RESULTS Act
Senate Committee Reviews RESULTS Act to Fix Medicare Lab Test Pricing Data
Stalled
No legislative action in over 90 days.
Legislative Progress
Key Points
- Congress would change how Medicare sets prices for many common lab tests, aiming to keep patient access stable.
- Starting with data collected in 2027 and used for payments in later years, Medicare would rely more on “final” private insurance payment amounts, not preliminary or disputed ones.
- For widely used lab tests, Medicare would get pricing data from a large, independent nonprofit claims database, instead of mainly relying on labs to report prices.
- If Medicare can’t get the database data for a common test, payments would generally roll forward with an inflation update instead of dropping due to missing data.
- The bill also requires Medicare to publicly explain how it calculated each lab test’s payment rate, so labs can check for errors.
Impact Analysis
Personal Impact
How this policy affects specific groups of people
Milestones
Read twice and referred to the Committee on Finance.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in Senate
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
4 articlesRESULTS Act aims to avert Medicare lab fee cuts that could hit physician office testing
The RESULTS Act would change how Medicare sets rates on the Clinical Laboratory Fee Schedule by revising how private payer data is used. It aims to improve the accuracy of data collection by relying on independent claims databases rather than just lab-reported figures to set payment levels.
ACLA Eyes RESULTS Act Vote at the End of the Year
The RESULTS Act calls for PAMA reform by permanently capping reimbursement cuts to 5% annually and identifying an independent claims database to help the federal government set Medicare rates for lab test claims, moving away from the criticized lab-based reporting approach.
Congress Introduces New Legislation to Reform Protecting Access to Medicare Act
The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act aims to reform the PAMA rate-setting process by using a third-party database of private payor claims to establish Medicare payment rates, ensuring data is representative of the entire laboratory market.
Source Information
Document Type
Congressional Bill
Official Title
RESULTS Act
Data Sources
Sponsor
Cosponsors
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