ACLA Reviewing HHS OIG Reports on Implementation of CLFS Reform

(WASHINGTON, DC) – American Clinical Laboratory Association (ACLA) President Alan Mertz issued the following statement today regarding the reports released by the Department of Health and Human Services Office of Inspector General (OIG) on Medicare payments for laboratory tests, and the status of efforts by the Centers for Medicare & Medicaid Services (CMS) to implement market based payment reform as called for by the Protecting Access to Medicare Act (PAMA):

“Since Congress began consideration of reform of the Clinical Laboratory Fee Schedule (CLFS), ACLA has advocated for a system that bases Medicare reimbursement on the broad scope of the laboratory market, encourages innovation, and protects access to laboratory services for Medicare patients.

We share some of the concerns raised by the OIG, namely that a significant portion of the laboratory market will be excluded from reporting private payor data, and limited time remains for CMS to provide labs with necessary information on key issues such as how tests can obtain advanced diagnostic laboratory test (ADLT) status.

However, ACLA takes exception to the suggestion by the OIG that ‘ongoing monitoring’ may be necessary in cases where payment rates increase.  In enacting PAMA, Congress was clear in its intent that Medicare reimbursement for laboratory testing services are to reflect true market rates.

ACLA has worked closely with Congress, CMS, the PAMA Advisory Panel, and other stakeholders on implementing CLFS payment reform.  While significant progress has been made, more work needs to be done before a new payment system that meets the requirements set forth by Congress is realized.  We remain committed partners in payment reform that is market based and provides Medicare patients with the benefits of diagnostic innovation.”


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About the American Clinical Laboratory Association

The American Clinical Laboratory Association (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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