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 flawed data collection process that continues to erode Medicare lab benefits for the country’s most vulnerable seniors.
In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) to ensure millions of seniors could maintain access to critical health services, including laboratory tests. As part of PAMA implementation, Congress directed the HHS Secretary to establish market-based rates for clinical laboratories; however, the Secretary deliberately disregarded Congress’ instruction and cherry-picked payment data from less than 1% of laboratories nationwide.
As a result, millions of Medicare beneficiaries who are highly dependent on routine lab tests for their health may lose access to these important tests as laboratories cannot provide these services in the face of unsustainable cuts of more than 30 percent across a range of diagnostic tests. Absent immediate Congressional action, HHS is set to repeat the same flawed process to set reimbursement rates again in 2020, posing a direct threat to seniors’ access to essential medical care for diabetes and other chronic conditions.
The Laboratory Access for Beneficiaries (LAB) Act, introduced by Rep. Scott Peters (D-CA), Rep. Gus Bilirakis (R-FL), Rep. Bill Pascrell (D-NJ), Rep. Kurt Schrader (D-OR), Rep. Richard Hudson (R-NC) and Rep. George Holding (R-NC), would delay the next round of data reporting by one year to ensure that all applicable laboratories required to report private payor data have the necessary time to do so. The bill also calls for the National Academy of Medicine to provide recommendations to Congress on less burdensome data collection methods and representative reimbursement rate calculations that result in the reliable, sustainable, market-based system originally intended by Congress.
“Our most vulnerable seniors are at the whim of a flawed data collection and reporting process that is fundamentally at odds with the quality care they deserve. They have seen the impact of PAMA’s misguided implementation already – laboratory closures, reduced test menus and longer wait times for care,” Julie Khani, ACLA President, said. “The LAB Act is a meaningful step forward to achieving comprehensive PAMA reform for clinical laboratory services. We applaud Reps. Peters, Bilirakis, Pascrell, Schrader, Hudson and Holding for their leadership in protecting Medicare beneficiaries and urge Congress to prioritize the LAB Act before seniors face another round of cuts.”
“It is imperative that Medicare beneficiaries continue to have access to life-saving clinical diagnostic laboratory tests. Unfortunately, Section 216 of PAMA established a deeply flawed framework that jeopardizes this access,” Susan Van Meter, Executive Director at AdvaMedDx, said. “The recently-introduced LAB Act is an important first step to improving the current rate setting process and ensuring market-based reimbursement rates for clinical laboratories, so that millions of Medicare beneficiaries can receive the medical care they need. We thank Reps. Bill Pascrell (D-NJ), Gus Bilirakis (R-FL), Scott Peters (D-CA), Kurt Schrader (D-OR), Richard Hudson (R-NC) and George Holding (R-NC) for their commitment to American patients, and we look forward to working with them to see the bill become law.”
“NILA is encouraged to see Reps. Pascrell, Bilirakis, Peters, Schrader, Hudson and Holding introduce legislation that acknowledges the flaws in the PAMA data collection process and we look forward to working with the National Academy of Medicine to analyze the process to develop a better system that will ensure the data accurately reflects the entire laboratory market,” Mark Birenbaum, PhD, Executive Director, NILA said. “We look forward to working with Congress to see this new system is put in place as quickly as possible so that patients continue to have access to essential laboratory tests.”
To view the LAB Act, click here.