Two Prominent Senators Push CMS to Make Changes on PAMA Rules

The Congressional pressure on the Centers for Medicare & Medicaid Services to make changes to its proposed final rules on the Protecting Access to Medicare Act (PAMA) have been ramped up, with two powerful U.S. Senators from both sides of the aisle asking for significant changes.

Sen. Orrin Hatch, a Utah Republican and chair of the Senate Finance Committee and Sen. Ron Wyden, the Oregon Democrat who is its ranking member, urged acting CMS administrator Andrew Slavitt to change both payment calculation methodologies and the timeline of implementing PAMA.

The letter comes on the heel of another letter from more than 40 members of the U.S. House of Representatives asking CMS to make changes to PAMA's final rules.

The biggest change requested in the Jan. 6 letter is how laboratories will report reimbursement data from payers so Medicare can set its own payment rates moving forward. Currently, labs that hold individual taxpayer ID numbers (TIN) who receive $50,000 or more in annual Medicare revenues are required to report their average rates from private payers.

In their letter, the senators noted that using TINs only would exclude hospital outreach laboratories.

Instead, both Hatch and Wyden suggested using the more widely held CLIA registration numbers as a more "expansive" alternative. "We ask CMS to analyze whether there is a way to use these numbers while still meeting the statutory intent of only including laboratories that receive a majority of their Medicare revenues from the clinical laboratory or physician fee schedules," they wrote.

Hatch and Wyden also asked for an extension of the current reporting deadline for pricing data. Under the proposed rule, labs would have to gather private payer data relevant to testing performed between July 31 and Dec. 31 of last year. That data would then have to be submitted by this March 31.

"The March 31 deadline is particularly unrealistic given that a final rule containing all of the information that laboratories will need to report has yet to be published," the letter said. Instead, Hatch and Wyden asked for a non-specific extension of the reporting deadline.

The requests are in line with what laboratory sector lobbies have been asking for in their comments submitted to the CMS on the proposed rule late last year. Some have asked for an extension of the reporting period into 2018.

There is no specific timeline for CMS to publish its final rule, although it is widely expected to occur within the coming weeks. The agency has not made any indication as to whether it is heeding the intense lobbying efforts for the changes.

Takeaway: The pressure on CMS to make changes to PAMA's reporting requirements continues to be ratcheted up with a letter coming from two powerful U.S. Senators.