CHA News Article

CMS Issues Final Rule Revising Medicare Payments for Clinical Lab Tests
Delays implementation by one year

The Centers for Medicare & Medicaid Services (CMS) last week issued the attached final rule revising the Medicare payment system for clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule and implementing other changes required by Section 216 of the Protecting Access to Medicare Act of 2014. In response to comments from CHA and other stakeholders, CMS has finalized an implementation date of Jan. 1, 2018 – a one-year delay from the proposed rule.

CMS has also finalized changes, advocated by CHA, to expand the definition of “applicable laboratory” by using the national provider identifier (NPI) rather than the tax identification number, as proposed. CMS will also consider hospital outreach laboratories that are independently enrolled in Medicare and have their own NPI to be applicable laboratories. Expanding this definition to include more hospital-based laboratories will better reflect market trends and lead to more appropriate reimbursement under the new payment system. CHA is currently reviewing the final rule and will provide members with additional details in the coming weeks. More information is available in a CMS fact sheet