Protecting Access to Medicare Act

ACLA Calls for Suspension of Flawed PAMA Rates in Comments to CMS

Association Cites CMS Failure to Implement CLFS Reform as Congress Intended, Says Proposed Rates Will Hurt Most Vulnerable Medicare Beneficiaries

(Washington, D.C.) – The American Clinical Laboratory Association (ACLA) today submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the agency’s preliminary payment determinations for lab tests under the Protecting Access to Medicare Act (PAMA).

“ACLA has consistently objected to the failure of CMS to implement the PAMA statute according to Congressional intent,” said Julie Khani, president of ACLA.  “The proposed rates published by CMS are based on a deficient data collection process that excluded the majority of laboratories from participating, resulting in the submission of inaccurate and incomplete laboratory payment data.  CMS must delay implementation of any new CLFS rates until it has collected data and calculated rates that accurately reflect all segments of the laboratory market, ensuring continued access to laboratory testing services for Medicare beneficiaries.”

The association has been consistent in stating its concerns with PAMA implementation, and recently joined 21 other stakeholders in a letter to CMS Administrator Verma requesting “immediate action to address the significant deficiencies in its process to establish new clinical laboratory payment rates.” At the core of the lab community’s objection is CMS’ sidestepping of congressional intent to establish fair market-based pricing based on the broad scope of the laboratory market.

“The proposed rates represent drastic pricing reductions far beyond those intended by Congress,” said Khani.  “If finalized, these rates will create severe disruptions in access to laboratory services, particularly for the most vulnerable Medicare beneficiaries.  It is critical that implementation of the draft payment rates is delayed, in order to achieve PAMA’s intent:  a true market-based payment solution for laboratory services.”

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ACLA is a not-for-profit association representing the nation’s leading clinical and anatomic pathology laboratories, including national, regional, specialty, ESRD and nursing home laboratories.   The clinical laboratory industry employ nearly 277,000 people directly, and generate over 115,000 additional jobs in supplier industries. Clinical laboratories are at the forefront of personalized medicine, driving diagnostic innovation and contributing more than $100 billion to the nation’s economy.

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