Monday, July 20, 2020

Very Brief Blog: CMS New Lab Test Expert Panel, Agenda, Membership, July 29-30, 2020

Every summer, CMS holds a public meeting in June to help it price new lab codes and holds a public advisory expert panel meeting in July for the same purpose.

CMS has posted an agenda and other materials relevant to the upcoming July 29-30 meeting.\

The home page for all the advisory panel announcements is here.

Agenda for July 29-30, 2020

Most importantly, find a 22 page agenda here.  This year, there are a mind-numbing 132 different items on the agenda - mostly PLA codes.  It's a virtual meeting, but the agenda includes Webex viewing instructions for the national audience.

Panel, Charter

The panel's charter was renewed in 2019 and can be found here.  It's established in Social Security Act 1834(f)(1) (from PAMA law, 2014).  HHS shall consult with an expert outside advisory panel, composed of an appropriate selection of invidiauls with expertise in issues related to clinical diagnostic laboratory tests, including molecular pathologists, researchers, and individuals with expertise in lab science or health economics.   The panel advises CMS on payment rates for new tests and factors "used in determining coverage and payment processes" for new tests.   

What Happens

The panel breaks into subcommittees and each group reviews a subset of the 132 items in detail, bringing a recommendation back to the committee of the whole.  The committee then votes on each member's preference for pricing.  For example, 5 members may vote to crosswalk to a $100 code, 5 may vote to crosswalk to a $200 code, and 4 may vote for gapfill.   CMS rolls up all these recommendations during August and produces a proposed price list in September.

In the cloud, I've put some actual transcript pages from the 2018 panel meeting.  You might find it arcane, confusing, repetitive or dull.  Well...yeah.  Peek here.

Who's On the Panel

The most recent listing of membership I could find was published June 28, 2019 (84 FR 31070).  

New panelists 2019-2022 are: Maria Arcila MD (Memorial Sloan Kettering), Karen Carroll MD (IDSA), Lydia Contis MD (Univ Pittsburgh), Elizabeth Harris MD (Humana), Kevin Krock PhD (Precision Dx), Elaine Lyon PhD (AMP), Heather Shappell MS CGG (NSGC).  

Ongoing members as of 2019 (a few of which may have rolled off by now) were Vickie Baselski PhD (ASM), Aaron Bossler MD PhD (AMP), Pranil Chandra DO (AMP), William Clark PhD (AACC), Stanley Hamilton MD (CAP, MD Anderson), Kimberly Hanson MD (IDSA), Michele Schoonmaker PhD (AMTA).