ASM and Partners Support Lab Fee Reform Under SALSA

Sept. 9, 2022

The Saving Access to Laboratory Services Act (SALSA), H.R 8188/S.4449, would favorably amend regulations in the Protecting Access to Medicare Act (PAMA). ASM jointly submitted a letter of support for H.R. 8188/S. 4449 to Congressional leadership as part of the Clinical Laboratory Coalition on Sept. 8, 2022.

Download Full Letter

Among other things, SALSA provisions would include: 

  • The definition of “widely available tests” would be those under $1,000 and offered by over 100 providers by National Provider Identifier, approximately two-thirds, (or 1,200 out of the 1,800 total codes) of the Clinical Laboratory Fee Schedule. Advanced diagnostic lab tests (ADLTs) and non-widely available tests will keep their current process under existing PAMA. For non-widely available tests, all test data will be reported instead of a sample of data.
  • The low volume threshold of $12,500 per reporting period for labs is also retained under existing PAMA to reduce burdens on the smallest physician office-based labs. 
  • Exclusion of Medicaid managed care from applicable data. As managed care traditionally have lower rates, the exclusion from private market data helps the overall average.
  • Removal of manual remittances will save labs from having to collect data on manual claims if they are a small part of their business. Manual remittances make up less than 10% of labs overall after private market data.
  • Increase the data reporting period from 3 to 4 years. 

Author: ASM Advocacy

ASM Advocacy
ASM Advocacy is making it easy and providing opportunities for members to advocate for evidence-based scientific policy.