on April 12 and said the denials would take effect in July. The change would have affected pathologists in several states. In communications to Cigna, the CAP maintained the professional component of clinical pathology (PC of CP) services are critical to the reliable and accurate diagnosis and treatment of patients. For Cigna to discontinue reimbursement for these services will prove detrimental to patients, and to the integrated delivery of care to which laboratory diagnostic services are central. More updates on this new development will be published in future editions of Advocacy Update and on our Advocacy Twitter channel.

The CAP urged federal lawmakers to support laboratory infrastructure, resources for testing, and public workforce investments in a comprehensive strategy as part of infrastructure bills being debated in Congress. In addition, the CAP asked Congressional leaders to increase resources for testing, enhance existing relief programs, and offer additional financial assistance to pathologists and laboratories.

In a May 25 letter to congressional leadership, the CAP said: “While Congress has made incredible investments in testing, vaccines, and economic support to physicians and their patients to address the impact of COVID-19, the instability caused by the pandemic remains and is likely to be a factor for several years. Now more than ever, patients and their treating physicians are relying on the expertise of pathologists.”

The CAP asked Congress to include additional resources as the public health emergency continues and several challenges remain. Those challenges include acquiring testing supplies, particularly test kits, plastic pipette tips specimen acquisition swabs, and transport media. These challenges impede access, especially for smaller health systems, limiting the capacity for rapid testing.

The CAP has advocated for an additional $10 billion investment in expanding domestic manufacturing for pandemic supplies, including those used throughout the testing process and any efforts to fully use the Defense Production Act. The CAP also requested that Congress extend the relief provided in the Consolidated Appropriations Act of 2021 to mitigate the Centers for Medicare and Medicaid Services (CMS) 2022 payment reductions to all non-evaluation and management (E/M) services.

On May 28, the Biden Administration released its final 2022 $6 trillion budget proposal, including $2.3 trillion for its infrastructure proposal, $1.8 trillion for its education and families plan, and $1.5 trillion in proposed discretionary spending. This final budget proposal is a follow-up to the initial budget proposal released on April 9. The final budget proposal does include an additional $8.7 billion for the Centers for Disease Control (CDC) and Prevention and a 23% boost to the Department of Health and Human Services (HHS).

Congress will ultimately determine the federal budget and is expected to do so by the end of 2021.

The proposed budget also asked Congress for $50.5 billion for the National Institutes of Health, and $6.5 billion for the new Advanced Research Projects Agency for Health, which would focus on cancer, diabetes, and Alzheimer’s disease research. The HHS budget would include $2.5 billion for COVID-19 and opioid pandemics. The administration also asked for $8.7 billion for the CDC, which would represent the largest budget authority increase in nearly two decades. The CDC would use this additional funding to support core public health capacity improvements in states and territories, modernize public health data collection nationwide, train new epidemiologists and other public health experts, and build international capacity to detect, prepare for, and respond to emerging global threats.

Additionally, the proposed budget supports lowering the Medicare eligibility age to 60. The proposed budget outlines a public option available through the Affordable Care Act marketplaces; and giving people aged 60 and older the option to enroll in the Medicare program with the same premiums and benefits as current beneficiaries but with financing separate from the Medicare Trust Fund.

On May 25, the Senate confirmed Chiquita Brooks-LaSure as the new Administrator of the Centers for Medicare & Medicaid Services (CMS). Ms. Brooks-LaSure will be the first Black CMS administrator to lead and oversee Medicare, Medicaid, and various insurance marketplace regulations.

Following her confirmation, Brooks-LaSure said her top priorities at the CMS will be to set policies to expand health insurance coverage and address health disparities.

Previously, Ms. Brooks-LaSure was a CMS deputy director who oversaw insurance marketplaces and regulations following the enactment of the Affordable Care Act. She also previously worked with Department of Health and Human Services Secretary, Xavier Becerra, while serving as a staffer on the House Ways and Means Committee.

On May 27, the CDC updated its Testing Strategies for SARS-CoV-2 to align with the Interim Public Health Recommendations for Fully Vaccinated People.

