RESULTS Act would base rate-setting on updated commercial market data and eliminate pending payment cuts for clinical laboratory services.
A coalition of healthcare organizations is urging congressional leaders to pass legislation reforming the Medicare Clinical Laboratory Fee Schedule (CLFS) before payment cuts take effect Jan 1, 2026.
The coalition sent a letter on Oct 30 to House and Senate leadership supporting the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act (S. 2761/H.R. 5269), bipartisan legislation that would overhaul the current CLFS rate-setting process.
The bill would ensure CLFS rates are based on current commercial market data representative of independent laboratories, hospital outreach laboratories, and physician office laboratories. It would also reduce administrative data collection and reporting requirements for clinical laboratories while lessening administrative burden on the Centers for Medicare & Medicaid Services.
Without congressional action, approximately 800 laboratory tests will face payment cuts of up to 15% beginning Jan 1, 2026, according to the coalition letter.
“The CLFS represents less than 1% of total Medicare spending, while clinical laboratory services inform 70% of clinical decision making,” the organizations wrote. “Timely access to innovative clinical laboratory tests is critical to the prevention, early detection, therapy selection, and effective management of chronic and life-threatening diseases.”
Current System Based on Limited Data
The coalition cited problems with the current system established by the 2014 Protecting Access to Medicare Act. The initial 2017 data collection captured information from less than 1% of clinical laboratories’ private payor data to determine CLFS rates, resulting in what the organizations called “artificially low payment rates.”
The limited data collection cut nearly $4 billion from the CLFS in the first three years following implementation, according to the letter.
Congress has delayed payment cuts for five consecutive years and postponed data reporting requirements for six years due to concerns about the system’s impact on patient access to laboratory services, the letter notes. The RESULTS Act would provide permanent relief by stabilizing Medicare payments and potentially encouraging more diagnostic innovation, while eliminating the pending payment reductions for clinical laboratory services, according to the coalition.
The coalition includes organizations representing laboratories, physicians, hospitals and health systems, healthcare providers, laboratory professionals, and diagnostic manufacturers.
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