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May 1, 2013  


CMS Wants Comments on EHR Safe Harbor Extension


CMS is accepting comments on proposed revisions to the current regulations that exempts the donation of certain types of EHR items and services from the prohibition on self referral and the anti-kickback prohibition. The current safe harbor provision that allows this to occur in the clinical laboratory/pathology world will expire by its terms on 12/31/13 and CMS is requesting public comment on whether the end date should be extended or removed all together.


We have heard from many pathology groups that express frustration with requests from referring physicians to provide expensive electronic health records software. Longstanding relationships and referral patterns have been disrupted when some labs offer this kind of equipment and services. The CSP will be submitting comments to CMS to request that the safe harbor provision end on 12/31/13 and that it not be continued.  The comment period ends on June 10, 2013 and we encourage you to submit your individual comments, which can be done electronically or by mail or fax. Go to http://www.regulations.gov and enter the regulation package ID of RIN 0938-AR70 . You can view the regulation  package and easily submit your comments.


CSP Obtains Changes to Proposed Law on HIV Screening   


AB 446 (Mitchell) as introduced would have required that all patients in a hospital ER, urgent care center, or clinic be asked to consent to HIV screening and have the results provided before they leave the facility. The CSP was joined by the hospital association and others in opposing this expensive, impractical, and difficult to implement new requirement. Though a laudable goal to screen more patients for HIV it is not common practice and would be particularly burdensome in the ER environment. The author listened to those objections and has removed those provisions.


The CSP continues to work with the author on one remaining provision regarding a change to current law as to what types of test results can be released electronically to patients based upon both the consent of the referring provider and the patient. Current law amended last year in AB 2253 (Pan), which was supported by the CSP would not have allowed electronic release of HIV results or a positive tissue biopsy without first having contact with the patient by the referring/ordering practitioner. AB 446 would change that for HIV results provided that electronic access is provided through a secure website and again the patient has consented to obtaining their lab results in this manner. The CSP continues to advocate that a positive HIV result should not be provided to the patient without both a confirmatory test and prior discussion with the patient. The author again motivated by positive public policy believes that for those patients who may be reluctant to return to their provider to obtain test results might be helped by being able to view those results electronically.  AB 446 is double referred to both Assembly Judiciary and Health Committees and we will continue to discuss that particular issue.    


Sequestration Affects Medicare Fee for Service Payments


As required by law, President Obama issued a sequestration order on March 1, 2013 requiring across-the-board reductions in Federal spending.


In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payments. Therefore, to prevent making over-payments, interim and pass-through payments related to the Medicare cost report will be reduced by 2 percent.   Beginning April 1, 2013 the 2 percent reduction will be applied to Periodic Interim Payments (PIP), Critical Access Hospital (CAH) and Cancer Hospital interim payments, and pass-through payments for Graduate Medical Education, Organ Acquisition, and Medicare Bad Debts.


Details are available on the website of our Medicare MAC www.palmettogba.com/medicare.  


Bill to Prohibit Retroactive Medi-Cal Rate Reduction Passes First Committee   


The Legislature adopted  a 10% Medi-Cal provider rate reduction that was to have taken effect on June 1, 2011 as part of the budget deal to close the then state budget deficit for 2011-12. Due to delays in CMS approval and a subsequent Federal  Court injunction that rate cut was never implemented for pathology services. The injunction did not cover independent clinical lab services. Earlier this year a panel for the Ninth Circuit Court of Appeals reversed the ruling and DHCS has  indicted their intent to retroactively recoup that 10% cut back to June 1, 2011. They would do so by cutting current provider rates by 10% and then also taking an additional 5% of current payments each month until the individual provider payments have been recovered.


There is a pending request to have the entire Ninth Circuit Court of Appeals hear an appeal of the 3 judge ruling and pending a decision on whether to grant that hearing DHCS will not yet take any action.  A decision could come any day. In the meantime a provider coalition is pushing two bills in the Legislature to block any retroactive "clawback" of the 10% both in fee for service payments or in reductions to Medi-Cal managed care plan capitation payments. SB 640 (Lara) passed the Senate Health Committee last Wednesday and AB 900 (Alejo) will be heard shortly in the Assembly Health Committee. If passed these bills would need to be signed by the Governor or accomplished in the current budget process to become law. The Governor has been reluctant to undo any of the prior budget cuts that were used to balance the budget. His current budget proposal for 2013-14 still contains savings from the 10% cut.   The CSP supports this effort and will keep you informed of developments.   


Save the Date


CSP 66th Annual Convention

December 3-7, 2013

Hyatt Regency San Francisco 




California Society of Pathologists
One Capitol Mall Suite 320
Sacramento, CA 95814 
Tel : 916-446-6001
Fax :  916-444-7462