ACLA to CMS: Overall Finalized Rates Still Fundamentally Flawed, Agency Must Halt Implementation

The American Clinical Laboratory Association (ACLA) stepped up its call to CMS to delay its flawed implementation of Congress’ efforts to modernize the Medicare clinical lab payment system and align payment rates with market prices in the Protecting Access to Medicare Act (PAMA).  While ACLA acknowledged several modifications to the draft rates by CMS following the public comment period, the association repeated its concerns with the failure of the agency to include the broad laboratory market in data collection as required by PAMA. “The final payment rates published make clear CMS ignored Congress’s instructions to gather commercial price information from all sectors of the clinical laboratory market and base Medicare payment rates on that data, an objection ACLA and many other stakeholders have made since CMS first proposed its data collection methodology in 2015. CMS’ decision to move forward with these rates is ill-advised, inconsistent with the statute and, most importantly, detrimental to patient care. Implementation of a modified Clinical Laboratory Fee Schedule (CLFS) that is inconsistent with PAMA must be delayed,” said Julie Khani, president of ACLA. To that end, the association recently joined 21 other stakeholders in a letter to CMS Administrator Seema Verma requesting “immediate action to address the significant deficiencies in its process to establish new clinical laboratory payment rates.” “We strongly urge CMS to suspend its flawed implementation of PAMA until the process adheres to what Congress intended.  We will advocate before all branches of government, including the courts if necessary, to ensure the best outcome for clinical laboratories and the Medicare beneficiaries we serve.”