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.

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

Read More

  • National Health Organizations Call on Congressional Leaders to Delay Flawed Reporting Process Jeopardizing Seniors’ Access to Laboratory Care

    July 17, 2019
    LAB Act would delay PAMA reporting period in order to improve data collection process for market-based rates WASHINGTON, D.C. – With 53 million Americans facing steep year-over-year cuts to vital clinical diagnostics, 26 national groups representing patient, provider, diagnostic and laboratory organizations called on Congressional leadership to delay a flawed data collection process that continues to erode Medicare lab benefits for the country’s mostContinue Reading »...
  • Reps. Peters, Bilirakis, Pascrell, Schrader, Holding and Hudson Introduce Bipartisan Legislation to Protect Seniors’ Lab Benefits, Improve Data Reporting Under PAMA

    June 28, 2019
    LAB Act (H.R. 3584) would delay PAMA reporting period in order to improve data collection process for market-based rates    WASHINGTON, D.C. — With 53 million Americans facing steep year-over-year cuts to vital clinical diagnostics, the American Clinical Laboratory Association (ACLA), AdvaMed, the National Independent Laboratory Association (NILA) and the Point of Care Testing Association applaud new bipartisan legislation introduced to address a flawedContinue Reading »...
  • New analysis challenges GAO Report’s assumptions on lab billing

    April 16, 2019
    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

    March 18, 2019
    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

    February 25, 2019
    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

    February 21, 2019
    ...
  • Seniors managing diabetes are counting on Congress to protect their essential lab services

    February 11, 2019
    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

    January 25, 2019
    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

    January 22, 2019
    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

    December 04, 2018
    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 »...
1 2 3 4 5 6 7