Recent Congressional Actions Seek to Address Medicare LCD, MA, and NSA Enforcement Reforms
A suite of bills recently introduced in Congress seek to address issues underlying Medicare local coverage determinations (LCDs), Medicare Advantage...
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The legislative spending package passed in Congress on Nov. 12 includes a provision that delays steep cuts to the Medicare Clinical Laboratory Fee Schedule (CLFS) for 30 days.
The bill (H.R. 5371) ends the government shutdown by providing fiscal year 2026 continuing appropriations for most federal agencies through Jan. 30, 2026. The CLFS cuts, expected to result in up to a 15 percent decrease for more than 800 tests, would have taken effect on Jan. 1, 2026, if this bill had not passed.
Section 6209 of the legislation revised the phase-in of reductions from private payer rate implementation and the reporting period for private sector payment rates for the establishment of Medicare payment rates.
The College of American Pathologists is among the stakeholder organizations calling for foundational reform to permanently repair the CLFS through the RESULTS Act (H.R. 5269/S.2761). This bill seeks to “provide long-term stability” for the CLFS “by improving the accuracy of, and feasibility of data collection for … payment rates applied under the Medicare program” for laboratory tests.
Sources:
https://www.congress.gov/bill/119th-congress/house-bill/5371/text
https://www.cap.org/advocacy/latest-news-and-practice-data/november-11-2025#story1
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