New Legislation Could Hit Pause on Lab Test Cuts Until 2028

A new bipartisan bill—the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act—aims to freeze Medicare Clinical Lab Fee Schedule (CLFS) rates through 2028 and reshape how future rates are set.

Why it matters: Labs have been bracing for up to 15% Medicare cuts across ~800 tests starting in 2026. Without intervention, independent labs, hospital outreach labs, and POLs would also be required to report 2019 private-payer data by March 2026—a costly and burdensome process. The RESULTS Act would give labs breathing room, remove onerous reporting requirements, and cap annual cuts at 5%.

What’s in the bill: The RESULTS Act would freeze Clinical Lab Fee Schedule (CLFS) rates at today’s levels through 2028. Starting in 2029, CMS would use claims data from more than 50 private insurers — a pool of 50 billion claims — to set rates instead of relying on direct lab submissions.

Cuts would be capped at 5% a year. Increases would face no ceiling. Updates would come every four years, not three. And niche codes — rare tests or advanced diagnostics — would get special handling to reflect their unique market.

The politics: The bill has sponsors in both chambers, a rarity in today’s Congress. But it faces three hurdles:

• Timing: Industry groups have just months to build support before the year ends.

• Crowded agenda: Telehealth flexibilities, Medicaid funding, and PBM reform are also competing for floor time.

• Budget math: If the Congressional Budget Office scores the bill as too costly, history suggests it won’t move.

Zoom out: CLFS rates have already been frozen for five years through one-off delays. If nothing changes, labs that fail to report payer data could face penalties of up to $10,000 a day, and roughly 3,000 hospitals would be pulled into the reporting requirements.

Past PAMA reform efforts — like the LAB Act in 2019 and SALSA in 2022 — collapsed under cost estimates. The RESULTS Act is narrower and more pragmatic, giving it a stronger chance. But success still depends on swift lobbying and a favorable budget score.

What this means for POLs: Freezing rates through 2028 gives POLs stability to plan investments in staffing, instruments, and new test lines. Just as important, shifting reporting to a centralized claims database removes a costly administrative burden that small labs were ill-equipped to handle.

From Clinlab.AI’s vantage point, this isn’t just about avoiding cuts. It’s about creating room for POLs to modernize and adopt tools — like AI-driven lab management — that improve efficiency, compliance, and patient outcomes. A stabilized reimbursement environment allows innovation to take root rather than being stifled by uncertainty.

Bottom line: If Congress passes the RESULTS Act, labs get stability and fewer reporting headaches. If it stalls, deep cuts and new reporting mandates land in January 2026.

New Legislation Could Hit Pause on Lab Test Cuts Until 2028, as the bipartisan RESULTS Act proposes freezing Medicare Clinical Lab Fee Schedule (CLFS) rates through 2028 and reshaping how future lab test rates are determined.