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RESULTS Act

Introduced Sep 10, 2025 · Last action Sep 10, 2025 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.

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Summary

This legislation is called the RESULTS Act. It is being reviewed by a committee.

Full bill text

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5269 Introduced in House (IH)]

<DOC>

119th CONGRESS
  1st Session
                                H. R. 5269

 To amend title XVIII of the Social Security Act to provide long-term
   stability for Medicare beneficiary access to clinical diagnostic
laboratory tests by improving the accuracy of, and feasibility of data
  collection for, the private payor-based fee schedule payment rates
   applied under the Medicare program for such tests, and for other
                               purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 10, 2025

Mr. Hudson (for himself, Mr. Peters, Mr. Bilirakis, Mr. Krishnamoorthi,
Mr. Fitzpatrick, Mr. Carter of Georgia, Mr. Joyce of Pennsylvania, Mr.
Ciscomani, Mr. Davis of North Carolina, Ms. Davids of Kansas, Ms. Ross,
Mr. Balderson, and Ms. Sewell) introduced the following bill; which was
 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

_______________________________________________________________________

                                 A BILL

 To amend title XVIII of the Social Security Act to provide long-term
   stability for Medicare beneficiary access to clinical diagnostic
laboratory tests by improving the accuracy of, and feasibility of data
  collection for, the private payor-based fee schedule payment rates
   applied under the Medicare program for such tests, and for other
                               purposes.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Reforming and Enhancing Sustainable
Updates to Laboratory Testing Services Act of 2025'' or the ``RESULTS
Act''.

SEC. 2. IMPROVING THE ACCURACY AND DATA COLLECTION FEASIBILITY OF THE
              PRIVATE PAYOR-BASED MEDICARE PAYMENT RATES FOR CLINICAL
              DIAGNOSTIC LABORATORY TESTS.

