RESULTS Act
Key claim: The RESULTS Act would require CMS to use a contracted nonprofit’s private-sector claims database to set Medicare payment rates for widely available clinical diagnostic laboratory tests beginning January 1, 2028.
Abstract
(HR5269 · 119th Congress) 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. Latest action (2025-09-10): Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Why this matters
The RESULTS Act proposes to replace or supplement the current Medicare Clinical Laboratory Fee Schedule data collection process with private-sector claims data sourced through a contracted nonprofit, potentially altering payment rates for widely available lab tests starting in 2028. If enacted, this could change reimbursement levels that labs receive and, indirectly, what tests are financially viable to offer to Medicare beneficiaries. The bill is at the introduction stage with no committee action yet reported.