Wednesday, December 18, 2019


Update:  The budget act, including the PAMA delay, was signed by President Trump.

Any PAMA price cuts for CY2020 will continue.

CY2021 will have 15% price cuts for the minority of codes whose 2017 survey prices are still, in CY2020, more than 15% above the 2017 survey.  Here.

The next PAMA data collection is delayed from 1Q2020 to 1W2021, but the data source dates will remain 1H2019.


The LAB act was formally introduced into Congress earlier in 2019, but many bills are introduced that die before entering actual legislation (the tadpoles to frogs metaphor). See June 2019 trade press here.

As 360DX reports today (December 18), the LAB act and its one-year delay of PAMA has been introduced into 1600-page omnibus financing bills that are now circulating on the hill.   360DX here.

Currently, CMS would run a data collection cycle in 1Q2020, to set three-year prices beginning January 2021.   The data collection would be based on lab claims paid in 1H2019.

LAB Act would stop the clock for a year, while also looking at flaws in the PAMA design process via a required investigation by the MEDPAC - the Medicare Payment Advisory Committee.

A December 1 article at AACC covers the same topic and notes there is still a federal lawsuit pending against CMS's regulatory interpretation of PAMA statute - here.   The court case lost at the first federal level, but on appeal, it had a win which sent it back for re-review at the first federal level again on different grounds.

At least one version of the Hill language is here, see page 1428 (Section N, HHS, Subtitle A Medicare, Medicare section 105 (of 8 sections).)  This is a typical legislative pathway; lots of 4-page little bills introduced by themselves during the year get rolled up as "page 1,428-31" of an omnibus bill at the end of the year.

I've put a cloud version of one version of the spending bill here.


Legal eagles will note that some aspects of the bill shift around, such as whether the PAMA report would be conducted by the National Academies of Science on the one hand or MEDPAC on the other.