New Bill Calls For 1-Year Delay in PAMA Reporting
July 2019 ~
A new bill, titled the Laboratory Access for Beneficiaries Act (H.R. 3584, “The LAB Act”), would delay the next round of PAMA data reporting by one year so that more laboratories that are required to report their private payer data to CMS have additional time.
The LAB Act has been referred to the House Committee on Energy and Commerce, as well as the House Committee on Ways and Means. However, the LAB Act won’t impact the pending 10% rate cut for most tests on the Medicare CLFS, scheduled for January 1, 2020. If passed into law, The LAB Act would maintain the current data collection period (1/1/2019 to 6/30/2019), but delay the upcoming data reporting period by one year until 2021.
Under PAMA, CMS set prices for lab tests based on private payor rates that it collected using payment data from clinical labs nationwide. However, some industry groups claim that a large number of labs were not required to report payment data, which has led to over-weighted data from larger firms and has resulted in lower cost structures than an average clinical lab.
Regulations issued by CMS in late 2019 expanded the pool of labs required to report their private payer payment data to include all hospital outreach labs with $12,500 or more of Medicare Clinical Laboratory Fee Schedule (CLFS) revenue received during January 1, 2019 through June 30, 2019.
The new regulations require labs that submit Medicare claims using 14X billing, which is used by hospital outreach labs, to report payment data. The regulations also changed the formula labs use to determine the percentage of revenue coming through the Clinical Laboratory Fee Schedule or Physician Fee Schedule in a way that will likely lead to more labs having to report payment data. Private payer data from applicable hospital outreach labs, as well as independent labs and POLs, is to be reported to CMS in the first quarter of 2020 and will be used to set new rates effective January 1, 2021.
The LAB Act would also require CMS to contract with the National Academy of Medicine to conduct a study on how to implement the least burdensome data collection process that would result in a representative and statistically valid data sample of private market rates from independent labs, hospital outreach labs and POLs.
An estimated 3,000 hospital outreach labs are now required to report. A spokesperson for NILA, says that NILA and ACLA will be launching a grassroots campaign encouraging lab workers and others to contact their congressmen and senators to support the new bill.