On February 3, 2026, President Trump signed into law the Consolidated Appropriations Act, 2026 (H.R.7148), an appropriations act that provides funding for various agencies including the Department of Health and Human Services. Critical to clinical laboratories, this Act includes: (1) a delay of a fee schedule reduction until 2027 through the end of 2029, protecting 2026 payments for clinical diagnostic laboratory tests from being reduced by more than 15% per year until 2027; and (2) a temporary fix to data reporting obligations for the clinical laboratory fee schedule, originally set to begin on February 1, 2026, based on data collected from 2019. In addition, the Act revises the law such that when clinical labs do have to report their private payor data, they can report based on data collected between January 1, 2025 to June 30, 2025 rather than 2019 data. This change will relieve applicable laboratories from having to search for reimbursement rates they had received seven years ago that do not reflect current market conditions. The Act also slightly delays when laboratories are required to report this information to the Centers for Medicare & Medicaid Services (CMS), pushing back the data collection period to May 1, 2026 through July 31, 2026, rather than February 1, 2026 to April 30, 2026. This extra period will allow applicable laboratories to revise their data collection processes and compile 2025 private payor data. Finally, the Act allows CMS to make further amendment and changes to this program through program instruction or other mechanisms, avoiding the need to go through formal rule making and allowing CMS to be more agile in fine tuning the program’s requirements.
Although the Act has presented an immediate fix to the looming historic rate reporting deadline and staves off cuts for some time, it does not fundamentally relieve the obligation of applicable laboratories to gather and report. As a result, it is likely that the industry will still advocate for passage of the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, wherein CMS would be obligated to secure much of the data it needs for a majority of these tests from an independent source rather than laboratory submissions as discussed in our prior analysis. Laboratories, including hospital laboratories, can expect CMS to start issuing guidance on the reporting process in the next couple of months.
