The RESULTS Act: A Turning Point for Laboratory Reimbursement and Patient Access

RESULTS Act Seeks Lasting Reform for Laboratory Reimbursement and Patient Access

For nearly a decade, clinical laboratories have operated under the shadow of the Protecting Access to Medicare Act (PAMA). While short-term congressional delays have prevented devastating reimbursement cuts, these stopgaps have offered only temporary relief. The result has been a cycle of instability that threatens the financial health of laboratories and, more importantly, patients’ access to essential diagnostic services.

That cycle must end.

With the introduction of the bipartisan Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, Congress has taken an important step toward replacing uncertainty with lasting reform. This legislation is more than just another fix—it is a meaningful course correction that acknowledges the foundational role diagnostics play in healthcare and aims to provide stability for laboratories, providers, and patients alike.

Key PAMA Reforms Under the RESULTS Act

The RESULTS Act directly addresses many of the flaws in PAMA’s original framework that have driven instability across the industry. Key provisions include:

• Caps annual cuts at 5% (instead of 15%), preventing destabilizing reimbursement shocks
• Excludes Medicaid MCO rates from the definition of private payors, ensuring more accurate market data
• Modernizes rate-setting by directing CMS to determine Clinical Laboratory Fee Schedule (CLFS) rates for widely available tests using an independent, not-for-profit commercial claims database that reflects all laboratory market segments
• Reduces administrative burden by extending the reporting cycle and allowing data collection through independent entities
• Enhancing transparency by making CLFS rates subject to administrative and judicial review

Together, these reforms protect patient access to diagnostics while creating the reimbursement stability laboratories need to plan strategically, invest in innovation, and strengthen the nation’s healthcare infrastructure.

Additional Provisions to Note

The RESULTS Act goes further by:

• Freezing CLFS rates (2026–2028), avoiding immediate cuts
• Resetting rates for 2029–2032 using broad private-payer data from an independent claims database
• Extending the data cycle to 4 years for less frequent, more predictable reporting
• Capping cuts at 5% but allowing full increases, ensuring fair adjustments in both directions
• Applying special rules for ADLTs and niche tests, recognizing their unique market dynamics

Together, these guardrails provide both near-term protection and long-term stability.

Impact of RESULTS Act on Lab Operations and Staffing

The RESULTS Act is not just about reimbursement mechanics. It’s about preserving access to timely, accurate diagnostics that guide 70% of medical decisions. Its impact will be felt across the healthcare ecosystem:

• Laboratories: Predictable reimbursement supports long-term investments in technology, workforce, and innovation. Community and regional labs, especially those serving rural or underserved areas, will be better positioned to remain viable.
• Providers: Stable access to laboratory services ensures reliable diagnostic results to guide care decisions. Without reform, reimbursement instability risks shrinking the testing landscape, creating gaps in care.
• Payors: A more representative data collection process ensures fair and sustainable rates, reducing disputes and administrative friction.
• Patients: The RESULTS Act safeguards access to routine and advanced testing, protecting seniors and those with chronic conditions who depend on diagnostics for personalized care.

A Critical Step Forward for Laboratories

The RESULTS Act ensures a more resilient diagnostic infrastructure by improving data integrity, rate transparency, and fairness in reimbursement. PAMA’s implementation was flawed, which initially relied on data from fewer than 1% of laboratories and produced payment rates that were neither representative nor sustainable. By introducing guardrails, improving data integrity, and ensuring transparency, this bill creates the conditions for a more resilient diagnostic infrastructure.

Legislation alone is not enough, however. Implementation will determine its ultimate impact, and stakeholders must remain actively engaged, from laboratories to providers to advocacy organizations.

Time to Build on This Momentum

Congress has signaled a commitment to permanent reform, and the RESULTS Act provides a path toward stability, sustainability, and innovation in laboratory medicine. Now it is up to all of us—laboratories, providers, payors, and patients—to ensure this momentum translates into lasting change.

At XiFin, we encourage laboratory leaders to join the American Clinical Laboratory Association’s (ACLA) Stop Lab Cuts campaign and to continue engaging with policymakers. Together, we can move beyond delay-driven policymaking and secure the future of diagnostics, innovation, and equitable access to care.