The CDC announced that fully vaccinated people can refrain from COVID-19 testing following a known exposure unless they are residents or employees of a correctional, detention facility or a homeless shelter. For the latest updates regarding COVID-19 testing, visit the agency’s website for Testing Strategies for SARS-CoV-2.

On May 25, Gov. Bill Lee signed a laboratory licensure deregulation bill (SB 982) to codify waiver elements of Tennessee’s COVID-19 executive order, which repealed the medical laboratory licensure act and laboratory personnel licensure requirements. The Tennessee Society of Pathologists (TSP) and the CAP supported the legislation to decrease administrative burdens and costs on clinical laboratory operations with the deferral to rigorous federal oversight under the federal CLIA program.

The law exempts Tennessee-licensed pharmacies with active CLIA-certificate of waivers from the Tennessee Medical Laboratory Act authorizes medical laboratory directors to monitor medical laboratory personnel remotely, redefines “waived” testing as laboratory test systems cleared by the FDA for home use, and waived testing under CLIA.

Importantly, the TSP and the CAP worked together to amend the bill to include amendments that provide that “hospital-based laboratories within the bill’s definition of ‘private laboratory’ exempt from state laboratory licensure, clarify the Act applies to medical personnel employed by and performing testing at a private laboratory.”

Additionally, the amendments retain the prohibition to “solicit the referral of specimens to the person's or another medical laboratory or contract to perform medical laboratory examinations of specimens in a manner that offers or implies an offer of rebates to any person submitting specimens, other fee-splitting inducements, participation in fee-splitting arrangements, or other unearned remuneration,” and ensures prohibition “applies to medical personnel employed by and performing testing at a private laboratory.”

With the revised law, laboratories are equitably applicable and it preserves a prohibition of bribes, rebates, fee-splitting, and other unethical forms of remuneration in exchange for referrals of patient specimens.

The TSP requested an additional amendment to support the maintenance of laboratory personnel requirements and licensure as Tennessee’s educational and credentialing standards are paramount compared to federal standards. However, the amendment was not included in the final bill. The newly enacted law will significantly decrease state regulatory burdens and expenses on laboratories beyond the COVID-19 pandemic.

All CAP members are invited to apply to serve on the CAP’s newly formed Diversity, Equity, and Inclusion (DEI) Committee. The committee’s charge is “to advance the CAP’s ability to maximize diversity, equity, and inclusion, and to support the visibility and participation of underrepresented pathologists and pathologists-in-training.” The DEI committee will report initially to the Board of Governors and will collaborate across CAP councils to grow and strengthen the diversity of the membership. If you have an interest in advancing efforts that give voice to diversity in the practice of pathology, apply today. Applications close June 18, 2021, for volunteer service through 2022.

Pathologists asked to take the CAP 2021 Practice Leadership Survey received emailed invitations on June 8. This survey will produce a report for CAP members on data regarding pathology practice economics, demographics, and market trends in the evolving business environment.

The survey specifically targets practice leaders and is designed to receive one response from each pathology practice in the United States. Invitations were sent to practice leaders on June 7 and the survey will remain open until June 18. Data from the survey will help CAP leaders determine which advocacy issues are most important to pathology practices and further assist CAP advocacy efforts on behalf of the pathology specialty. The survey is targeted to practice leaders who can answer the questions for the whole practice.

The survey will provide pathology practices with the objective data they need to understand how they compare to their peers, how others are dealing with current health care trends, and what business practices are becoming more or less common. Survey participants will have early access to survey results and will receive a $20 gift card. The survey should take approximately 20 minutes to complete.

The survey invitation was sent to all board-certified pathologists with 5 or more years in practice, but only one leader per practice should complete the survey. If your practice has not received an invitation, please contact practicesurvey@cap.org.

It's June and that means a new Advocacy News Quiz. Last month, over 90 pathologists took the quiz. See how you compare against your fellow CAP members’ in the June News Quiz and brag about your top scores on social!

Take the news quiz