ACLA Supports Government Passage of Provisions for Clinical Laboratory Fee Schedule

The American Clinical Laboratory Association (ACLA; Washington DC, USA), a not-for-profit association representing USA clinical laboratories on key federal and state government reimbursement and regulatory policies, voiced support for provisions in the Sustainable Growth Rate (SGR) extension legislation, now passed by the US Senate, that reform the Clinical Laboratory Fee Schedule (CLFS) by providing a more rational process for transitioning to changes in reimbursement.

“The ACLA worked diligently with Congress on many of the lab industry’s key priorities and we are pleased that the Senate included in the SGR extension bill several of our proposals for modernizing how Medicare reimburses clinical laboratories,” said Alan Mertz, President of the ACLA; “When the president signs this bill, clinical labs will avoid another potential round of indiscriminate, across-the-board payment cuts and, most importantly, seniors’ access to diagnostic testing will be protected.” The SGR extension legislation will also bring predictability in reimbursement over the next several years, provide more transparency, and allow more time for laboratories and other stakeholders to prepare for changes, as well as ensure that Medicare reimbursement for anatomic pathology services will not suffer significant cuts. In addition, it will provide more opportunity for stakeholders to work with the Centers for Medicare and Medicaid Services (CMS) on implementing these important reforms.

“Clinical laboratories provide the critical information needed for 70% of physician decisions and aid early diagnosis and treatment of chronic diseases that, when caught early, prevent years of increasing costs to the healthcare system,” said Mr. Mertz; “Yet, despite this critical role in the diagnosis and treatment of disease, clinical laboratories have been subjected to repeated cuts in Medicare reimbursement in the past. These cuts, in addition to the threat of further unrestricted adjustments by CMS through an adjustment process announced last year, threatened innovation and patient access to important laboratory services.”

Specifically, the proposal repeals CMS authority to make changes to the CLFS based on technological changes and – replaces it with a process to adjust reimbursement based on market rates, provides a per test phase-in of reductions in reimbursement, creates a payment-adjuster for laboratories serving the most vulnerable Medicare beneficiaries, and requires a clearly defined, transparent process for reconsideration of CLFS rates.

“We are committed to continuing to work with Congress, CMS, and other stakeholders in reforming the CLFS while ensuring that the process reflects the actual broad scope of the laboratory market, recognizes the value of laboratory services, and protects access for Medicare beneficiaries,” said Mr. Mertz.

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American Clinical Laboratory Association