Monday, June 12, 2017

Brief Blog: ACLA Continues to Weigh In on PAMA Policy with House and CMS

In June, ACLA continues to weigh in on how CMS implements PAMA Section 216, repricing of national Medicare lab fee schedules based on market price surveys.

ACLA and other stakeholders have raised concerns that CMS is using methodology that will result in incorrect and excessively low repricing.
  • ACLA's June 1 letter to the House Ways & Means committee is online here.
  • ACLA's June 7 letter to Seema Verma, administrator of CMS, is online here.
The House letter has a range of topics - bad execution of PAMA law at CMS; illogical gapfill/crosswalk amounts for obscure rationales; and need to nix the 14 day rule.

The Verma letter asks that PAMA be delayed, and rapid interim final rulemaking should require hospital outreach labs to be part of PAMA, giving them November-January to report.  ACLA anticipates that PAMA repricing could be implemented (with extra hospital lab data) by 7/2018, and the next cycle of data collection should be pushed from 2020 to 2021.

For a March 2017 press release providing an overview of the issues facing ACLA and other lab gruops, here.  A March letter to HHS leader Tom Price was signed by ACLA, AdvaMed, CAP, and other groups (here).

One Washington Hillwatcher noted that academic medical centers, in general, do not like DAIA.