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November 2017
IDSA Continues to Press for Diagnostics Reimbursement

IDSA continues to advocate for appropriate reimbursement for ID diagnostic tests to ensure patient access to testing and to spur diagnostics innovation. IDSA successfully defeated recent proposals to curtail reimbursement for important ID diagnostics, and is now working to alter another harmful proposal.

IDSA Defeats CMS “Palmetto” Proposal to Reduce Diagnostics Reimbursement

The Centers for Medicare and Medicaid Services (CMS) last spring issued two draft Local Coverage Determination (dLCD) payment policies for Palmetto GBA’s multiplex nucleic acid tests for respiratory viruses and foodborne gastrointestinal (GI) panels that would severely curtail coverage and reimbursement for both tests. Palmetto GBA is a Medicare contractor that oversees Medicare payments in 45 states. IDSA worked with the Association for Molecular Pathology, the College of American Pathologists, the American Society for Microbiology, and the Pan-American Society for Clinical Virology to submit respiratory virus and GI comment letters on the proposed policies to provide expert clinical perspectives on how these panels are reasonable and necessary for patient care. In response to these efforts, Palmetto retracted both proposals.

IDSA Works to Prevent Proposed 10 Percent Reduction in Diagnostic Reimbursement

Over the past two years, CMS, at the direction of Congress, has attempted to collect data on private payor reimbursement for diagnostic tests on which to base revised Medicare reimbursement. IDSA and other physician organizations have repeatedly expressed concerns that that the data collection would be overly burdensome for clinical laboratories and subsequently result in inadequate reimbursement rates for diagnostic tests. CMS released preliminary diagnostics reimbursement rates in late September for diagnostic tests for 2018. The agency is planning to finalize the proposed rates in November, which are then scheduled to take effect on January 1, 2018. If the preliminary rates are implemented as planned, most ID diagnostic tests will get a 10 percent reduction in 2018, with a possibility of additional 10 percent reductions over the next two years for a total 30 percent reduction by 2020. These rates will not reflect market-based payments, as IDSA believes Congress intended.

IDSA submitted comments to CMS following the release of the preliminary 2018 rates outlining specific concerns and providing recommendations. The Society has also been working with the American Medical Association and a number of laboratorian- and clinician-focused organizations to educate Congress on the potential impacts of decreased reimbursement on patient care. The group met with House Committee on Energy and Commerce and Senate Finance Committee staff this summer to recommend in part that CMS issue an interim final rule so that the agency may conduct a regional survey of private payer payments for clinical tests.

IDSA will continue to advocate for a reimbursement system that promotes innovative diagnostics and improves patient access as CMS moves forward in their efforts to reform clinical laboratory diagnostic reimbursement. Join the Member Advocacy Program (MAP) today to stay abreast of IDSA advocacy efforts and how you can get involved.

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