A group of laboratories lost their challenge against the definition of “applicable laboratories” under the Protecting Access to Medicare Act of 2014 because did not account for a majority of hospital labs when calculating Medicare reimbursements.
At stake were billions of dollars in Medicare reimbursements that federal judge Amy Berman Jackson said was not in her jurisdiction. Jackson dismissed the case on Sept. 21 on the grounds that the labs cannot challenge the lost funding in a court of law.
The American Clinical Laboratory Association (ACLA) commented on the decision in a statement issued on Monday, president of the association Julie Khani called it “an extremely disappointing outcome.”
The statement read, in part:
“This is an extremely disappointing outcome for ACLA’s members and the millions of seniors they serve – including the most vulnerable Medicare beneficiaries – who rely on clinical laboratory tests for their most basic health needs. While the District Court’s opinion acknowledges that ACLA’s ‘arguments on the merits raise important questions,’ the District Court refused to consider those arguments, because it erroneously concluded that Congress had stripped it of jurisdiction to do so. The Court’s decision that it is powerless to require HHS to comply with the statutory requirements sets a harmful precedent that allows agencies to circumvent Congress’ express directions at the expense of patient care.”
The issue comes about due to regulations put in place by the Protecting Access to Medicare Act of 2014, which requires “applicable laboratories” to report their pricing to the Department of Health and Human Services so the numbers can be used to calculate total Medicare reimbursements. As aforementioned, the problem is in the definition of “applicable laboratories,” which excludes 99 percent of hospital laboratories from the reporting requirements, according to the plaintiff’s case.
The ACLA is continuing to review other legal options and Modern Healthcare reported they are also considering to appeal the ruling.
To view the ACLA’s full statement, visit their page.
For more about the lawsuit, check out Modern Healthcare’s article.
Or read Becker’s Hospital Review’s take.