CLFS Reform Introduced in Congress

• Legislation reforming how Medicare pays for laboratory tests has been introduced in Congress 

• The new bill would relieve laboratories of the burden of reporting private payer payment data 

Legislation to reform the way the Centers for Medicare and Medicaid Services (CMS) calculates clinical laboratory payment rates has been introduced in Congress. The bill seeks to address flaws in the way CMS developed its current method of establishing payment rates. Congress tasked CMS with developing payment rates that reflected the market rate for these services. 

The new legislation would relieve clinical laboratories of the burden of reporting private payer payment rates and the associated volume. Instead, CMS would use data from a “qualifying independent claims data entity” to calculate new median payment rates. Much of the old PAMA structure would remain in place, including requiring CMS to develop volume-weighted median payment rates and capping cuts at 15 percent annually.  

The measure, called the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, was introduced by U.S. Representatives Richard Hudson (R-NC), Gus Bilirakis (R-FL), Brian Fitzpatrick (R-PA), Raja Krishnamoorthi (D-IL) and Scott Peters (D-CA), and Senator Thom Tillis (R-NC) and Senator Raphael Warnock (D-GA). ASCP leaders are currently reviewing the legislation.