AMT was one of 36 organizations that signed an August 2, 2018 letter to Members of the three Congressional committees with oversight of the Medicare program, urging legislative relief from CMS’s flawed implementation of the Protecting Access to Medicare Act of 2014 (PAMA).
The organizations signing the letter represent clinical laboratories, laboratory personnel, medical device manufacturers, hospitals, physicians, and patient advocacy groups. PAMA directed CMS to modernize the Clinical Laboratory Fee Schedule (CLFS) by moving from a static fee schedule to a market-based system, basing reimbursement on payments private payers make to the broad spectrum of laboratory providers, independent laboratories, hospital laboratories, and physician office laboratories. Unfortunately, CMS ignored Congress’s intent and implemented a pricing scheme that excluded data from the vast majority of laboratory providers and was overly reliant on data from the largest national labs. The result of CMS’s skewed data collection is reimbursement rates that are not market-based, which will result in cuts of over 30% for 18 of the top 25 tests.
Link to read the coalition’s letter
Link to July report issued by the Galen Institute, critical of CMS’s implementation of PAMA