March 5, 2026
The Honorable Shelley Moore Capito
The Honorable Tammy Baldwin
Chair
Ranking Member
Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
United States Senate Washington, DC 20510
United States Senate Washington, DC 20510
The Honorable Robert Aderholt
The Honorable Rosa DeLauro
Chair
Ranking Member
Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies United States House of Representatives
Appropriations Subcommittee on Labor, Health and Human Services Education, and Related Agencies United States House of Representatives
Washington, DC 20515
Washington, DC 20515
Dear Chair Moore Capito, Ranking Member Baldwin, Chair Aderholt, and Ranking Member DeLauro:
The undersigned organizations are committed to ensuring that our nation’s children receive high- quality, appropriate, and equitable healthcare. A key means of achieving these goals are laboratory tests that provide healthcare professionals with objective data to evaluate the health status of their young patients. Unfortunately, providers often do not have the most accurate information to interpret these data and ensure our children receive the best care possible. Fortunately, the Centers for Disease Control and Prevention (CDC) can address this vital, but underappreciated issue, if Congress provides them with $10 million to advance this initiative. When evaluating the causes of an illness, healthcare professionals evaluate test results within the context of a normal range of values, or reference intervals, for the medical condition. If the value is outside of this range, the care team may order medical treatment or additional testing to address the situation. Therefore, the normal range used to interpret the value must be precise, otherwise the patient could be misdiagnosed, precipitating wasteful, unnecessary testing or harmful interventions. While reference intervals are widely available for adults, pediatric reference intervals (PRIs) are often of poor quality or nonexistent. Laboratories do not have the resources to obtain the necessary samples from healthy children to develop their own appropriate normal ranges. Therefore, they often rely upon intervals derived from specimens from sick children, which distort the ‘true’ normal range. Alternatively, adult reference intervals may be used. However, adult ranges do not reflect the different growth and developmental stages of children and can lead to misdiagnosis and inappropriate care.
A national effort is needed to deal with this children’s health issue.
March 5, 2026 Page Two
Congress recognized the importance of this issue when it asked CDC to develop and submit a plan outlining how PRIs can be improved in the fiscal year 2020 budget. In 2021, the agency addressed the issue in the Department of Health and Human Services congressional justification to Congress. CDC stated they have the infrastructure in place to achieve this objective. The agency is proposing to: • collect clinical samples through its National Health and Nutrition Examination Survey (NHANES), which has the organization and expertise to collect the specimens from healthy children; and • utilize its Environmental Health Laboratory (EHL) to generate reference intervals for children and disseminate the information to clinical laboratories. EHL has developed reference intervals in the past through industry standards. The House of Representatives and Senate Appropriations committees included report language in the Fiscal Year 2026 Departments of Labor, Health and Human Services, Education, & Related Agencies appropriations bills encouraging CDC to begin work on this initiative. However, the agency needs an additional $10 million to initiate and advance this vital work. The undersigned organizations support the CDC’s approach and urge Congress to provide the funding needed to improve PRIs and ensure quality and equitable care for our country’s children. We are asking Congress to appropriate an additional $10 million to CDC’s FY 2027 budget for the Environmental Health Laboratory to fund this important initiative. We appreciate your consideration on this matter.
Academy of Clinical Laboratory Physicians and Scientists American Academy of Pediatrics American Association of Nurse Practitioners American Clinical Laboratory Association American College of Clinical Pharmacy American Medical Technologists American Society for Clinical Laboratory Science American Society for Clinical Pathology American Society of Andrology American Society of Hematology American Society of Pediatric Hematology/Oncology American Urological Association Ann & Robert H. Lurie Children’s Hospital of Chicago Arkansas Children's Hospital ARUP Laboratories Association for Academic Pathology Association for Diagnostics & Laboratory Medicine Association of Pediatric Hematology/Oncology Nurses Association of Public Health Laboratories Association of Schools and Programs of Public Health Avalon Healthcare Solutions Children’s Healthcare of Atlanta
March 5, 2026 Page Three
Children’s Hospital Association Children’s Hospital Colorado Children’s Hospital of Philadelphia
Children’s National Hospital Children’s Pathology Chiefs Children’s Wisconsin COLA, Inc. College of American Pathologists Endocrine Society International Society of Andrology Laboratory Corporation of America Holdings National Association of Pediatric Nurse Practitioners National Hispanic Medical Association
National Rural Health Association Nationwide Children’s Hospital PCOS Challenge: The National Polycystic Ovary Syndrome Association Pediatric Endocrine Society Phoenix Children’s Hospital Quest Diagnostics Seattle Children's Hospital Siemens Healthineers Society for Pediatric Pathology Society for Reproductive Investigation University of Pittsburgh Medical Center (UPMC) Health System Vanderbilt Health West Virginia University Medicine Children’s Hospital Yale New Haven Children’s Hospital
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