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Sponsored by Rep. Richard Hudson(R-NC 9)
Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025 or the RESULTS Act This bill requires the use of particular data from the private sector to inform Medicare payment rates for certain widely available laboratory tests. Specifically, the Centers for Medicare & Medicaid Services (CMS) must contract with an entity that maintains a database of claims data for clinical diagnostic laboratory tests that (1) are not advanced diagnostic tests, and (2) were furnished by more than 100 providers and suppliers of such services over a specified six-month period (i.e., widely available tests). The database must meet specified requirements, such as having data that is representative of the entire country and from more than 50 private payors and claims administrators. The contracted entity must be a nonprofit entity that is not affiliated with any government agency, any insurance issuer or provider, or any other organization in the health care sector. Beginning January 1, 2028, the CMS must use the information obtained from the database to inform Medicare payment rates for these widely available laboratory tests. The bill additionally specifies processes for determining payment rates for laboratory tests that are not advanced diagnostic tests, are not widely available, and lack adequate claims data. The CMS must use certain existing processes to set appropriate rates. The bill also delays scheduled payment reductions for laboratory tests until 2028 and allows for judicial and administrative review of payment rates.
Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025 or the RESULTS Act This bill requires the use of particular data from the private sector to inform Medicare payment rates for certain widely available laboratory tests. Specifically, the Centers for Medicare & Medicaid Services (CMS) must contract with an entity that maintains a database of claims data for clinical diagnostic laboratory tests that (1) are not advanced diagnostic tests, and (2) were furnished by more than 100 providers and suppliers of such services over a specified six-month period (i.e., widely available tests). The database must meet specified requirements, such as having data that is representative of the entire country and from more than 50 private payors and claims administrators. The contracted entity must be a nonprofit entity that is not affiliated with any government agency, any insurance issuer or provider, or any other organization in the health care sector. Beginning January 1, 2028, the CMS must use the information obtained from the database to inform Medicare payment rates for these widely available laboratory tests. The bill additionally specifies processes for determining payment rates for laboratory tests that are not advanced diagnostic tests, are not widely available, and lack adequate claims data. The CMS must use certain existing processes to set appropriate rates. The bill also delays scheduled payment reductions for laboratory tests until 2028 and allows for judicial and administrative review of payment rates.
The RESULTS Act amends Medicare's clinical diagnostic laboratory test payment system under the Social Security Act to change how private payor rate data is collected and used to set Medicare payment rates. It shifts the data collection process for many common ('widely available') lab tests to rely on an independent third-party claims database rather than direct reporting by individual laboratories, while adjusting reporting timelines and definitions.
If enacted, this bill could reduce the reporting burden on individual laboratories for common test types by shifting data collection to a large third-party claims database, potentially improving the accuracy and stability of Medicare's payment rates for lab tests and delaying scheduled rate cuts, which could affect laboratory revenues and beneficiary access to testing services.
AI-generated analysis may contain errors. Always refer to the official bill text.