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.