Lab Industry Group Asks CMS to Extend PAMA Implementation Timeline to 2019

The American Clinical Laboratory Association has asked CMS to delay implementation of a new market-based payment system by another year. CMS is aware that labs have encountered technical challenges in reporting the data the agency needs to publish a fee schedule based on private payor rates and implement the Protecting Access to Medicare Act by Jan. 1, 2018, as planned. The agency is considering labs' request for an extension, according to an agency official. The ACLA explained that the goal of the requested delay is to redefine the term "applicable laboratories" so that it "represents a true snapshot of the actual laboratory industry." The delay would also ensure that "CMS has the capacity to accept and analyze the enormous data files laboratories will be submitting," and "allow laboratories time to actually gather, format, and validate the data for submission. For clinical lab fee schedule rates to accurately reflect and follow market prices, CMS must ensure that the applicable laboratory definition allows hospital outreach laboratories to report private market rates. Only through adequate sampling of all significant laboratory market sectors can we be assured that new CLFS rates under PAMA accurately reflect the market." Carol Blackford, director of CMS's Hospital and Ambulatory Policy Group, noted at the meeting yesterday that one of the most common questions CMS is getting from labs is whether they qualify as an applicable lab. Blackford acknowledged that CMS has received a number of requests from individual labs and major industry organizations for an extension to the reporting period. "What we have heard is that they've encountered many unexpected issues with compiling the data, having vendor software that may not be updated, and the large volume of manual remittances lacking HCPCS billing codes," she said. "So, it's turned out to be a bit more cumbersome than was anticipated." Another reason for this may be because labs are finding the data reporting portal hard to navigate. ACLA members worked with CMS to test its web-based data reporting portal at the end of last year, which revealed "significant problems," and many labs were unable to submit data during the testing period. "These flaws have remained in place during the data reporting period, as labs have attempted to submit private payor data, per the ACLA." Regarding the requests to delay PAMA implementation, however, Blackford was more conciliatory. She and others have discussed this with senior leadership at CMS, and "we're hoping to be able to make a determination as quickly as possible," she said. "We are committed to implementing the statutory requirement and are committed to working together to assure that our lab fee schedule payments are accurate and transparent."

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