UPDATE

May 4, 2018

 
Physician Rate Setting Bill Passes Assembly Health Committee

AB 3087 (Kalra D-San Jose) did pass the Assembly Health Committee and now moves to the Assembly Appropriations Committee.  This radical new legislation that would increase patient out-of-pocket costs and result in a dangerous government intrusion into the health care market by creating state-sanctioned rationing of health care for all Californians.
 
Assembly Bill 3087 would establish an undemocratic, government-run commission with nine political appointees who would unilaterally set the price for all medical services that are not already controlled by the government, essentially eliminating commercial health care markets in California. In its first iteration none of the political appointees are required to be patient-focused or have any tangible experience in the delivery of health care to patients. Amendments would add one physician to the panel.
 
The CSP has joined with a variety of medical organizations, the hospital association, health plans and the Ca. Chamber of Commerce in opposing the bill. It would allow the Commission to set rates for physician services using Medicare rates as a benchmark indicating the rates would be higher but with no specifics. The bill does nothing to address the inadequate payment rates of Medi-Cal or Medicare or lack of primary care physicians. In the Assembly Health Committee the bill passed on a party line vote with many Democrats voting yes but indicating their strong reservations with the specifics of how this process would work and the potential impact. All acknowledge the unsustainability of increasing health care costs but this singular focus on physician payments is not the solution. 
 
The CMA has established a site to help physicians reach out to their legislators to express their opposition. Physicians are urged to visit actnow.io/PriceFixing

Bill to Expand Scope for MLTs Passes Assembly

The CSP sponsored AB 2281 (Irwin) that would expand the types of tests that a Medical Laboratory Technologist can perform. The law adopted in 2002 that created the MLT license category limited MLTs to moderate complexity testing that did not involve microscopic analysis. California has the most restrictive MLT law in the nation while most states either have no similar limit on the type of moderate complexity tests that can be performed or don't license MLTs at all and defer to federal law.
 
AB 2281 would simply add three specific moderate complexity procedures blood smear reviews, microscopic urinalysis, and ABO/Rh blood typing to the duties of MLTs. This limited expansion was developed by a Laboratory Workforce Committee under the auspices of the Ca. Hospital Assoc. and lab professionals. It is also consistent with a report on the State of the California Medical Laboratory Technician Workforce released by the Healthforce Center at UCSF in January 2017.  That study compared regulation of MLTs by other states, the numbers of MLTs in each state, and their utilization as part of the lab workforce.
 
These three procedures were chosen because they are all moderate complexity tests, are high volume in many labs, are part of current MLT training programs and performed by MLTs in most other states.
 
AB 2281 will help clinical labs address the aging of the lab workforce and allow higher trained Clinical Lab Scientists to focus on high complexity testing and the more difficult lab tasks. AB 2281 passed the Assembly on a unanimous vote and now will be heard in the Senate.

Policy Update for HPV Testing and Co-Testing

The CSP reached out to the Medi-Cal program to urge that the policy on HPV testing be altered. Their policy had limited coverage for CPT 87264 to patients age 30 or older. Due to our advocacy that policy was altered and the notice below has been published. Labs that had previous denials for this code based upon age will have those claims automatically reprocessed retroactive to 1/1/17.

Effective retroactively for dates of service on or after January 1, 2017, the age restriction for CPT-4 codes 87624 (infectious agent detection by nucleic acid [DNA or RNA]; Human papillomavirus, high-risk types [e.g. 16, 18, 31, 33, 35 ,39, 45, 51, 52, 56, 58, 59, 68]) and 87625 (infectious agent detection by nucleic acid [DNA or RNA]; Human papillomavirus, types 16 and 18 only, includes type 45, if performed) is updated for the Medi-Cal program. The age restriction for these HPV testing and co-testing codes is updated from "30 to 65 years of age," to "21 years of age and older."

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of providers.

This change is based on the recommendations from the American Society of Colposcopy and Cervical Pathology (ASCCP) 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors.

This information is reflected in the following provider manual(s):
Provider Manual(s)
Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics

Save the Date

CSP Annual Meeting
 November 26-December 3, 2018
 Hyatt Regency San Francisco

 
California Society of Pathologists
One Capitol Mall Suite 800
Sacramento, CA 95814 
Tel : 916-446-6001
Fax :  916-444-7462