Lab association extends legal challenge over reimbursement cuts

laboratory
ACLA appealed a lower court's ruling that dismissed its case against HHS over lab payments. (Pixabay)

The American Clinical Laboratory Association (ACLA) isn’t giving up on its effort to block a payment rule that will cut lab reimbursement by an estimated $670 million next year.

On Friday, the ACLA filed an appeal of a district court’s decision to dismiss the organization’s lawsuit against the Department of Health and Human Services (HHS) last month. In its initial complaint, ACLA argued that a 2016 rule that required labs to submit data about how they set their prices was unlawful because it excludes “a large body of relevant data.” ACLA also highlighted a discrepancy that allowed hospital-based labs that don’t bill Medicare directly to be exempt from the requirements.

The rule left LabCorp and Quest Diagnostics, two of the industry’s largest independent laboratories and ACLA’s most prominent members, feeling the biggest impact.

Webinar

Home State Health Leverages Conversational AI to Activate Their Members, Address SDOH, and Improve Quality Measures

Like many health plans, engaging and activating vulnerable populations at scale is critical to Home State Health. This case study from Home State Health focuses on engaging Medicaid members at scale on numerous topics leading to desired outcomes including: working with the State to develop the most optimal opt-in program; the benefits of Conversational AI in orchestrating tailored dialogues at scale; and how to design and launch Conversational AI programs.

RELATED: District court sides with HHS in lab association suit challenging payment rates

In a statement, ACLA President Julie Khani said the rule singles out just 1% of labs, which “undermines Congress’s goal of ensuring patients benefit from a market-based system for critical laboratory services.”

“HHS’s misguided and flawed data collection process continues to threaten access to lifesaving lab services and ultimately the health outcomes of millions of seniors across the country—a reality that is clear for those serving on the front lines of our health care system and one that will have increasing ramifications for beneficiaries if not addressed,” she added.

ACLA is clinging to a small passage in D.C. District Court Judge Amy Berman Jackson’s opinion that the organization’s “arguments on the merits raise important questions.”

Khani also called on Congress to “reform and modernize the Clinical Laboratory Fee Schedule” while it fights its battle in the courts.

Suggested Articles

UnitedHealth's Optum unit has completed its $4.3 billion acquisition of DaVita Medical Group after getting the final OK from the Federal Trade Commission…

Cigna chief David Cordani said it’s time to pump the brakes on calls for a healthcare system overhaul like “Medicare for All.”

Uber is moving further into healthcare with a new partnership with startup Grand Rounds enabling some of the largest employers in the U.S. to cover the cost of…