On Thursday, October 15, CMS announced it would drop the price of COVID high throughput testing from $100 to $75, at the same time, that it will implement a performance bonus of $25 per test for a 48 hour turnaround.
See yesterday's posting here. Seema Verma had flagged the changed in a September speech, without this level of detail.
Today, Friday, CMS released the actual 10-page legal document supporting the policy change. It's Ruling 2020-1-R2. See it here:
On the same day, October 16, WSJ ran a story on rapid mass testing by Broad Institute for numerous New England colleges. The WSJ says that some labs provide COVID testing on a 4 day timeline for $100, while Broad provides testing in 18 hours for $25. (That assumes coordinated mass testing programs in place, though, it's not one-off retail testing of any patient.)
On October, Reps. Sherrill, DelBene, Sewell introduced the "SPEEDY COVID-19 Tests Act" with payment tiers of +25% over CMS for <24 hours, standard pay to 48 hrs, and no pay after 72 hours. Here, here.
Collection to "Completed Test"
CMS clearly refers to a two calendar day turnaround from the time of specimen collection to the time of "completing the test." I had a few calls from labs hoping the 48 hours was going to be from the time of lab receipt, not patient test.
Completed Test Means: Ready to Release
CMS defines a "completed test" as one that is complete and the report is "ready to be released." Sounds like that has to occur by 11:59 pm on the third calendar day (e.g. Monday to Wednesday).
Two Calendar Days
The policy refers both to "two calendar days" (not 48 hours). I suspect a test taken at 8 am Monday and returned Wednesday is two calendar days, whether 8 am or 8 pm on Wednesday (but that's just a hunch). I'm assuming that "two calendar days" does not mean a test taken Monday and reported Tuesday, which I would call "one calendar day."
Don't Mess With Us and Wait Five Days by Batching
CMS strongly defends its reasoning in the Administrator's R2 ruling. It notes that it priced high throughput tests at $100, assuming they required high resources for fast turnaround. CMS comments that some labs may have taken advantage of the agency, and use economical limited resources and batching to produce tests at long delays of 3-6 days. Continue doing that, and pay a financial penalty, says CMS.
Don't Just Push Part B to Front of Queue
CMS provides a rational for the "majority of cases in previous month" clause - a 51% rule - because it doesn't want labs to merely push Medicare Part B cases to the front of a queue and delay everyone else.
Generally, CMS policy decisions and fee schedule changes must go through public comment (administrative rule making.) I've heard it said that the positioning of these pop-up internally generated Administrator's Rulings is a little dubious under the Administrative Procedures Act, depending on the weight and content of the matter involved.