CLN - Federal Insider
Under the Protecting Access to Medicare Act (PAMA), from May 1-July 31, all applicable labs must report their private payer data collected from January 1, 2025, through June 30, 2025, to the Centers for Medicare and Medicaid Services (CMS).
To aid labs with this requirement, CMS has updated its Clinical Laboratory Fee Schedule (CLFS) and PAMA reporting webpage with several operational resources, including new FAQs, the applicable Healthcare Common Procedure Coding System code list, the CLFS Submitter and Certifier user guides, and the CLFS data reporting template.
The 2026 PAMA reporting requirement applies to all labs that have more than $25,000 in annual Medicare CLFS payments, including hospital, independent, and physician office laboratories.
Approximately 2,600 hospitals fit this category, according to Laboratory Economics. Yet only 46% of lab directors and executives say they will fulfill PAMA’s data reporting requirements, according to a March survey from Laboratory Economics. Without overall reporting from hospitals, the CLFS rate calculations for 2027 will be skewed by lower commercial insurance rates offered by Quest and Labcorp.
Based on CMS’ CLFS and PAMA reporting webpage, the Association for Diagnostics & Laboratory Medicine (ADLM) recommends that labs focus on a few immediate steps:
Although Congress delayed the next scheduled round of PAMA cuts until 2027, the 2026 reporting cycle is moving forward, and timely preparation will be critical to compliance. ADLM aims to continue to keep members informed as implementation moves forward. The association is also actively working alongside allied stakeholders to fix longstanding flaws in PAMA and advocate for reforms that better support patient access and the clinical laboratory community.
The Association for Diagnostics & Laboratory Medicine (ADLM), along with several other organizations, encouraged Congress to advance a Labor, Health and Human Services, Education, and Related Agencies (LHHS) appropriations bill that supports the modernization and long-term sustainability of public health data infrastructure.
In a letter addressed to Subcommittee on LHHS chairs Shelley Moore Capito (R-W.Va.) and Robert Aderholt (R-Ala.) and ranking members Tammy Baldwin (D-Wis.) and Rosa DeLauro (D-Conn.), ADLM explained that data systems are the foundation of a strong, responsive, and resilient public health system. Updating and integrating data infrastructure is a core function of public health. Whether preventing overdoses, tracking disease trends, responding to outbreaks, or monitoring chronic disease, maternal and child health, and environmental exposures, public health leaders depend on timely, accurate, and complete data. Without reliable, interoperable systems, agencies are forced to rely on fragmented, manual processes that slow responses and create gaps in critical information, leaving communities exposed.
Equally important is maintaining the Centers for Disease Control and Prevention (CDC) and state, tribal, local, and territorial (STLT) public health workforce of highly trained experts to keep these systems operational, ADLM said. Without these professionals, agencies risk delayed responses, gaps in disease surveillance, and diminished capacity to protect communities. Sustaining CDC’s infrastructure, its expert workforce, and the STLT public health workforce is essential to a resilient, effective national public health system.
To support these critical initiatives, ADLM requested $340 million for Public Health Data Modernization at the CDC, as well as $55 million for Response Ready Enterprise Data Integration and $100 million for the CDC’s Center for Forecasting and Outbreak Analytics as Congress finalizes the fiscal year 2027 LHHS bill.
The Australian Parliament passed legislation banning life insurance companies from discriminating against applicants based on their genetic testing results. The bill, which was made law through Royal Assent from Governor-General Samantha Mostyn on April 8, will take effect on October 8, giving insurers time to comply with the new law.
Experts are saying that the bill will strengthen public confidence in genetic testing and may even provide additional incentive for the Australian government to invest more in a nationwide preventive genomic screening program.
“It paves the way for government investment in preventive genomic screening for adults … knowing people won't have to weigh up preventive health against financial fears,” said Jane Tiller, PhD, in a statement. Tiller is a genomics and legal expert at Monash University in Melbourne, Australia, and co-leader of a pilot nationwide genetic screening program called DNA Screen.
In the United States, the Genetic Information Nondiscrimination Act of 2008 offers federal protection against health insurers’ and employers’ discrimination regarding genetic information. However, this law does not include life, long-term care, and disability insurance. Thus, these areas of coverage depend on state law and lack uniform protection against discrimination.
While Australia’s new legislation was being pushed for, Tiller’s research group at Monash University explored the feasibility of implementing DNA Screen. She and her colleagues published a report in 2023 titled the A-GLIMMER (Australian Genetics & Life Insurance Moratorium: Monitoring the Effectiveness and Response) Project.
“The most common reason people who had initially registered interest in the DNA Screen study ultimately declined was because of life insurance fears,” Tiller said. “We conducted a survey of thousands of decliners, and more than 50% cited insurance concerns as their reason for declining.” A peer-reviewed paper on these results is currently in the final stages of review.