Legislation has been introduced in both the U.S. Senate and U.S. House of Representatives to reform the way Medicare pays for clinical laboratory services. The measure, called the
Saving Access to Laboratory Services Act, is intended to fix flaws in the payment rate methodology adopted by the Centers for Medicare & Medicaid Services (CMS) when it established regulations to implement the Protecting Access to Medicare Act (PAMA). PAMA was intended to revamp the Medicare Clinical Laboratory Fee Schedule (CLFS) so that payment rates reflected market prices.
Unfortunately, flaws in CMS’s rate-setting methodology heavily weighted data from large reference labs, which tend to receive lower payment rates due to their economies of scale. The result was sub-market pricing, a result that has had a significant effect on clinical laboratories, particularly those at hospitals and smaller regional labs. ASCP is currently reviewing the legislation.
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