Protecting Access to Medicare Act

Signed into law on April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) includes the most extensive reform of the Medicare Clinical Laboratory Fee Schedule (CLFS) since it was established in 1984. Section 216 of PAMA creates a new Section 1834A of the Social Security Act, which contains many of the CLFS…

Signed into law on April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) includes the most extensive reform of the Medicare Clinical Laboratory Fee Schedule (CLFS) since it was established in 1984. Section 216 of PAMA creates a new Section 1834A of the Social Security Act, which contains many of the CLFS reforms. Starting on January 1, 2017, most rates on the CLFS will be derived from private payor rates for laboratory services. PAMA also designates certain tests as “advanced diagnostic laboratory tests” (ADLTs); includes provisions affecting coding, coverage and oversight of the CLFS; and makes some changes to CMS’s review of mis-valued codes in the Physician Fee Schedule (PFS) affecting anatomic pathology services provided by laboratories.

The Centers for Medicare and Medicaid Services (CMS) is working on rules to implement these provisions. In particular, CMS must finalize rules by June 30, 2015 that explain how the agency will collect private market data and set new CLFS rates. ACLA is working with the agency, our laboratory membership, and other lab industry stakeholders to ensure that the rules result in a workable and transparent process and fee schedule that ensure adequate patient access to the highest quality clinical laboratory services and that enable physicians and patients to lower costs and achieve higher quality health care outcomes.

Click here for a summary of CLFS reform provisions in PAMA.

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