Bill > S2761

This bill (the RESULTS Act) aims to improve the accuracy and data collection process for Medicare payment rates for clinical diagnostic laboratory tests, with a focus on tests that are widely available and not considered advanced diagnostic laboratory tests (non-ADLT). The bill introduces several key changes to how laboratory test payment rates are determined starting in 2027 and 2028. Specifically, the legislation establishes a mechanism for collecting payment data from a qualifying independent national nonprofit claims database that includes at least 50 billion claims from over 50 private payors. The bill defines detailed criteria for what constitutes a qualifying claims database and independent claims data entity, including requirements for data validation, privacy, and statistical significance. For laboratory tests where no payment data is available, the bill provides a default adjustment method that would increase the previous year's payment rate by the Consumer Price Index. The legislation also mandates that the Secretary of Health and Human Services make payment rate calculations publicly available and provides technical improvements to ensure more accurate, market-based data collection. These changes are intended to provide long-term stability for Medicare beneficiaries' access to clinical diagnostic laboratory tests by creating a more robust and transparent payment rate determination process.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/2761/all-info