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Saving Access to Laboratory Services Act

Source: Congress.gov  ·  2,357 words in original text
What This Bill Does
This bill amends Medicare's rules for paying clinical diagnostic laboratory services (blood tests and similar lab work). It allows Medicare to collect payment information from a sample of labs instead of requiring all labs to report. The bill also changes how Medicare sets payment amounts and reduces how often labs must report data.
Who It Affects
Clinical diagnostic laboratories that receive Medicare payments, including independent laboratories, hospital laboratories, hospital outreach laboratories and physician office laboratories. The Centers for Medicare and Medicaid Services (the federal agency that runs Medicare). Private insurance companies that pay for lab tests. Medicaid managed care organizations.
Key Provisions
- Starting January 1, 2026, Medicare can collect payment information from a statistically valid sample of laboratories instead of all laboratories for widely available clinical diagnostic laboratory tests (Sec. 2(a)(1)). - The sample methodology must be representative of payment rates from private insurance companies and include different types of laboratories weighted by how often each type performs the test (Sec. 2(a)(1)). - A laboratory qualifies as "applicable" if it receives at least $12,500 in Medicare payments during the first six months of the calendar year before the data collection period, replacing a previous majority revenue test (Sec. 2(b)). - A "widely available clinical diagnostic laboratory test" means a test that costs less than $1,000 per test and is performed by more than 100 laboratories during the first six months of the year before the data collection period (Sec. 2(a)(1)). - Starting in 2024, payment increases for widely available tests are capped at 2.5 percent per year in 2024 and 2025, then 3.75 percent in 2026 and 2027, then 5 percent in 2028 and beyond; other tests have a 5 percent annual cap (Sec. 2(d)). - Data collection periods move from reporting periods beginning January 1, 2027, through March 31, 2027, and reporting occurs every four years instead of every three years (Sec. 2(a)(2)). - Laboratories where fewer than 10 percent of paid claims come through electronic standard transactions can exclude manual payments from the payment information they report (Sec. 2(c)(2)).
What Changes
If this bill becomes law, most laboratories will no longer need to report all their private insurance payment data to Medicare. Instead, Medicare will collect detailed information from a smaller sample of selected laboratories. Labs will also report data less frequently (every four years instead of every three years) and starting later (2026 instead of 2024). The definition of which labs must participate changes to require at least $12,500 in Medicare payments rather than majority revenue from Medicare. Payment increases will face yearly limits that are lower for widely available tests than for other tests.
Important Definitions
- "Widely available clinical diagnostic laboratory test": a test that costs less than $1,000 per test and is performed by more than 100 laboratories. - "Applicable laboratory": a laboratory receiving at least $12,500 in Medicare payments during the first six months of the calendar year immediately before the data collection period. - "Applicable information": payment data from private insurance companies that laboratories must report to Medicare (Sec. 2(c)). - "Electronic standard transaction": Not specified in bill text (the bill references a federal regulation definition).
Effective Date
The use of statistical sampling begins with data collection periods for reporting periods starting on or after January 1, 2026 (Sec. 2(a)(1)). The new laboratory definition takes effect January 1, 2025 (Sec. 2(b)). The Secretary of Health and Human Services must implement most amendments through rulemaking by December 31, 2024 (Sec. 2(e)).
Important: This plain English summary was generated by AI and is provided for informational purposes only. It is not legal advice. Always consult the official bill text on Congress.gov or a qualified attorney for legal matters.