Congress members seek delay in proposed CLFS overhaul

A bipartisan coalition of more than two dozen members of the House of Representatives sent a letter to CMS this week asking for a delay in massive proposed changes to the Clinical Laboratory Fee Schedule (CLFS) due to begin January 1, 2017.

The letter from 26 representatives notes that Section 216 of the Protecting Access to Medicare Act (PAMA), which the CLFS proposed rule was based on, contains two significant deadlines that have already passed. The final CLFS rule was supposed to be issued by June 30, 2015, with stakeholders submitting data beginning January 1, 2016. Instead, the proposed rule was not released until September 2015. As a result, the letter urges a delay from the implementation deadline in January 2017 outlined by PAMA.

The proposed rule would require certain laboratory and physician offices to report private payer rates and volume data. CMS would then base CLFS rates on the weighted median of private payer rates collected in this manner.

The American Hospital Association (AHA) noted concern with this proposal in its comment letter to CMS, writing that most hospital and physician office laboratories would not be considered an “applicable laboratory” according to CMS’ definition. Without these facilities submitting payment and volume data, the AHA believes the data would come primarily from large, independent laboratories, which would substantially decrease reimbursement.

Without a final rule yet published by CMS, it’s unclear if the agency still intends to stick with its January 1, 2017, deadline for implementation. The proposed rule called for data collected from laboratories covering July 1, 2015, through December 1, 2015, to be submitted by March 31.