AACC Commends CMS for Postponing Medical Test Reimbursement Changes

On June 17, the Centers for Medicare and Medicaid Services (CMS) released the final rule implementing the clinical laboratory provisions of the Protecting Access to Medicare Act (PAMA) of 2014, which will make the most significant changes to medical test reimbursement that clinical laboratories have seen in three decades. AACC applauds CMS for delaying full enactment of these reforms until 2018, a delay AACC had encouraged to give labs time to prepare for the new payment system and ensure that patient access to critical tests is not hindered.
 
It was in October 2015 that CMS first released a proposed rule to revise the Medicare payment system for clinical laboratory tests by establishing market-based pricing for existing tests. The proposed rule stipulated that, starting in 2016, certain laboratories would periodically report how much they’re paid for tests by private payers. CMS would then set the Medicare reimbursement rate as the mean of the private payer rate, with the new prices taking effect in 2017.
 
Upon review of the draft rule, AACC was concerned that some of the proposed payment revisions would adversely affect the ability of many laboratories to continue testing or force them to significantly scale back their test menus. In order to safeguard patient access to vital tests, the association recommended making several improvements to the rule. In addition to urging CMS to delay implementation, the association also recommended that CMS broaden the criteria for labs reporting private sector payment data to include some hospital and physician office laboratories in order to avoid setting artificially low payment rates.
 
AACC commends CMS for addressing the lab community’s concerns in the final rule, and the association is carefully reviewing the rule to assess the potential impact on laboratories of the agency’s revised provisions.
 
“AACC is pleased that CMS seriously considered the concerns that the clinical lab community presented to the agency before transitioning to this new payment system,” said AACC CEO Janet B. Kreizman. “By working with the community to implement changes to the clinical lab fee schedule in a thoughtful, prudent manner, CMS has the potential to improve testing for patients through increased transparency and enhanced integration of new tests and technology into the fee schedule, while also protecting labs from drastic and untenable cuts.”