    (a) Acquiring Data for Widely Available Non-Advanced Diagnostic
Laboratory Tests From a Qualifying Comprehensive Claims Database of an
Independent National Nonprofit Entity.--Section 1834A(a) of the Social
Security Act (42 U.S.C. 1395m-1(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)--
                            (i) by striking ``requirements.--Subject to
                        subparagraph (B)'' and inserting
                        ``requirements.--
                            ``(i) In general.--Subject to subparagraph
                        (B) and except as provided for in clause
                        (ii)'';
                            (ii) in clause (i), as added by clause (i)
                        of this subparagraph--
                                    (I) by striking ``paragraph (2)''
                                and inserting ``paragraph (2)(A)'';
                                    (II) by inserting ``, in accordance
                                with the provisions of this section,''
                                before ``report to the Secretary'';
                                    (III) by striking ``applicable
                                information (as defined in paragraph
                                (3)) for a data collection period (as
                                defined in paragraph (4))'' and
                                inserting ``applicable information (as
                                defined in paragraph (3))--
                                    ``(I) for a data collection period
                                (as defined in paragraph (4)) beginning
                                before January 1, 2027,'';
                                    (IV) by striking the period at the
                                end and inserting ``; and''; and
                                    (V) by adding at the end the
                                following new subclause:
                                    ``(II) for a data collection period
                                beginning on or after January 1, 2027,
                                for each clinical diagnostic laboratory
                                test for which final payment is made
                                under this part to the laboratory
                                during such period.''; and
                            (iii) by adding at the end the following
                        new clause;
                            ``(ii) Collection and submission of data.--
                                    ``(I) In general.--With respect to
                                data collection periods for reporting
                                periods beginning on or after January
                                1, 2028, and for purposes of this
                                section, in the case of a widely
                                available non-ADLT clinical diagnostic
                                laboratory test (as defined in
                                paragraph (2)(E)), the Secretary shall
                                collect and use applicable information
                                from a qualifying comprehensive claims
                                database (as defined in paragraph
                                (2)(C)) of a qualifying independent
                                claims data entity (as defined in
                                paragraph (2)(D)) with which the
                                Secretary has in effect a contract
                                under subclause (II) for each such test
                                furnished during the respective data
                                collection period and for which final
                                payment is made under this part during
                                the year in which such data collection
                                period occurs.
                                    ``(II) Contract with qualifying
                                independent claims data entity for
                                access to applicable information.--As
                                soon as practicable after the date of
                                enactment of this clause, the Secretary
                                shall identify and enter into a
                                contract with a qualifying independent
                                claims data entity for the purpose of,
                                with respect to widely available non-
                                ADLT clinical diagnostic laboratory
                                tests furnished during a data
                                collection period, such entity
                                reporting to the Secretary applicable
                                information from a qualifying
                                comprehensive claims database of the
                                entity for such tests for which final
                                payment is made under this part during
                                the year in which such data collection
                                period occurs and for which there is
                                applicable information within such
                                database for such period.''.
                    (B) in subparagraph (B)--
                            (i) in clause (i), by striking ``2025'' and
                        inserting ``2027'';
                            (ii) in clause (ii), by striking
                        ``beginning January 1, 2026, and ending March
                        31, 2026'' and inserting ``beginning January 1,
                        2028, and ending March 31, 2028''; and
                            (iii) in clause (iii), by striking ``three
                        years'' and inserting ``4 years'';
            (2) in paragraph (2)--
                    (A) by striking ``Definition of applicable
                laboratory.--In this section, the term `applicable
                laboratory' means'' and inserting ``Definitions.--In
                this section:''
                    ``(A) Applicable laboratory.--
                            ``(i) Reporting periods before 2028.--With
                        respect to reporting periods beginning before
                        January 1, 2028, the term `applicable
                        laboratory' means'';
                    (B) in subparagraph (A), as inserted by
                subparagraph (A) of this paragraph--
                            (i) in clause (i), in the second sentence,
                        by striking ``paragraph'' and inserting
                        ``clause''; and
                            (ii) by adding at the end the following new
                        clause:
                            ``(ii) Reporting periods beginning during
                        2028 and subsequent years.--With respect to
                        reporting periods beginning on or after January
                        1, 2028, the term `applicable laboratory' shall
