The RESULTS Act (S. 2761) modifies how Medicare pays for clinical diagnostic laboratory tests by establishing a new data collection system beginning January 1, 2028, that uses private insurance claims information to set more accurate payment rates. Under the bill, the Secretary of Health and Human Services must contract with an independent nonprofit organization that maintains a comprehensive database of at least 50 billion insurance claims to collect pricing data on "widely available" lab tests—those provided by more than 100 providers nationally. The legislation updates Medicare's payment calculation methods to incorporate this private-sector pricing data, establishes fallback payment mechanisms when data is unavailable, and requires the Secretary to publicly explain how laboratory test payment rates are determined. The bill also includes transition rules and extends payment reduction limits through 2028, aiming to align Medicare lab test payments more closely with actual private insurance rates while providing transparency in the payment-setting process.
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