Amid the COVID-19 Public Health Emergency (PHE), the Department of Health and Human Services’ Office of Inspector General urged the Centers for Medicare & Medicaid Services (CMS) to enhance their approach to setting Medicare rates for clinical diagnostic laboratory tests under the Clinical Laboratory Fee Schedule. This, according to a report by the OIG, would help improve communication with stakeholders in future public health emergencies.
During the PHE, CMS faced challenges in increasing testing capacity due to limitations in their standard rate setting procedures. According to the OIG report, Medicare Administrative Contractors were not able to set rates that adequately covered the cost of COVID-19 viral tests for all laboratories. The OIG also noted that CMS may have missed opportunities to gather important information from laboratory associations and MAC pricing coordinators when making decisions about new Clinical Diagnostic Laboratory Test (CDLT) rates.
To better support laboratories and patients during times of crisis, CMS should improve how rates are set and increase collaboration with stakeholders. By addressing these issues, CMS can ensure that Medicare rates for clinical diagnostic laboratory tests are appropriate during public health emergencies.
