RESULTS Act
- Bill Number
- S. 2761
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-09-10: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-04-28T11:03:22Z
AI-Generated Summary
Purpose This legislation amends title XVIII of the Social Security Act to stabilize Medicare payments for clinical diagnostic laboratory tests. It aims to improve the accuracy of private payor-based fee schedule rates and make data collection more feasible, particularly for widely available non-advanced diagnostic laboratory tests (non-ADLTs).
Key Provisions
- Data Collection Changes: Starting with data collection periods in 2027, the Secretary of Health and Human Services must contract with a qualifying independent claims data entity (a national nonprofit organization meeting specific criteria) to obtain applicable information from a qualifying comprehensive claims database for widely available non-ADLT tests. This replaces direct reporting by applicable laboratories for these tests.
- Definitions Updated: New terms define "widely available non-ADLT clinical diagnostic laboratory test" (tests with payments to more than 100 providers in a prior period), "qualifying independent claims data entity," and "qualifying comprehensive claims database" (requiring at least 50 billion claims from over 50 payors, covering all states, with privacy and quality controls). "Applicable laboratory" retains its current regulatory meaning for periods before 2028 but shifts afterward.
- Applicable Information: For periods beginning in 2027, this focuses on final payment rates (last payment made, excluding denied, appealed, erroneous, or recouped amounts) and test volumes from private payors.
- Default Payment Mechanisms: If no contract exists or no data is available for a widely available non-ADLT test, payment defaults to the prior year's rate increased by the Consumer Price Index for all urban consumers. For non-widely available non-ADLT tests lacking data, payment uses cross-walking to a comparable test or gapfilling.
- Reporting and Payment Adjustments: Data collection periods shift to begin January 1, 2027; reporting periods extend to every four years in some cases. Limits on payment reductions change (e.g., 5% cap starting in 2029), and Medicaid managed care data is excluded before 2028. The Secretary must publicly explain payment rates.
- Other Updates: Technical corrections clarify payment rate application periods; review limitations on certain payment decisions sunset before 2029.
Significant Changes to Existing Law
- Replaces laboratory-reported data with independent database data for widely available non-ADLT tests beginning in 2028 reporting periods.
- Extends data collection and reporting intervals and updates the definition of "final payment rate" to exclude non-final transactions.
- Introduces new default payment formulas and public transparency requirements not present in current law.
- Modifies payment reduction caps and excludes certain managed care data from earlier periods.
Potential Impacts
- Government Agencies: Increases administrative responsibilities for the Centers for Medicare & Medicaid Services (CMS) in contracting with data entities, rulemaking, and public explanations of rates.
- Citizens: Aims to provide more stable Medicare beneficiary access to laboratory tests by reducing payment volatility.
- International Relations: No direct effects identified.
Main Stakeholders Affected
- Medicare beneficiaries receiving clinical diagnostic laboratory tests.
- Clinical laboratories (both applicable and non-applicable) that bill Medicare.
- Qualifying independent claims data entities and private payors whose data is used.
- The Department of Health and Human Services and CMS, which administer the changes.
- Providers and suppliers submitting claims for these tests.
Notable Legal, Constitutional, or Political Implications
- The bill operates within existing Medicare administrative authority under the Social Security Act and does not appear to raise constitutional issues.
- It introduces new contractual and data-sharing requirements with private nonprofit entities while maintaining privacy protections under HIPAA.
- Bipartisan introduction may reflect efforts to address ongoing concerns about laboratory payment accuracy without altering core Medicare structure.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (10)
Sen. Warnock, Raphael G. [D-GA], Sen. Budd, Ted [R-NC], Sen. Welch, Peter [D-VT], Sen. Marshall, Roger [R-KS], Sen. Banks, Jim [R-IN], Sen. Padilla, Alex [D-CA], Sen. Curtis, John R. [R-UT], Sen. Shaheen, Jeanne [D-NH], Sen. Blackburn, Marsha [R-TN], Sen. Daines, Steve [R-MT]
Recent Actions
- 2025-09-10: Read twice and referred to the Committee on Finance.
- 2025-09-10: Introduced in Senate
Bill Versions
- Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025 — issued 2025-09-10 — PDF (25 pages)