Washington, D.C. – On September 22, the Centers for Medicare & Medicaid Services (CMS) released its 2018 preliminary private payor rate-based payment amounts for clinical diagnostic laboratory tests. The preliminary rates are based on private payor rates reported by laboratories and are part of the market-based payment reforms enacted in Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA). CMS plans to finalize the market-based Clinical Laboratory Fee Schedule (CLFS) in November 2017, following a public comment period, and the new market-based rates are effective January 1, 2018.
The Coalition for 21st Century Medicine (C21) commends CMS for releasing the preliminary private payor rate-based payment amounts as part of the agency’s implementation of PAMA. C21 supports the implementation of the PAMA market-based rates on January 1, 2018, following a one-year delay by CMS that allowed providers additional time to collect and report private payor rates. In anticipation of the new market-based system beginning January 1, 2018, C21 members collected and submitted to CMS rates paid by private payors for their tests, in accordance with the agency’s requirements. C21 believes the PAMA system will establish transparent, predictable, and market-based pricing for laboratory tests.
C21 also urges CMS to finalize a streamlined process for designating advanced diagnostic laboratory tests (ADLTs) which will serve as a catalyst for innovative genomic diagnostics that benefit patients by personalizing medical treatment decisions.
C21’s mission is to improve the quality of health care by encouraging research, development, and commercialization of innovative diagnostic technologies that will personalize patient care, improve patient outcomes, and substantially reduce healthcare costs. The group’s members include Aspira Labs, Assurex Health, Bioarray Genetics, Biocept, Biodesix, Biotheranostics, CardioDx, CareDx, Castle Biosciences, Counsyl, Crescendo Bioscience, Foundation Medicine, GE, Genetic Alliance, Genomic Health, Guardant Health, Kleiner Perkins Caufield & Byers, MDxHealth, Myriad Genetic Laboratories, Prometheus, Sera Prognostics, Vermillion, and Veracyte.