ASCP Endorses Legislation to Fix Medicare Lab Test Payment Flaws

ASCP is supporting legislation to fix flaws with the way that the Centers for Medicare and Medicaid Services (CMS) prices the Clinical Laboratory Fee Schedule (CLFS). Known as the Saving Access to Laboratory Services Act (SALSA), the legislation was recently introduced in both the House and Senate.

These flaws developed as a result of the way that CMS implemented provisions of the Protecting Access to Medicare Act (PAMA). PAMA required clinical laboratories to report test price and volume data to CMS so that CMS could create a new fee schedule using market rates. Unfortunately, CMS relied almost exclusively on pricing data from large reference labs, which resulted in below-market pricing. In addition, CMS’s reporting requirement created significant reporting burdens for laboratories.

The new bill would extend reporting periods from three to four years. It would require CMS to use sampling to lessen the reporting burden for laboratories required to report data. Importantly, the legislation would require CMS to weight payment rates by market segment to better reflect market rates. Lastly, the bill reduces the cap in payment rate cuts that could be imposed from 15 percent per year to 2.5 percent in 2023, then 5 percent for 2024 and beyond. ASCP will be working with the rest of the laboratory community as fixing PAMA’s flaws are key to revamping clinical laboratories financial viability, which is essential to restoring a sound workforce.