FERGUSON BILL WOULD INCREASE SENIORS’ ACCESS TO KEY DIAGNOSTIC TESTING
Measure would update Medicare payment rules for diagnostic lab tests

WASHINGTON – Rep. Mike Ferguson, R-N.J., on Thursday introduced bipartisan legislation that would update Medicare’s payment schedule to encourage the use of the latest developments in diagnostic laboratory testing for seniors’ patient care management.

The Advanced Laboratory Diagnostics Act (ALDA) would reform and update outdated Medicare policies that actually discourage the development and adoption of new clinical diagnostic laboratory tests.

Ferguson is a member of the House Energy and Commerce Committee and the vice chairman of the panel’s Health Subcommittee. He introduced the bill with Reps. Phil English, R-Pa., Bobby Rush, D-Ill., and Mike Thompson, D-Calif.

“Diagnostic laboratory testing forms the core of patient care management, and it’s important that Medicare’s payment rules reflect the extraordinary advances being made in diagnostic laboratory testing,” Ferguson said. “Updating Medicare’s rules not only will increase the quality of seniors’ care but also hold down health care costs.”

While accounting for less than 2 percent of all Medicare spending, the results of diagnostic laboratory tests influence up to 70 percent of all health care decisions.

Medicare’s clinical laboratory fee schedule has not been updated in 22 years and does not reflect the rapid advances in diagnostic laboratory testing.

“As Congress continues to work to reign in the unsustainable health care costs which plague the Medicare program, we must implement cost-effective policies to increase patient access to health care services,” English said. “By increasing access to diagnostics lab tests, this measure will help to reduce health care costs over the long term and ensure seniors can take advantage of the high-quality, evidence based health care technologies of the modern day.”

Specifically, the bill introduced by Ferguson and English would establish a demonstration project to evaluate a new Medicare payment system for molecular diagnostic tests designed to more appropriately reflect the value of clinical diagnostic technologies in patient care management, their associated resource requirements and potential to reduce other long-term health care costs

The legislation would allow stakeholders to appeal and correct historic payment errors that often lead to inadequate reimbursement for clinical diagnostic lab tests as well as discourage development of new lab tests. It also would establish a uniform process by which Medicare carriers will determine reimbursement rates for new clinical diagnostic lab tests and provide enhanced transparency at CMS with respect to Medicare reimbursement decisions.

The bipartisan bill has been endorsed by the American Society for Clinical Laboratory Science, the Association of American Medical Technologists, and the Clinical Laboratory Management Association.