U.S. Regulatory/Legislative News
1. CLMA & ASCLS APPLAUD STUPAK AND BURGESS FOR INTRODUCING
LEGISLATION TO MODERNIZE LAB FEE SCHEDULE
The Clinical Laboratory Management Association (CLMA), the American Society for Clinical Laboratory Science (ASCLS), American Medical Technologists (AMT), and the American Society for Clinical Pathology (ASCP) applaud the leadership of Representatives Bart Stupak (D-MI) and Michael Burgess (R-TX) for introducing key legislation that will modernize the clinical diagnostic laboratory fee schedule. H.R. 1452, the “Medicare Clinical Diagnostic Laboratory Fee Schedule Modernization Act of 2009,” which was introduced March 11, 2009, requires the Secretary of Health and Human Services to convene a negotiated rulemaking committee to develop a modernized, consensus-driven clinical laboratory fee schedule.
The current clinical laboratory fee schedule that provides Medicare Part B reimbursement for clinical laboratory services was adopted 25 years ago, based on 1983 local prevailing charge data. Since that time, the cost of clinical diagnostic laboratory tests, laboratory equipment, supplies, and medical professional staff has increased exponentially. This legislation establishes a consensus-driven process to modernize the laboratory fee schedule to reflect these increased costs.
In recent years, laboratories have suffered real reductions in their Medicare Part B reimbursement levels - not just reductions in the rate of increase as has been experienced by other health care services. The current Medicare fee schedule does not fully reflect changes in cost, technology, complexity and delivery of clinical laboratory services over the past two decades.
The legislation was referred to the Committees on Energy and Commerce and Ways and Means for consideration. If the negotiated rulemaking committee fails to reach consensus the Congress retains authority to implement a modernized fee schedule.
CLMA continues to ask our members to contact Congress to build support for HR 1452. To date 645 messages from CLMA members have gone to the House reaching 161 Representatives in 44 states. This is clearly having an impact as we now have TEN co-sponsors; Representatives Michael Burgess (TX), C.W. Bill Young (FL), Sanford Bishop (GA), Rick Boucher (VA), Bob Goodlatte (VA), Lee Terry (NE), Russ Carnahan (MO), Tom Latham (IA), Leonard Boswell (IA) and most recently this week Fred Upton (MI). If you are a constituent of any these co-sponsors, please take a moment to thank them through their individual web sites at http://www.house.gov/.
CLMA sincerely thanks all of you who have responded so far, but there is still more work to be done.
Please take action! Now that HR 1452is introduced, we need your support. CLMA asks that you contact your Representative to co-sponsor the bill.
To contact your Representative, please use CLMA’s “one-click” advocacy software, CapWiz. The link below will connect you to an action alert with a template letter asking your Representative to co-sponsor HR 1452. Your letter will automatically be emailed to your Representative based on zip code match.
House Letter to Co-sponsor HR 1452:
http://capwiz.com/clma/issues/alert/?alertid=12901321&type=ML
As health care reform continues to rapidly progress on Capitol Hill, it is critical that we gain as many co-sponsors as possible on the House Energy and Commerce Committee in order to give HR 1452 the best chance of inclusion in health care reform legislation.
Please check the list of Energy and Commerce Committee members using the link below. If you are a constituent, please use the CapWiz link above to contact your legislator as soon as possible.
http://energycommerce.house.gov/index.php?option=com_content&view=
category&layout=blog&id=160&Itemid=61
For an Executive Summary and Section by Section Analysis of HR 1452, please visit the Policy page at http://www.clma.org/KnowledgeCenter/knc.aspx?s=advc&t1=policy.
To read the actual legislative text for “Clinical Laboratory Diagnostic Fee Schedule Modernization Act of 2009,” please visit http://thomas.loc.gov/. Search using “HR 1452.”
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2.President Obama Proposes Additional Medicare and Medicaid Cuts
to Fund Health Care Reform
On June 12, 2009, President Obama released an additional $313 billion in cuts to Medicare and Medicaid over 10 years to help fund health care reform legislation currently being drafted by Congress.
This is in addition to a 10-year, $634 billion reserve fund solely dedicated to funding health care reform included in the President’s 2010 budget proposal. This brings the total to $948 billion over 10 years to pay for reform, which has an estimated cost of over $1 trillion dollars over ten years according to experts.
The $634 billion reserve fund included in the President’s 2010 budget proposal was intended solely as a “substantial down payment” on health care reform and not to fully fund it. The reserve fund includes $316 billion in proposed savings from Medicare and Medicaid over 10 years. A large portion of the Medicare savings would come from cuts to Medicare Advantage (MA) by introducing competitive bidding to the plans. There is also a proposal that encourages hospitals to reduce readmission rates and bundle Medicare payments for certain post-acute care.
