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Dive Summary:
- A coalition of more than 30 trade groups from across the healthcare industry is calling on Congress to pass legislation that would prevent steep cuts in Medicare reimbursements for laboratory testing services from taking effect in January.
- in a letter sent last week To congressional leaders, groups including AdvaMed, the American Clinical Laboratory Association, the American Medical Association and the American Hospital Association said the legislation is necessary to stabilize Medicare payments for diagnoses established under the Medicare Clinical Laboratory Fee Schedule, or CLFS.
- The organizations support a bill called the Sustainable Updates to Laboratory Testing Services Reform and Improvement Act, or RESULTS, that would direct CMS to contract with an independent, nonprofit commercial claims database to set CLFS rates for widely available tests.
Diving information:
The RESULTS Law was introduced in September in both the House and Senate with bipartisan support. It aims to reform the CLFS rate-setting process established under the Protecting Medicare Access Act of 2014, or PAMA, to halt payment reductions of up to 15% that are scheduled to go into effect Jan. 1 for about 800 lab tests.
Such cuts threaten patients’ access to routine, life-saving diagnostic tests, the groups said.
PAMA aimed to create a national fee schedule, based on private market data, that would reflect a variety of laboratories serving Medicare beneficiaries. However, industry groups contend that PAMA created a process that sets reimbursement rates artificially low, resulting in nearly $4 billion in CLFS cuts in the first three years.
Congress has acted to delay in payment cuts in each of the last five years. Health care groups argue it is time to enact permanent reform through RESULTS legislation. His request comes amid a federal government shutdown that is on track. become the longest in US history..
ACLA said CLFS rates for testing widely available would rely on robust claims data from private payers, while clinical laboratories would have to report commercial rate data directly to CMS for tests that are not widely available, such as proprietary diagnostics and those for rare diseases.
In addition to revamping the rate-setting process to reflect updated market information, the bill aims to reduce the data collection and reporting burden on clinical laboratories and the administrative burden on CMS by extending the rate-setting cycle to every four years.
It would also set limits on annual payment reductions and exclude artificially low Medicaid managed care payment rates from the data used to establish reimbursement levels.
