RESULTS Act
- Bill Number
- H.R. 5269
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-09-10: 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.
- Last Updated
- 2026-07-03T08:05:38Z
AI-Generated Summary
Purpose The legislation amends title XVIII of the Social Security Act to stabilize Medicare beneficiary access to clinical diagnostic laboratory tests. It improves the accuracy and feasibility of collecting data used to set private payor-based fee schedule payment rates under the Medicare program.
Key Provisions
- Data Collection Changes: For widely available non-ADLT clinical diagnostic laboratory tests, the Secretary of Health and Human Services must contract with a qualifying independent claims data entity (a national nonprofit meeting specific criteria) to obtain applicable information from a qualifying comprehensive claims database, rather than requiring direct reporting from applicable laboratories. This applies to data collection periods beginning on or after January 1, 2027, with reporting periods starting January 1, 2028.
- Definitions and Scope: Introduces terms such as "widely available non-ADLT clinical diagnostic laboratory test" (tests with payments to more than 100 providers/suppliers) and "non-widely available non-ADLT clinical diagnostic laboratory test." Updates the definition of "applicable laboratory" for reporting periods beginning in 2028.
- Payment Rate Calculations: Requires use of "final payment rates" (last payment made, excluding denied, appealed, erroneous, or recouped amounts). Establishes default payment rules if no contract exists or no data is available, including inflation adjustments or cross-walking/gapfilling methods.
- Timeline Adjustments: Extends data collection periods (e.g., shifting from 2019–2026 to 2027 onward), modifies reporting windows, and updates limits on payment reductions (e.g., reducing the cap to 5% starting in 2029).
- Transparency and Other Rules: Requires public explanations of payment rates. Excludes Medicaid managed care organization rates for periods before 2028. Sunsets certain review limitations after January 1, 2029.
Significant Changes to Existing Law
- Replaces laboratory-reported data with third-party claims database data for many non-ADLT tests, altering the Protecting Access to Medicare Act (PAMA) framework.
- Introduces new default payment mechanisms and processes for tests lacking reported data.
- Modifies "applicable information" to emphasize final payment rates and adjusts data collection periods and reduction caps.
- Adds requirements for public explanations of rates and contracts with independent data entities.
Potential Impacts
- Government Agencies: The Centers for Medicare & Medicaid Services (CMS) must identify and contract with a qualifying entity, establish new rulemaking parameters by December 31, 2026, and manage updated data processes.
- Citizens: Aims to support continued access to laboratory tests for Medicare beneficiaries through more stable, market-based rates.
- International Relations: No provisions address international matters.
Main Stakeholders Affected
- Medicare beneficiaries and providers of clinical diagnostic laboratory tests.
- Applicable laboratories and private payors.
- The qualifying independent claims data entity (national nonprofit).
- The Department of Health and Human Services and CMS.
Notable Legal, Constitutional, or Political Implications The bill modifies statutory Medicare payment authority under the Social Security Act without altering constitutional structures. It relies on notice-and-comment rulemaking and contracts, potentially affecting administrative processes and data privacy compliance (including HIPAA). No explicit political or constitutional issues are addressed in the text.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (99)
Rep. Peters, Scott H. [D-CA-50], Rep. Bilirakis, Gus M. [R-FL-12], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Carter, Earl L. "Buddy" [R-GA-1], Rep. Joyce, John [R-PA-13], Rep. Ciscomani, Juan [R-AZ-6], Rep. Davis, Donald G. [D-NC-1], Rep. Davids, Sharice [D-KS-3], Rep. Ross, Deborah K. [D-NC-2], Rep. Balderson, Troy [R-OH-12], Rep. Sewell, Terri A. [D-AL-7], Rep. Lofgren, Zoe [D-CA-18], Rep. Kennedy, Mike [R-UT-3], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Dingell, Debbie [D-MI-6], Rep. Horsford, Steven [D-NV-4], Rep. Bresnahan, Robert P. [R-PA-8], Rep. Craig, Angie [D-MN-2], Rep. Dunn, Neal P. [R-FL-2], Rep. Auchincloss, Jake [D-MA-4], Rep. Panetta, Jimmy [D-CA-19], Rep. Mullin, Kevin [D-CA-15], Rep. Gottheimer, Josh [D-NJ-5], Rep. Kean, Thomas H. [R-NJ-7], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Thompson, Mike [D-CA-4], Rep. Brownley, Julia [D-CA-26], Rep. Pettersen, Brittany [D-CO-7], Rep. Rouzer, David [R-NC-7], Rep. McBride, Sarah [D-DE-At Large], Rep. Moore, Blake D. [R-UT-1], Rep. Thanedar, Shri [D-MI-13], Rep. Davis, Danny K. [D-IL-7], Rep. Langworthy, Nicholas A. [R-NY-23], Rep. Cohen, Steve [D-TN-9], Rep. Tenney, Claudia [R-NY-24], Rep. Moore, Tim [R-NC-14], Rep. Sánchez, Linda T. [D-CA-38], Rep. Crenshaw, Dan [R-TX-2], Rep. Trahan, Lori [D-MA-3], Rep. Carey, Mike [R-OH-15], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Levin, Mike [D-CA-49], Rep. Weber, Randy K. Sr. [R-TX-14], Rep. DelBene, Suzan K. [D-WA-1], Rep. Fletcher, Lizzie [D-TX-7], Rep. Landsman, Greg [D-OH-1], Rep. Soto, Darren [D-FL-9], Rep. Pou, Nellie [D-NJ-9] and 49 more
Recent Actions
- 2025-09-10: 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.
- 2025-09-10: 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.
- 2025-09-10: Introduced in House
- 2025-09-10: Introduced in House
Bill Versions
- Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025 — issued 2025-09-10 — PDF (25 pages)