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The American Hospital Association and the American Medical Association are among more than 30 provider groups asking House and Senate leaders for payment reform to the Medicare Clinical Laboratory Fee Schedule.
The groups want Congress to pass the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, legislation that would prevent deep pending payment cuts for clinical laboratory services scheduled to go into effect on Jan. 1, 2026.
“Without action, around 800 laboratory tests will be subject to payment cuts of up to 15% on January 1, 2026, threatening patient access to routine and life-saving diagnostics,” the healthcare providers said in the October 31 letter.
Spending on clinical laboratory services represents less than 1% of total Medicare spending, the groups said. But these services inform 70% of clinical decision-making.
WHY THIS MATTERS
Rep. Richard Hudson, R-N.C., introduced the RESULTS legislation in September to the House committees on Energy and Commerce and Ways and Means.
The bipartisan and bicameral bill would improve the accuracy and data collection that is used for the private payer-based Medicare payment rates for clinical diagnostic laboratory tests. Congress established a national fee schedule in 2014, based on private market data from laboratories.
But in 2017, less than 1% of clinical laboratories’ private payer data was used to determine the rates, resulting in artificially low payment rates and cutting nearly $4 billion from the Medicare Clinical Laboratory Fee Schedule in the first three years alone, the letter said.
THE LARGER TREND
Congress has delayed payment cuts and reporting for lab services for five years.
The providers want permanent relief through the RESULTS Act.
Passage would ensure better rates and reduce administrative data collection and reporting burden on both labs and the Centers for Medicare and Medicaid Services, the groups said. It would also provide sustainability in Medicare payment.
“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,” the letter said.
Email the writer: SMorse@himss.org