On August 8th the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule outlining how payment reductions for the Clinical Laboratory Fee Schedule (CLFS) would be implemented due to the provisions in the Consolidated Appropriations Act of 2023. The agency’s rule would cap lab fees at 15% through 2026 as compared to the amount established the year before. A new data reporting period is set to begin January 1, 2024, ending March 31. These reductions and the methodology used to determine them have been widely criticized by the lab community for relying on data obtained from an onerous self-reporting system that over-represented large commercial laboratories with significant resources that receive lower rates influenced by their efficiencies of scale. This flaw has led to significant reductions in reimbursement rates – more than Congress originally intended.

ADLM and fellow stakeholders have been advocating for a fix to this flawed approach and has been engaged in vigorous efforts to urge Congress to pass the Saving Access to Laboratory Service Act (SALSA) with significant outreach and meetings with legislative offices about the issue. SALSA seeks to modify the laboratory fee methodology used by CMS by adopting a statistical sampling method in lieu of the current self-reporting process.

ADLM, alongside its allies, remain steadfast in its commitment to a legislative fix for PAMA.