RESULTS Act
- Sponsor
- Rep. Hudson, Richard [R-NC-9]
- Committees
- Ways and Means Committee (primary)
- Last action
- Sep 10, 2025
Bottom line
This bill aims to stabilize Medicare payments for lab tests by using a centralized, independent data source for common tests and adjusting payment reduction caps to ensure long-term sustainability and patient access.
What it actually does
This bill amends the Social Security Act to reform how Medicare pays for clinical diagnostic laboratory tests. It shifts data collection for 'widely available non-ADLT' tests from individual laboratories to a qualifying independent claims database, updates definitions for 'applicable information' and 'final payment rate,' adjusts reporting periods, and modifies limits on payment reductions, aiming to improve the accuracy and feasibility of private payor-based fee schedule payment rates.
Proponents argue
Supporters argue that the current system for setting Medicare payment rates for clinical diagnostic laboratory tests (CDLTs) is flawed, leading to inaccurate rates, administrative burden on laboratories, and potential threats to beneficiary access. They contend that using a comprehensive, independent claims database for widely available tests will provide more accurate, market-based data, reduce reporting burdens on labs, and ensure long-term stability for the diagnostic testing industry, ultimately preserving patient access to essential tests.
Opponents contend
Critics might argue that shifting data collection to a single independent entity could introduce new points of failure or potential biases, or that the proposed payment adjustments might still lead to insufficient reimbursement for some labs, particularly smaller or specialized ones. Some might also contend that the bill's changes do not go far enough to address fundamental issues with the Medicare payment system for CDLTs or that the new definitions and processes add unnecessary complexity.
The bill is moderately complex due to its technical nature and amendments to existing law, requiring careful reading. The estimated reading time is reasonable for understanding its provisions.
Section 2(a)(1)(A)(ii), amending SSA 1834A(a)(1)(A)
Shifting Data Collection for Widely Available Non-ADLTs to Independent Claims Database
For widely available non-advanced diagnostic laboratory tests (non-ADLTs), starting January 1, 2028, Medicare will no longer require individual laboratories to report private payor data. Instead, the Secretary of HHS will contract with a 'qualifying independent claims data entity' to collect this information from its comprehensive claims database.
Supporters argue
This change will provide more accurate and representative market-based data by drawing from a comprehensive, independent source, reducing the burden on individual labs and ensuring more sustainable payment rates.
Critics contend
Some might argue that relying on a single entity for data collection could create a single point of failure, potential for data biases, or lack of transparency compared to direct reporting from labs.
Tradeoffs
Balances the desire for comprehensive, accurate data with concerns about centralizing data collection and potential impacts on smaller labs or specialized tests.
Section 2(a)(2)(C)-(E), amending SSA 1834A(a)(2)
New Definitions for Data Collection and Entities
The bill introduces several new definitions: 'non-widely available non-ADLT clinical diagnostic laboratory test,' 'qualifying independent claims data entity' (a national nonprofit, non-affiliated, certified entity with a comprehensive database), 'qualifying comprehensive claims database' (a database with specific criteria like 50B+ claims, 50+ payors, 50 states representation, quality assurance), and 'widely available non-ADLT clinical diagnostic laboratory test' (a non-ADLT test furnished by over 100 providers/suppliers in a 6-month period).
Section 2(c)(1), amending SSA 1834A(a)(3)
Updated Definition of 'Applicable Information' and 'Final Payment Rate'
For data collection periods starting January 1, 2027, 'applicable information' for widely available non-ADLTs will include the final payment rate and volume paid by each private payor during the entire year (not just the data collection period). For other tests (non-widely available non-ADLTs and ADLTs), it's the final payment rate and volume during the data collection period. 'Final payment rate' is explicitly defined as the last payment made and excludes denied, appealed, erroneous, or recouped payments.
Section 2(c)(4), amending SSA 1834A(b)(3)
Modifications to Limits on Payment Reductions
The bill extends the current payment reduction limits. The 0% reduction limit (from 2017) is extended to '2017 and each subsequent year.' The 10% reduction limit (for 2017-2028) is maintained for 2017-2028. The 15% reduction limit (for 2026-2028) is changed to a 5% reduction limit for '2029 and each subsequent year.'
Section 2(b)(2), amending SSA 1834A(b) by adding new paragraph (6)
Default Payment for Widely Available Non-ADLTs Without Data
For widely available non-ADLTs, if CMS cannot contract with a qualifying independent claims data entity or if there's no applicable data in the database for a reporting period starting January 1, 2028, the payment rate for that test will be the previous year's rate, increased by the Consumer Price Index (CPI) for all urban consumers. This 'default' rate applies for a 'qualified rate period' until data becomes available again.
Section 2(b)(3), amending SSA 1834A(b) by adding new paragraph (7)
Payment for Non-Widely Available Non-ADLTs Without Data
For non-widely available non-ADLTs (those still reported by individual labs), if no applicable data is reported for a test starting January 1, 2028, CMS will use a 'cross-walking' method (linking it to a comparable test) or a 'gapfilling' process (determining a rate when no comparable test exists) to set the payment rate. If this process was used in a previous year, the rate for the current year will be the previous year's rate.
Section 2(b)(4), amending SSA 1834A(b) by adding new paragraph (8)
Public Explanation of Payment Rates
The Secretary is required to make publicly available an explanation of the payment rate for each clinical diagnostic laboratory test, including supporting data necessary for a laboratory to assess the accuracy of the calculations.
This provision sunsets the existing limitation on administrative and judicial review of Medicare payment rates for clinical diagnostic laboratory tests, effective January 1, 2029.
Section 2(c)(5), amending SSA 1834A(h)(1)
Why it matters:This is a technical adjustment to an existing statutory provision, common in legislative drafting, rather than an attempt to obscure its intent.
Case for: Supporters would argue that removing the limitation on administrative and judicial review of payment rates after January 1, 2029, allows for greater oversight and potential correction of errors in the rate-setting process once the new system is fully established.
Case against: Critics might argue that maintaining some limitations on review could help prevent excessive litigation and administrative burden on CMS, especially during the initial years of implementing a new payment system.
Estimated impact: Potentially significant for laboratories seeking to challenge payment rates post-2029, but no immediate direct fiscal impact.