RESULTS Act
Congress targets steadier Medicare lab test payments by using private claims data and public rate explanations
Stalled
No legislative action in over 90 days.
Legislative Progress
Key Points
- Congress would change how Medicare sets prices for many common lab tests by using a large private insurance claims database, instead of relying mainly on labs to report prices.
- Starting in 2027–2028, Medicare would focus on “final payment” amounts (what insurers actually paid after adjustments), aiming for more accurate prices.
- If Medicare can’t get the outside database contract or the needed data for widely used tests, payments would generally roll forward from the prior year and rise with inflation.
- For less-common lab tests with no reported data, Medicare could set payment by matching to similar tests or using a gap-setting process, then hold that rate steady in later years.
- Medicare would have to publicly explain how it calculated each lab test payment rate, so labs can check the math and data behind the price.
Impact Analysis
Personal Impact
How this policy affects specific groups of people
Milestones
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.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in House
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
8 articles
ASCP Endorses the RESULTS Act
ASCP endorses the RESULTS Act (S. 2761 / H.R. 5269) to reform Medicare CLFS pricing by shifting to third‑party claims data collection, improving private-payer-based rates, and reducing lab reporting burden.
STOP LAB CUTS
Advocacy explainer describing how the RESULTS Act would use paid claims from a comprehensive commercial database, reduce lab reporting, and pause additional CLFS cuts until new rates can be set.
ADLM Endorses RESULTS Act and Joins Coalition Urging Congressional Action
ADLM backs the RESULTS Act, arguing current CLFS methods over-weight large lab data and drive cuts; highlights the bill’s approach to use broader market data and reduce administrative burden.
Source Information
Document Type
Congressional Bill
Official Title
RESULTS Act
Data Sources
Sponsor
Cosponsors
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