The Centers for Medicare & Medicaid Services (CMS) has opened a crucial 60-day public comment period concerning two vital information collection activities under the Clinical Laboratory Improvement Amendments (CLIA) program. Published in the Federal Register on April 22, 2026, this notice invites public and industry stakeholders to submit feedback on proposed extensions and revisions to federal requirements governing clinical laboratories. This initiative reflects CMS's commitment to maintaining robust standards for laboratory testing while adapting to technological and operational advancements.
The Mandate for Public Input: Paperwork Reduction Act
Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are legally mandated to publish notices in the Federal Register for any proposed collection of information from the public. This includes both new collections and extensions or reinstatements of existing ones. The PRA aims to minimize the reporting and recordkeeping burden on the public while ensuring the practical utility of collected information. CMS's current notice fulfills this requirement, providing an opportunity for affected parties to scrutinize and comment on the necessity, accuracy, and efficiency of these information collections.
Interested parties have until June 22, 2026, to submit comments. Feedback can address various aspects, including the accuracy of burden estimates, the necessity and practical utility of the proposed information collection for effective agency function, ways to enhance information quality and clarity, and the potential for utilizing automated collection techniques or other forms of information technology to reduce burden. Comments can be submitted electronically via regulations.gov or through regular mail to the CMS Office of Strategic Operations and Regulatory Affairs in Baltimore, Maryland.
Information Collection 1: CLIA Regulations (CMS-R-26)
The first information collection, identified as CMS-R-26 (OMB Control Number: 0938-0612), represents a revision and extension of currently approved collections related to the Clinical Laboratory Improvement Amendments Regulations. Enacted in 1988, CLIA, specifically section 353 of the Public Health Service Act, mandates that the Department of Health and Human Services (HHS) establish certification requirements for any entity performing tests on human specimens, with specific exceptions. These requirements ensure that laboratories meet performance standards based on test complexity and the inherent risks associated with erroneous results.
This extension package incorporates significant revisions stemming from recent regulatory updates. These include a final quality assessment rule published on January 24, 2003, and more recently, a comprehensive final rule on fees, histocompatibility, personnel, and alternative sanctions published on December 28, 2023 (88 FR 89976). The 2023 rule introduced critical amendments to histocompatibility and personnel regulations under CLIA. These changes were designed to address obsolete provisions and integrate technological advancements, reflecting recommendations from the Centers for Disease Control and Prevention's (CDC) Clinical Laboratory Improvement Advisory Committee (CLIAC).
Key additions include new sections such as 493.1278 (histocompatibility) and various sections from 493.1359 to 493.1491 (personnel). These amendments necessitate that participating laboratories revise and update their existing policies and procedures to align with the new or modified requirements. The collection affects a broad spectrum of entities, including businesses, not-for-profit institutions, and various levels of government. CMS estimates a substantial burden for this collection, involving 49,626 respondents, resulting in over 88 million annual responses and more than 14.5 million total annual hours.
Information Collection 2: Deeming Authority and State Exemption (CMS-R-185)
The second information collection, CMS-R-185 (OMB Control Number: 0938-0686), is an extension of an existing, approved collection. This request focuses on the processes for granting and withdrawing deeming authority to private nonprofit accreditation organizations and for CLIA exemption under state laboratory programs. CLIA's framework allows for the recognition of private accreditation bodies and state licensure programs if their standards are determined to be equal to or more stringent than the federal HHS requirements.
Regulations implementing these provisions were initially published on February 28, 1992, at 42 CFR part 493, with Subpart E specifically addressing the recognition of accreditation organizations and state programs. Subsequent revisions on May 14, 1998, restructured and consolidated the requirements within Subpart E, enhancing clarity and user-friendliness without altering the fundamental mandates. This streamlining effort aimed to make the documentation more customer-oriented and easier to understand for accreditation bodies and state programs seeking federal approval.
Similar to the first collection, the final rule CMS-3326-F, published on December 28, 2023, played a role in the current extension. This rule necessitated that accreditation organizations and state licensure programs update their policies and procedures to remain compliant with regulations outlined in 493.553-557. These entities are continuously required to meet or exceed CLIA regulations to maintain their recognized status. This collection primarily affects the private sector, including businesses and not-for-profit institutions. CMS projects a considerably smaller burden for this collection, with 9 respondents, 9 annual responses, and 5,359 total annual hours.
Implications for Clinical Laboratories and Regulators
The dual notices from CMS underscore the dynamic nature of federal oversight in clinical laboratory testing. The extensive revisions to CLIA regulations, particularly concerning personnel and histocompatibility testing, highlight an adaptive regulatory environment that responds to scientific advancements and operational realities. For laboratories, these updates often translate into necessary adjustments in quality assurance protocols, staff training, and recordkeeping practices. For accreditation organizations and state programs, the continuous requirement to align their standards with or exceed federal CLIA mandates ensures a consistent baseline of quality across the diverse landscape of clinical testing facilities. Public comment during this period is vital for ensuring that the regulatory burden is appropriate and that the collected information effectively serves its purpose of safeguarding public health through reliable laboratory results.