The $313 billion in additional savings would extend the solvency of the Medicare Hospital Insurance Trust Fund seven years until 2024. It includes $110 from productivity adjustments to Medicare payments, $106 billion from reducing hospital subsidies for treating the uninsured as coverage increases, $75 billion due to paying better prices for Medicare Part D drugs, and $22 in other savings (cuts to nursing homes, long-term care hospitals, and physician imaging services).
To read the “White House Facts Sheet” on additional savings to pay for health care reform, please visit http://www.whitehouse.gov/MedicareFactSheetFinal/.
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3. Senate HELP Committee Begins Mark up of Health Reform Legislation
Senate Finance Committee Delays Mark up
The Senate Health, Education, Labor and Pensions (HELP) committee has begun the process of marking up draft health care reform legislation. The incomplete 615-page draft “Affordable Health Choices Act” was released on June 9, 2009.
The bill includes changes to individual and group markets such as not excluding preexisting conditions, no discrimination based on health status, and the requirement to include quality incentives and preventative health care services in all policies. It would expand Medicaid eligibility to 150 percent of the poverty level and establish an Affordable Health Benefit Gateway in each state. Gateways would be established to help qualified individuals and qualified employer groups purchase affordable health insurance products.
The bill also includes provisions to improve the quality and efficiency of the health care system, to modernize disease prevention of public health systems, and to increase access to preventative health services. It also seeks to increase the healthcare workforce and prevent health care fraud abuse.
The unfinished draft is missing final language on a public plan option and an employer mandate to provide coverage. A detailed summary of the bill includes several options for legislators to consider as they proceed with the mark up. Three options for a public plan included in the summary are:
Option A: A public health insurance plan operated by the Federal Government with a payment schedule that is set in statute and is based on Medicare.
Option B: A health insurance plan, though operated under contract from the Department of Health and Human Services (HHS), would play by the same rules as commercial health insurance carriers.
Option C: Drop the public plan option.
The bill summary creates a shared responsibility framework whereby individuals would be required to have health insurance coverage, and employers that do not provide health care coverage would be required to contribute to the cost of coverage for their employees. Five options on requiring shared responsibility from employers were included as follows:
Option A: Pay or Play: Employers (not including small employers) that do not offer coverage that meets certain criteria, must pay a per-worker fee.
Option B: A Free Ride Penalty: There is no requirement that employers over coverage, nor are standards applicable, but any large employer whose employees are on Medicaid must repay the Federal cost for an employee’s Medicaid coverage.
Option C: For any employee not offered affordable coverage by an employer, where the employee enrolls in a publicly standardized plan through a Gateway, that employer must remit to the government the amount the employer would have paid for that employee’s coverage had they remained in the employer-sponsored insurance.
Option D: Drop the employer mandate.
Option E: Allow employers to incentivize healthy behaviors, such as increasing the 20 percent limitation on premiums, and the gift tax that applies to prizes/rewards to employees for better behavior/participation in programs, etc.
The Congressional Budget Office (CBO) recently analyzed the draft “Affordable Health Choices Act” and determined that the major provisions would increase the federal deficit by $1 trillion over 10 years. At the same time the bill would only reduce the number of uninsured by 16 million. This initial cost analysis only covers the health insurance coverage provisions. CBO is currently analyzing the cost of legislative language for a public plan option, and the “pay or play,” and “free riders” versions of the employee mandate presented in the draft bill.
A preliminary CBO report on a draft Senate Finance Committee health reform plan estimated a cost of $1.6 trillion over 10 years. The Finance Committee has not yet released draft legislation. The CBO score prompted Chairman Max Baucus (MT) to delay the committee’s mark up until after the July 4th recess, so that they may discuss ways to reduce the bill by $600 billion. Also, the committee is waiting for complete cost estimates before drafting a reform bill.
There are late breaking reports that some health care proposals in the plan may be brought in at less than $1 trillion while still covering 97 percent of Americans.
To read an “Affordable Health Care Choices Act” Section by Section Narrative with Options, please visit http://op.bna.com/hl.nsf/id/sfak-7surwf/$File/Kennedy%20Options%20Paper.pdf.
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4. House Committees Release Draft Health Care Reform Plan and Begin Hearings
On June 19, 2009 the three House committees with jurisdiction over health care - Energy and Commerce, Ways and Means, and Education and Labor – released a tri-committee health care reform plan in the form of a legislative discussion draft.
The plan includes a Health Insurance Exchange, a public plan option, an individual and employer mandate, and expansion of Medicaid
The Health Insurance Exchange would create a transparent and functional marketplace for both individuals and small employers to select among private and public plans. It would be subject to reforms and consumer protections and would eventually be open to all employers as another option to cover their employees. States may opt to operate the Exchange if they follow the federal rules for the national Exchange.
As part of the Exchange, the public plan option would operate on a level playing field and will be subject to the same reforms as the private plans. It will be self-sustaining and will be financed only by its premiums.
Insurance companies will not be allowed to discriminate based on an individual’s health status or pre-existing conditions. The plan provides “sliding scale” affordability credits available to families with low and moderate income to help them pay for coverage.
