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.
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New analysis challenges GAO Report’s assumptions on lab billing
A new analysis from Braid-Forbes Health Research exposes the Government Accountability Office’s (GAO) flawed assumptions about lab billing practices by presenting survey data on more than 20 million actual clinical laboratory claims. Braid-Forbes’ analysis of publicly available data demonstrates that the GAO’s claim – that labs are receiving “excess payments” by charging Medicare for individual component tests in greater numbers rather than charging reducedContinue Reading »... -
ACLA Files Reply Brief Ahead of Oral Arguments in ACLA v. Azar Appeal
HHS’ data collection process under PAMA disregards Congressional intent, jeopardizing lab access for millions of seniors Washington, D.C. – The American Clinical Laboratory Association (ACLA) filed a reply brief today ahead of oral arguments in the ACLA v. Azar appeal which has been scheduled for April 23, 2019. The brief reinforces ACLA’s argument that the U.S. Department of Health and Human Services (HHS) failedContinue Reading »... -
Leading Health Groups Challenge GAO’s Flawed Report on Medicare Lab Billing
Washington, D.C. – In response to broad and misleading claims in a recent Government Accountability Office (GAO) report, leading clinical laboratory, diagnostic and provider organizations challenged the agency on a number of recommendations that could lead to disruption to seniors’ access to critical laboratory diagnostics. The joint letter from AdvaMedDx, American Clinical Laboratory Association (ACLA), College of American Pathologists (CAP), National Independent Laboratory Association (NILA)Continue Reading »... -
Letter from Industry Stakeholders in Response to GAO Report on PAMA
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Seniors managing diabetes are counting on Congress to protect their essential lab services
For America’s seniors, diabetes is now the number one health condition leading to frequent emergency room visits, according to a recent study in the Annals of Internal Medicine. On top of that staggering statistic, the CDC reports that one in four seniors has diabetes—the highest prevalence among any age group. Most patients know that disease monitoring and management requires reliable access to routine testing.Continue Reading »... -
ACLA Statement on GAO Analysis & Medicare Lab Payments
Latest report reflects misleading, inaccurate assumptions on Medicare lab billing & payment Washington, D.C. – Following the recent release of the Government Accountability Office’s (GAO) report on billing and reimbursement for clinical lab tests under the Medicare program, Julie Khani, President of the American Clinical Laboratory Association (ACLA), issued the following statement: “GAO’s conclusions on overbilling of laboratory services in the Medicare program are fundamentallyContinue Reading »... -
For patients, PAMA reforms can’t wait
As we gaveled in a new Congress this month, protecting lab services for America’s seniors has never been more important. A recent piece in the Washington Post is the latest example of the value of essential lab services in early diagnosis and treatment of some of the most complex, serious health conditions facing patients – a critical element in our broader efforts to addressContinue Reading »... -
ACLA Files Appeal in ACLA v. Azar, Asks U.S. Court of Appeals to Address HHS’s Overreach in Data Reporting
HHS’s continued flawed implementation of PAMA threatens beneficiaries’ access to critical lab services Washington, D.C. – Today, the American Clinical Laboratory Association (ACLA) advanced its case against the U.S. Department of Health and Human Services’ (HHS) flawed and harmful implementation of the Protecting Access to Medicare Act (PAMA). ACLA’s opening brief argues that HHS has exceeded its statutory authority, circumventing Congress’ stated directive ofContinue Reading »... -
ACLA Appellant/Petitioner Brief: American Clinical Laboratory Association v. Alex Azar
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In a divided Washington, protecting seniors’ health care is an issue where everyone agrees
As lawmakers work to advance final legislative proposals, Congress has the chance to take decisive action on one issue that has bipartisan support: protecting seniors’ access to essential, life-saving lab services. Recognizing the critical role of routine testing for patient health and overall cost savings, more than 30 organizations representing patients, health care professionals, laboratories and diagnostic manufacturers are calling on Congress to takeContinue Reading »...
