Bipartisan House Group Pushes CMS to Delay Lab Pay Changes

BNA’s Health Care Daily Report™ sets the standard for reliable, high-intensity coverage of breaking health care news, covering all major legal, policy, industry, and consumer developments in a...

By Michael D. Williamson

March 29 — More than 20 members of an influential House panel March 29 urged the CMS to delay a new Medicare payment system for clinical lab tests.

The process to update the payments under the clinical laboratory fee schedule “will be improperly rushed” if the Centers for Medicare & Medicaid Services continues with its current timeline for implementing the changes, a bipartisan group of 27 House Ways and Means Committee members said in a letter to acting CMS administrator Andy Slavitt.

In calling for the delay, the lawmakers noted that the CMS has been late issuing a final rule for the new pay system.

An October 2015 proposed rule (80 Fed. Reg. 59,386) outlined plans to use data collected from clinical labs about how much they are paid by private insurers for tests, to determine Medicare payment rates for lab tests .

The new lab payment system is scheduled to begin Jan. 1, 2017.

Medicare pays approximately $8 billion per year for the approximately 1,300 lab tests covered by the fee schedule. The proposed changes could result in $360 million less in Part B payments in fiscal year 2017 for Medicare-covered clinical lab tests.


Ways and Means Health Subcommittee Chairman Pat Tiberi (R-Ohio) and Rep. Bill Pascrell Jr. (D-N.J.) were the lead signers of the letter.

A clinical labs group praised the lawmakers for issuing the letter. Alan Mertz, president of the American Clinical Laboratory Association, said in a March 29 statement that a “successful transition” to a new payment system, “marked by reasonable and achievable milestones for clinical laboratories—is in the best interest of patients, clinical laboratories, and the Medicare program as whole.”

The CMS was unable to provide a comment immediately when contacted by Bloomberg BNA March 29.

Missed Deadlines

Given rulemaking delays, the 2017 implementation date “is not feasible and should be delayed,” the lawmakers said.

Congress set the 2017 implementation date in the Protecting Access to Medicare Act (PAMA) of 2014, the law that authorized the CMS to make the lab fee changes.

PAMA also required the CMS to issue the lab payment final rule by June 30, 2015, the lawmakers wrote. In addition, the law mandated labs to begin reporting the payments they receive from private insurers by January 2016, according to the letter.

“Obviously, neither of these deadlines has been met,” the letter said. It added Congress set up “this specific set of milestones to ensure that laboratories and CMS would have sufficient time to collect, report, submit and analyze private payor data, and establish new reimbursement rates.”

Comments (under docket CMS–1621–P) on the proposal, which were due in November 2015, showed the industry also supports an implementation delay .

To contact the reporter on this story: Michael D. Williamson in Washington at

To contact the editor responsible for this story: Brian Broderick at