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On September 13, Sens. Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI) released an updated legislative proposal to repeal and replace portions of the Affordable Care Act (ACA). The new bill would roll federal funding for the ACA’s premium subsidies and Medicaid expansion into a single pool, and then convert it into block grants to the states. The legislation would also convert federal Medicaid funding to a per capita allotment and limit growth of federal Medicaid spending starting in 2020.

According to the Congressional Budget Office (CBO), the new bill would result in millions fewer people with comprehensive health insurance coverage. The new legislation is also predicted to reduce budget deficit by at least $133 billion by 2026. The CBO said it is unable to do complete analysis of the plan, including exact coverage impact, in the short window as requested by lawmakers.

The legislation would give states broad discretion to use the block grant funds, making the impact of the bill very difficult to predict. States could choose to eliminate popular safeguards on coverage for individuals like pre-existing conditions, parental coverage for young adults, and elimination of annual, and lifetime coverage caps. The Senate has a September 30 deadline to pass the bill through the reconciliation process, which requires a simple majority or a tie plus an affirmative vote by Vice President Mike Pence to pass the chamber. A new draft of this legislation was circulated Sunday and the CAP expects to see several new drafts should the Senate decide to move forward to vote later this week.

Similar to previous Senate legislation to repeal and replace the ACA, these versions still do not align with the health reform objectives set forth by the CAP. The CAP developed high-level policy principles that we want to see in any repeal and replacement package. These principles included ensuring that individuals with insurance can continue to access affordable coverage without interruption while the health care system takes steps toward coverage and access for all Americans; maintaining key insurance market reforms that protect patients (e.g. covering pre-existing conditions); protecting prevention and screening services that are currently covered; stabilizing and strengthening the individual insurance market; and reducing regulatory burdens on physicians. The new Senate proposal and updated draft does not address the CAP’s overarching principles or the regulatory burdens on physicians.

The American Medical Association, the American Hospital Association, American's Health Insurance Plans, the Federations of American Hospitals, the American Academy of Family Physicians, BlueCross BlueShield Association, the American Society of Clinical Oncology, AARP and many other consumer groups have all expressed opposition to the legislation.

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The CAP, along with the American Association of Blood Banks, the American Society for Apheresis, the American Society of Hematology and the Renal Physician's Association, recently sought clarification on a recent directive by the National Government Service (NGS) that conflicted with the current standard of practice regarding physician supervision requirements and coverage to non-physicians for the performance of apheresis procedures. On September 20, the CAP learned that the NGS is revising their directive.

As a result of the unclear language, Medicare contractors would have required apheresis procedures to be performed by physicians, or that a physician be in attendance in the room at all times during the performance of the procedure. Furthermore, payment to non-physician practitioners would have no longer been made. These issues, among others, trigged the CAP and its partners to submit a request for clarification to the Centers for Medicare and Medicaid Services (CMS).

Based on the CAP's comment letter to NGS on September 19 and the intersociety collaboration, the NGS is revising their directive and has retracted their August 24 announcement regarding the Coverage for Therapeutic Pheresis Procedures.

The CAP will provide further updates on this issue in STATLINE later this year.

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Reserve your seat at featured Advocacy Courses

Registration is still open for key CAP policy and advocacy courses and roundtable discussions important to the pathology specialty during CAP17 at the Gaylord National Harbor from October 8–11, 2017.

Learn about the new Pathologists Quality Registry and how it can help you comply with the Quality Payment Program in 2017 during "Optimize Your Medicare Bonus Potential With the Pathologists Quality Registry." One-hour sessions are offered on Monday and Tuesday, October 9 and 10, at 9:30 AM, NOON, 2:30 Pm.

Additional CAP advocacy courses and roundtable discussions are also available at CAP17:

  • M1596: How is My Payment Determined for Pathology Services?
  • R1690: My Surgical Pathology and Cytopathology Coding Dilemmas
  • R1691: Current Payment Policy Challenges in Pathology Practice
  • S1620: Medicare's New Quality Payment Program and the Physician Fee Schedule

Moreover, hear about the current trends in Pathology Practice and how it shapes CAP Advocacy efforts.

  • STA007C: Results from the 2017 CAP Practice Characteristics Survey

Check out the full list of Advocacy courses offered at CAP17.

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