Once insurance market reforms and the affordability credits are in place, individuals will be required to obtain health care insurance, except in cases of hardship. Those that chose not to obtain coverage would pay a penalty based on two percent of adjusted gross income above a specified level.
According to the plan employers have the option of providing health insurance coverage for employees, or contributing funds on their behalf based on eight percent of their payroll. Employers that offer coverage must meet minimum benefit requirements. Certain small business would be exempt from the requirement that employers provide coverage.
The plan has provisions on improving quality of care, expanding preventative services, fighting health care fraud and abuse, and increasing the health care workforce. It proposes to expand Medicaid to individuals and families with incomes below 133 percent of the federal poverty level.
All three House committees held hearings this week on health reform and intend to mark up draft legislation after the July 4, 2009 recess.
To read a discussion draft of the House tri-committee proposal please visit http://edlabor.house.gov/documents/111/pdf/publications/DraftHealthCareReform-BillText.pdf.
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EDUCATION NEWS
5. New Educational Tracks! Explore our Growing and Innovative Educational Offerings for 2009! Click here to learn more about our educational tracks.
NEW 2009 audioLab PRICING STRUCTURE!
CLMA Members-$249
Non-Members-$299
Be sure to visit the audioLab Year-at-a-Glance for the updates to the 2009 audioLab schedule. Click Here to access the calendar.
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6. Check Out Education-On-Demand!
Access Professional Development Without Leaving My Office?
Schedule Education When It’s Convenient for Me?
Earn Continuing Education Credits Whenever I Want?
Where Do I Sign Up?
Education-On-Demand is a fast, convenient and economical way to access recordings from some of CLMA’s most popular and timely audioLab presentations. Whether you train one, or train 100, the same low price applies.
$149 per 90-minute webinar (member price) and $199 (non-member price)
CLMA’s Education-On-Demand: Who says you can’t have it all?
For more information please visit www.clma.org/ondemand
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7. Discounted Bundled Pricing for 2009 audioLabs!
Are you a busy laboratory manager with a tight budget for continuing education for you and your staff? CLMA recognizes that this a common challenge many of our members face and is here to help! Our discounted bundled pricing allows you to purchase a group of high-quality educational programs in an extremely cost effective manner! Choose from packages of 5, 10, or 15 audioLabs. You are not restricted by topic or educational track. Mix and match the topics to best meet the educational needs of you and your staff. Click Here
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8. Summer Symposium
Join your colleagues in Seattle for the first CLMA Seasonal Meeting of 2009 focusing on Patient Safety. Being held at the beautiful Grand Hyatt Seattle, the 1 and a half day program delves deep into Patient Safety issues affecting your laboratory's diagnostic accuracy and reliability. The incredible pricing of this conference has been realized through the generous support from our sponsors. Click here for more information
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9. 27th Annual Lab Institute - Special Rates for CLMA Members!
27th Annual Lab Institute:
Advancing in the Eye of the Storm - Arlington, VA
09/23/09-09/25/09
SPECIAL RATES FOR CLMA MEMBERS!
Register Before Augsut 11th to Save $100!!
Click the link below to access the registration form. The discounted rate for CLMA members is only available by using the hard copy registration form. The discounted rate is not included in online registration.
http://www.ioma.com/issues/downloads/LabInstitute09Prelim.php
For program updates, please visit: www.g2reports.com/labinstitute09
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Association News
10. New Membership Categories
CLMA is excited to introduce four new membership categories. These new categories reflect the needs of our current members as well as opening up CLMA membership to a much wider and more diverse audience.
The new categories are:
Future Leaders - A new membership category aimed at clinical laboratory professionals in the early stages of their career who are not yet in a management or supervisory position. The new Future Leaders category offers access to all CLMA membership benefits including career links, networking forums, information databases, professional development discounts, Education- On -Demand and more at a dues rate that fits a future leaders' budget.
Lifetime Membership - This is an easy way to support CLMA without ever having to renew your membership. Lifetime members receive all the valuable CLMA regular membership benefits plus the recognition of being a CLMA lifetime member.
Bundled Membership - CLMA recognizes that budgets are tight, but your staff still needs access to quality professional development, networking opportunities and valuable online resources. That is why we're introducing the new Bundled Membership enabling hospitals, laboratories and other facilities access to all that CLMA has to offer at a lower per person cost to you.
Corporate Membership - Receiving value is what it's all about and CLMA provides value to corporations as well as to individual members. Whether you're a hospital, laboratory or industry partner, CLMA has a value-based corporate package designed to grow your people, provide access to the industry and drive favorable legislation.
We believe these new categories will help expand CLMA's membership base and enable even more people to take advantage of CLMA's cutting-edge professional development and membership offerings.
More information on the new membership categories can be found here.
Sponsorship
For information on sponsoring a CLMA Email Alert, please contact Rebecca Baker at rbaker@clma.org or 312/673-5827.
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