                        have the meaning given such term in section
                        414.502 of title 42, Code of Federal
                        Regulations, as in effect on May 1, 2025,
                        except without application of paragraph (3) of
                        such section.''; and
                    (C) by adding at the end the following new
                subparagraphs:
                    ``(B) Non-widely available non-adlt clinical
                diagnostic laboratory test.--The term `non-widely
                available non-ADLT clinical diagnostic laboratory test'
                means, with respect to a reporting period, a clinical
                diagnostic laboratory test that is not an advanced
                diagnostic laboratory test and that is not described in
                subparagraph (E).
                    ``(C) Qualifying independent claims data entity.--
                The term `qualifying independent claims data entity'
                means an entity that satisfies each of the following
                criteria:
                            ``(i) The entity is a national nonprofit
                        organization that is not affiliated with any
                        Government agency, insurance issuer, group
                        health plan, provider of services or supplier,
                        or other organization in the health care
                        sector.
                            ``(ii) The entity collects data and
                        maintains a qualifying comprehensive claims
                        database (as defined in subparagraph (D)).
                            ``(iii) The entity is certified by the
                        Secretary to be a qualified entity (as defined
                        in paragraph (2) of section 1874(e)) with
                        respect to having access to data described in
                        paragraph (3) of such section.
                            ``(iv) The entity, with respect to all data
                        included in the qualifying comprehensive claims
                        database of the entity, complies with all
                        applicable Federal and State privacy and
                        security requirements, including HIPAA privacy
                        and security law (as defined in section 3009 of
                        the Public Health Service Act).
                            ``(v) The entity applies quality assurance
                        processes to validate all data that is included
                        in the qualifying comprehensive claims database
                        of the entity, including comprehensive
                        statistical testing.
                    ``(D) Qualifying comprehensive claims database.--
                The term `qualifying comprehensive claims database'
                means an independent database of private payor claims
                data, which--
                            ``(i) includes at least 50,000,000,000
                        claims from more than 50 private payors and
                        claims administrators;
                            ``(ii) is a statistically significant
                        repository of claims data that is
                        representative for all 50 States and the
                        District of Columbia;
                            ``(iii) includes only data that is
                        validated by quality assurance processes,
                        including comprehensive statistical testing;
                            ``(iv) complies with all applicable Federal
                        and State privacy and security requirements, as
                        described in subparagraph (C)(iv);
                            ``(v) provides for version control of
                        claims to enable the collation and submission,
                        for purposes of this section, of only claims
                        representative of final payment amounts; and
                            ``(vi) includes claims data with respect to
                        widely available non-ADLT clinical diagnostic
                        laboratory tests.
                    ``(E) Widely available non-adlt clinical diagnostic
                laboratory test.--The term `widely available non-ADLT
                clinical diagnostic laboratory test' means, with
                respect to a reporting period, a clinical diagnostic
                laboratory test that is not an advanced diagnostic
                laboratory test and for which, during the first 6
                months of the year immediately preceding the data
                collection period for such reporting period, the number
                of providers of services and suppliers receiving
                payments under this section (as determined by the
                Secretary using the national provider identifier of the
                provider of services or supplier on the claim submitted
                for payment under this part for such test) exceeds
                100.'';
            (3) in paragraph (5)--
                    (A) by inserting ``final'' after ``The''; and
                    (B) by inserting ``or from a qualifying
                comprehensive claims database pursuant to paragraph
                (1)(A)(ii)'' after ``reported by a laboratory under
                this subsection'';
            (4) in paragraph (6)--
                    (A) by inserting ``(or, with respect to a widely
                available non-ADLT clinical diagnostic laboratory test,
                the qualifying comprehensive claims database of the
                qualifying independent claims data entity with a
                contract under paragraph (1)(A)(ii))'' after ``In the
                case where an applicable laboratory'';
                    (B) by striking ``payment rate'' each place it
                appears and inserting ``final payment rate'';
                    (C) by inserting ``(and such different payment
                rates do not relate to the same claim)'' after ``for
                the same payor for the same test''; and
                    (D) by inserting ``or qualifying independent claims
                data entity, as applicable,'' after ``the applicable
                laboratory'';
            (5) in paragraph (9)(A), by inserting ``required to be
        reported by such laboratory'' after ``in reporting
        information'';
            (6) in paragraph (10)--
                    (A) by striking ``by a laboratory'' after
                ``information disclosed''; and
                    (B) by inserting ``by a laboratory or the
                qualifying independent claims data entity with a
                contract under paragraph (1)(A)(ii)'' after ``under
                this subsection''; and
            (7) in paragraph (12)--
                    (A) by striking ``Regulations.--Not later than June
