The Centers for Medicare and Medicaid Services (CMS) has extended the deadline through May 30, 2017 for certain labs to submit private payer data to the agency. The extension comes after AACC joined nine other laboratory organizations in writing to Department of Health and Human Services Secretary Tom Price, MD, making the case that Medicare should put on hold its plan to reform the clinical laboratory fee schedule and replace it with market-based pricing under the Protecting Access to Medicare Act (PAMA). The letter emphasized that in early March many laboratories still were in the data collection phase as they struggled with complex regulatory requirements and a malfunctioning data collection system at CMS. The original deadline was March 31.
However, the letter also asked CMS to revisit the definition for “applicable laboratory” under the regulation, which determines which lab’s prices CMS enters into the new equation to determine market rates. “PAMA payment reforms depend on an accurate measurement of true private market rates,” the letter noted. “However, the Health and Human Services (HHS) Office of Inspector General (OIG) analysis of the current CMS definition for ‘applicable laboratory’ assessed that only 5 percent of clinical laboratories will report data, with an estimated complete exclusion of hospital laboratories.” The letter went on to say that “…the exclusion of an entire laboratory sector, particularly hospitals operating large outreach laboratories, negatively affects the integrity of rate calculations under PAMA. The implications are immense and would ultimately threaten to reduce laboratory infrastructure.”