Protecting Access to Medicare Act

ACLA Commends CMS’ Decision to Exercise Enforcement Discretion for Reporting Applicable Information Under PAMA

(Washington, D.C.) – The American Clinical Laboratory Association (ACLA) today lauded the decision by the Centers for Medicare and Medicaid Services (CMS) to exercise enforcement discretion until May 30, 2017 for laboratories reporting private payor pricing data as required by the Protecting Access to Medicare Act (PAMA).

“ACLA appreciates the decision by CMS to exercise enforcement discretion until May 30, 2017,” said Julie Khani, president of the ACLA. “We are committed to working with CMS, Congress and other stakeholders to implement reform of the Clinical Laboratory Fee Schedule as Congress intended, resulting in Medicare payment rates that reflect the broad scope of the laboratory market, recognize the value of laboratory services, and protect access for Medicare beneficiaries.”

ACLA, the nation’s largest organization representing clinical laboratories, has noted in the past that reform of the Medicare Clinical Laboratory Fee Schedule (CLFS) as outlined by PAMA, comes with complications that hamper the ability of laboratories to collect and report data.  Of particular concern to the lab community is the current definition of “applicable laboratory,” those labs required to report private payor data, which according to the Office of Inspector General’s (OIG) analysis, would include only 5 percent of labs, excluding all hospital laboratories and impacting the rate calculations used to ultimately set Medicare prices for test services.

In a letter to Health and Human Services (HHS) Secretary Tom Price signed by ACLA and other stakeholders, the lab community expressed its concerns that CMS would implement changes to the CLFS while significant programmatic issues remain unresolved.

“ACLA supports reforming the Medicare payment system, but it is imperative that modifications work in favor of patient access, and recognize the value and role of diagnostics,” said Khani.  “We look forward to continuing to work with CMS on addressing these issues and achieving a fair and effective solution that reinforces a robust laboratory market and protects patient access to important diagnostics.”

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The ACLA is a not-for-profit association representing the nation’s leading national, regional and esoteric clinical laboratories on key issues of common concern, including federal and state government reimbursement and regulatory policies. 

 

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