The National Independent Laboratory Association (NILA) applauds a bipartisan, bicameral group of legislators for working together to introduce the Saving Access to Laboratory Services Act (SALSA) to protect community and regional independent laboratories from drastic cuts to reimbursement in 2023 and future years. Introduced by Senators Sherrod Brown (D-OH) and Richard Burr (R-NC) and Representatives Gus Bilirakis (R-FL), Richard Hudson (R-NC), Bill Pascrell (D-NJ), Scott Peters (D-CA), and Kurt Schrader (D-OR), SALSA will repair a flawed data reporting and rate setting methodology put in place by the Protecting Access to Medicare Act (PAMA) of 2014.
Per NILA, SALSA will repair a flawed data reporting and rate setting methodology put in place by the Protecting Access to Medicare Act (PAMA) of 2014.
SALSA is asking to amend title XVIII of the Social Security Act to improve the accuracy of market-based Medicare payment for clinical diagnostic laboratory services, to reduce administrative burdens in the collection of data, and for other purposes.
A few modifications SALSA addresses include changing the use of statistical sampling for widely available clinical diagnostic laboratory tests from January 1, 2023 to beginning on or after January 1, 2026. Also, in lieu of requiring the reporting of applicable information from each applicable laboratory, the Secretary shall require the collection and reporting of applicable information from a statistically valid sample of applicable laboratories for each such widely available clinical diagnostic laboratory test.
To meet this requirement, it is recommended the Secretary develop a methodology for a statistically valid sample for each applicable HCPCS code for a widely available clinical diagnostic laboratory test. This methodology would provide a sample that allows for the payment amount for such a test to be representative of rates paid by private payors to applicable laboratories receiving payment including independent laboratories, hospital laboratories, and physician office laboratories that furnish the widely available clinical diagnostic laboratory test.
The methodology developed shall be designed to reduce administrative burdens of data collection and reporting on applicable laboratories.
The definition of widely available clinical diagnostic laboratory tests would be a payment rate of under $1,000 per test and performing more than 100 tests in the first 6 months of the calendar year preceding the data collection period. SALSA is also recommending a reporting period frequency of every 4 years rather than every 3 years.
Additionally, SALSA is requesting the exclusion of manual remittances. This is defined as an applicable laboratory for which less than 10 percent of the laboratory’s total paid claims during a data collection period are paid by private payors by means other than an electronic standard transaction.
Please read the entire SALSA draft text for a more in-depth understanding of the bill.