SWHR Concerns on Clinical Laboratory Fee Schedule

In letters to the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services, SWHR expressed serious concerns regarding the 2018 Clinical Laboratory Fee Schedule (CLFS) final payment rates. SWHR stated that the CLFS payment rates — if implemented — would have significant impact on patient care.

SWHR states that CMS relied on a significantly deficient data collection process to establish new payment rates for clinical laboratory tests, resulting in unreliable and unsustainable rates that fall short of Congress’ goal of establishing a market-based system. Before CMS proceeds with implementation of the CLFS payment rates on January 1, 2018, SWHR strongly believes the agency must:

1. Address data integrity concerns
2. Ensure that the private payer data CMS collects accurately represents all segments of the clinical laboratory market
3. Provide a transparent process to allow for the validation of the data collected by CMS

SWHR strongly encouraged CMS to work with Congress and stakeholders to ensure that the clinical laboratory payment system under PAMA truly reflects a market-based approach.

Read the letters to the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services.