WASHINGTON, D.C. – U.S. Senators Sherrod Brown (D-OH) and Richard Burr (R-NC) introduced the bipartisan Saving Access to Laboratory Services Act last week, to update Medicare’s payment system for clinical diagnostic laboratory services, ensuring seniors have access to the most innovative tests and treatments on the market.
“Clinical labs are an essential part of our health care infrastructure, providing critical services – from COVID-19 diagnostics to innovative genomic testing,” said Senator Brown. “Right now, current law threatens Medicare beneficiaries’ access to these vital lab services, which is why I’m proud to partner with my colleague Senator Burr to ensure seniors continue to have access to high-quality diagnostic services, by protecting access to clinical labs.”
“Diagnostic testing plays a critical role in maintaining seniors’ everyday health and longevity,” said Senator Burr. “But for years, flawed data collection under Medicare has created an inaccurate payment system, threatening seniors’ access to these important services. That’s why I’m proud to work with Senator Brown on this important legislation to fulfill Medicare’s mandate to provide a market-based payment system, ensuring sustainable access to these high-quality services for seniors.”
In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) to ensure Medicare’s clinical laboratory fee schedule (CLFS) aligned with the rates that were paid by private insurers. Under this bill, many clinical labs were required to submit rate information to the Centers for Medicare and Medicaid Services (CMS) to then be used to calculate rates under CLFS. Over time, the data collected and reported failed to capture a representative sample of the various segments of the clinical lab market. According to the Medicare Payment Advisory Commission (MedPAC), independent labs were overrepresented while hospital and physician office labs were underrepresented.
As a result of the flawed reporting methodology, Congress has intervened three times to delay subsequent CLFS reporting periods and twice to delay cuts to maintain access to clinical diagnostic lab services for seniors. In 2015, Senator Brown led a letter to Acting Administrator Slavitt of the CMS requesting that they delay a rule that would impose a significant burden on clinical laboratories across the country and could threaten access to clinical laboratory services for Medicare beneficiaries. In December 2019, Brown’s Laboratory Access for Beneficiaries (LAB) Act, which delayed CLFS reporting periods by a year and required MedPAC to issue a report on the implementation of PAMA, was signed into law. MedPAC’s report, which was issued in June 2021, included a proposal to improve the PAMA reporting process.
The Saving Access to Laboratory Services Act provides a permanent fix to the lab reporting of private sector payer rates to create a more representative, sustainable, and market-based CLFS. By implementing MedPAC’s proposal to improve data collection processes, Brown’s legislation would also reduce reporting burdens on labs by changing the required reporting periods from every three years to every four years and implements permanent guardrails against excessive payment cuts and increases on rates for tests.
Representatives Bill Pascrell (NJ-09), Richard Hudson (NC-08), Scott Peters (CA-52), Kurt Schrader (OR-05), and Gus Bilirakis (FL-12) introduced companion legislation in the U.S. House of Representatives.
