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Congressional Bill Offers Labs PAMA Pricing Relief

by | Jun 29, 2022 | News, Open Content

Legislation introduced last week would require the use of a more reliable representative sample to determine lab test reimbursement rates.

The Protecting Access to Medicare Act (PAMA) Congress passed nearly a decade ago mandated that Medicare Part B prices for lab tests be based on market rates. It was an idea that all embraced, including the lab industry. What nobody could foresee is how the Centers for Medicare & Medicaid Services (CMS) would sabotage the plan by imposing a pricing scheme that excluded price data from hospital-based labs. By basing Clinical Laboratory Fee Schedule (CLFS) rates on lower reimbursing freestanding labs, the CMS PAMA implementation scheme artificially deflated reimbursement rates, nearly strangling independent labs in the process.

But now PAMA relief may be on the way. Last week, Congress introduced legislation, the Saving Access to Laboratory Services Act (SALSA), requiring CMS to use a more statistically reliable representative sample of lab test prices to determine CLFS reimbursement rates. SALSA would also provide labs administrative relief by increasing the time between price reporting periods from three to four years.

Not surprisingly, industry response to SALSA has been positive. The American Clinical Laboratory Association (ACLA), which is suing CMS in federal court to challenge the PAMA pricing scheme, praised and called for passage of the bill, noting that it enjoys bipartisan support in both houses of Congress.