PAMA Reform

ACLA urges Congress to pass the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act. The RESULTS Act is the long-term reform urgently needed to correct flaws in the implementation of the Protecting Access to Medicare Act (PAMA), passed by Congress in 2014 to reform the Medicare Clinical Laboratory Fee Schedule (CLFS). Congress intended for private market data collected from all types of laboratories, including hospital outreach laboratories, independent laboratories, and physician office laboratories, to be the basis for CLFS payment rates. Unfortunately, the first round of data collection captured data from fewer than one percent of laboratories, artificially reducing Medicare payment rates to 75 percent of laboratory tests on the CLFS by $3.8 billion in just three years.

Bipartisan leaders in Congress have been striving to protect patient access to clinical laboratory services and have effectively raised awareness on Capitol Hill about the need for long-term relief from CLFS cuts. Congress has intervened six times on a bipartisan basis to prevent further cuts. However, cuts of up to 15 percent are scheduled to begin January 1, 2027, absent Congressional action.

The RESULTS Act, led by Reps. Richard Hudson (R-NC), Gus Bilirakis (R-FL), Brian Fitzpatrick (R-PA), Raja Krishnamoorthi (D-IL), and Scott Peters (D-CA), along with Senators Thom Tillis (R-NC) and Reverend Raphael Warnock (D-GA), is smart policy that would reform CLFS rate-setting. Under the RESULTS Act, CMS would secure comprehensive paid claims data for widely available tests, that is representative of all segments of the laboratory market from an independent not-for-profit commercial payor database. Use of the database would dramatically reduce administrative burden for laboratories and CMS. For non-widely available tests, such as proprietary tests for rare diseases, laboratories would continue to report private payor data to CMS directly. Data collection and reporting for Advanced Diagnostic Laboratory Tests (ADLTs), of which there are 15, would continue to occur annually. The RESULTS Act would exclude Medicaid managed care rates from CLFS rate calculations, as they are not truly market-based rates. To ensure stability for the Medicare program and clinical laboratories, during the implementation period, the RESULTS Act would freeze CLFS rates and cancel pending cuts of up to 15%. Once fully implemented in 2029, the RESULTS Act would limit payment reductions to 5 percent per year to protect laboratories from sudden destabilizing rate changes that could reduce patient access to innovative testing services.

The legislation further would reduce administrative burden on both clinical laboratories and CMS by extending the rate-setting cycle to every four years.
The RESULTS Act represents a sensible, long-term solution that would improve CLFS rate setting, provide payment stability and predictability for the Medicare program, dramatically reduce data reporting for laboratories, and facilitate investment in innovative diagnostics. A commonsense pathway forward is needed to protect patient access to laboratory services, safeguard the nation’s clinical laboratory infrastructure, and support innovation to advance the next generation of personalized care.

Join the Stop Lab Cuts campaign. Clinical laboratories along with many provider, patient, and consumer stakeholder groups are coming together to advocate for sustainable Medicare rates for laboratory services. The Stop Lab Cuts campaign advocates for a long-term solution to ensure patient access to laboratory testing services, protect the nation’s clinical laboratory infrastructure, and support innovation in testing to advance the next generation of personalized care.

Visit StopLabCuts.org to learn more.

Updated February 2026