UPDATE

June 12, 2018

 

Physician Rate Setting Held in Assembly Committee

AB 3087 (Kalra D-San Jose) was held on the Suspense File in the Assembly Appropriations Committee. That means it is dead for the year and session.  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 have established 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.
 
When the bill's fate was announced by the Appropriations Committee Chair she indicated that the author and sponsors agreed to not move the bill but that the issue is by no means dead. The dialogue on this policy will continue on into next year.
 
In the meantime the 2018-19 state budget that is headed to the Governor includes funding to create a state database of healthcare payments. It would collect and analyze the actual payments made to physicians, hospitals and other providers by health plans and insurers. There is a bill moving through the Legislature that would create the same database and is part of the health care reform study committee outcome.


Bill to Expand Scope for MLTs Moving in Senate

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 still has opposition from the union that represents CLSs and, interestingly also MLTs. They have now been joined by several other unions representing unrelated employees who claim that MLTs are not adequately trained to perform these additional procedures. AB 2281 passed the Senate Business and Professions Committee Monday on a 6-0 vote and now moves to the Senate Appropriations Committee.


Medicare- Notice From Noridian on Standing Order for Lab Tests

Laboratory Orders Must be Submitted Within 12 Months of Order

Noridian has received notice of errors from the Comprehensive Error Rate Testing Contractor (CERT) for laboratory claims that have "Standing Orders" that are over 12 months old. In some cases, specifically for End Stage Renal Disease beneficiaries, standing orders submitted for review were over 12 months old.

When the laboratory service(s) is initially ordered, medical necessity is established; therefore, at the time of the initial order, the beneficiary's medical records must include documentation indicating the service is reasonable and necessary as well.

In addition to information that justifies the initial provision of the service (s), clinical information must be in the beneficiary's medical record to support that the laboratory service continues to remain reasonable and necessary. For the claim (date of service) under review, information used to justify continued medical need must be timely.

Noridian has determined that timely documentation for laboratory service standing orders is defined as a medical record in the preceding 12 months. Providers may wish to set a reminder to renew such orders on or about 12 months from the previous order.


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