CMS is finally taking steps to implement the Medicare clinical laboratory payment reforms mandated by the Protecting Access to Medicare Act of 2014 (PAMA). Under PAMA, CMS must base Medicare payment rates for clinical laboratory tests on private payor rates beginning January 1, 2017. The statute requires that CMS establish the parameters for the private sector payment data collection under this provision through notice and comment rulemaking no later than June 30, 2015 – a deadline CMS has missed. On August 31, 2015, CMS submitted its Medicare clinical diagnostic laboratory test payment system proposed rule to the White House Office of Management and Budget (OMB) for regulatory clearance – the last stop before publication in the Federal Register. The text of the proposed rule is not available at this stage, but the clinical lab industry should soon see more details on this long-anticipated policy.
This article is presented for informational purposes only and is not intended to constitute legal advice.
