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...
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.
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 firstname.lastname@example.org
To contact the editor responsible for this story: Brian Broderick at email@example.com
The lawmakers' letter to the CMS is at http://waysandmeans.house.gov/wp-content/uploads/2016/03/PAMA-letter_March-29.pdf.
The 2015 proposed rule is at https://www.gpo.gov/fdsys/pkg/FR-2015-10-01/pdf/2015-24770.pdf.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)