RESULTS Act

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.