Bill > HR5269

This bill, known as the RESULTS Act (Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025), aims to improve the accuracy and data collection for Medicare payment rates for clinical diagnostic laboratory tests. The bill modifies existing Medicare law by introducing a new method for collecting and calculating payment rates for laboratory tests, primarily focusing on widely available non-advanced diagnostic laboratory tests (non-ADLT). Starting in 2028, the bill requires the Secretary of Health and Human Services to collect data from a qualifying independent claims data entity with a comprehensive claims database that includes at least 50 billion claims from over 50 private payors. The legislation establishes specific criteria for the claims database and the data entity, including requirements for privacy, data validation, and statistical representation. For tests without sufficient reported data, the bill provides alternative payment calculation methods, such as cross-walking to comparable tests or using a gap-filling process. Additionally, the bill includes provisions to make payment rate calculations more transparent by requiring public explanations of how rates are determined. The changes are designed to create a more stable and accurate payment system for clinical diagnostic laboratory tests under Medicare, ensuring long-term accessibility for beneficiaries.

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https://www.congress.gov/bill/119th-congress/house-bill/5269/all-info