                30, 2015,'' and inserting ``Regulations.--
                    ``(A) For data collection periods before 2027.--Not
                later than June 30, 2015, for data collection periods
                beginning before January 1, 2027,''; and
                    (B) by adding at the end the following new
                subparagraph:
                    ``(B) For data collection periods beginning with
                2027.--Not later than December 31, 2026, the Secretary
                shall establish through notice and comment rulemaking
                parameters for data collection periods beginning on or
                after January 1, 2027.''.
    (b) Incorporating Data Collection Improvements Into Private Payor-
Based Medicare Payment Rates for Clinical Diagnostic Laboratory Tests
That Are Not Advanced Diagnostic Laboratory Tests.--
            (1) Calculation of weighted median of private payor-based
        rates.--Section 1834A(b)(2) of the Social Security Act (42
        U.S.C. 1395m-1(b)(2)) is amended--
                    (A) by inserting ``and, in the case of widely
                available non-ADLT clinical diagnostic laboratory
                tests, with respect to data collection periods for
                reporting periods beginning on or after January 1,
                2028, for each such test furnished by an applicable
                laboratory with respect to which there is applicable
                information made available to the Secretary pursuant to
                paragraph (1)(A)(ii)) of such subsection'' after
                ``under subsection (a) for a data collection period'';
                and
                    (B) by inserting ``final'' before ``payment rates
                reported''.
            (2) Default adjustment in cases of widely available non-
        adlt clinical diagnostic laboratory tests for periods for which
        there is no contract with a qualifying independent claims
        entity or no applicable information in the qualifying
        comprehensive claims database.--Section 1834A(b) of the Social
        Security Act (42 U.S.C. 1395m-1(b)) is amended--
                    (A) in paragraph (1)(A), by striking ``paragraph
                (3)'' and inserting ``paragraphs (3) and (6)''; and
                    (B) by adding at the end the following new
                paragraph:
            ``(6) Default payment for widely available non-adlt
        clinical diagnostic laboratory tests for periods for which
        there is no contract with an independent entity or with respect
        to which there is no data.--
                    ``(A) In general.--With respect to data collection
                periods for reporting periods beginning on or after
                January 1, 2028, in the case of a widely available non-
                ADLT clinical diagnostic laboratory test with respect
                to which subsection (c) does not apply, if a
                circumstance described in subparagraph (B) applies with
                respect to such a reporting period and such a clinical
                diagnostic laboratory test, payment for such test under
                this section for a year beginning during the qualified
                rate period described in subparagraph (C), shall be
                equal to the amount of payment for such clinical
                diagnostic laboratory test under this section for the
                previous year, increased by the percentage increase in
                the Consumer Price Index for all urban consumers (all
                items; United States city average) over the previous
                year.
                    ``(B) Circumstances described.--For purposes of
                subparagraph (A), with respect to a data collection
                period and a widely available non-ADLT clinical
                diagnostic laboratory test, the circumstances described
                in this subparagraph are if the Secretary--
                            ``(i) is not able to enter into a contract
                        under subsection (a)(1)(A)(ii) with a
                        qualifying independent claims data entity with
                        respect to such data collection period; or
                            ``(ii) determines that there is no
                        applicable information with respect to such
                        clinical diagnostic laboratory test and data
                        collection period in the qualifying
                        comprehensive claims database of such
                        qualifying independent claims data entity.
                    ``(C) Qualified rate period described.--For
                purposes of subparagraph (A), the qualified rate
                period, with respect to a data collection period and a
                widely available non-ADLT clinical diagnostic test to
                which a circumstance described in subparagraph (B)
                applies, is the period--
                            ``(i) beginning on the first day of the
                        second year following the first data collection
                        period with respect to which such circumstance
                        applies with respect to such test; and
                            ``(ii) ending with the last day of the year
                        following the first data collection period with
                        respect to which such circumstance no longer
                        applies with respect to such test.''.
            (3) Payment in cases in which there is no reported
        applicable information for non-widely available non-adlts.--
        Section 1834A of the Social Security Act (42 U.S.C. 1395m-1),
        is amended--
                    (A) in subsection (b), as amended by paragraph
                (2)--
                            (i) in paragraph (1)(A), by striking
                        ``paragraphs (3) and (6)'' and inserting
                        ``paragraphs (3), (6), and (7)''; and
                            (ii) by adding at the end the following new
                        paragraph:
            ``(7) Payment for non-widely available non-adlt clinical
        diagnostic laboratory tests for which there is no applicable
        information.--
                    ``(A) In general.--For determining payment under
                this subsection for a year in the case of a non-widely
                available non-ADLT clinical diagnostic laboratory test
                with respect to which subsection (c) does not apply, if
                the Secretary determines that no applicable information
                has been reported under subsection (a)(1)(A)(i) by any
                applicable laboratory for such test with respect to the
                most recent data collection period (beginning with data
                collection periods for reporting periods beginning on
                or after January 1, 2028), payment for such test under
                this section for such year shall be determined as
                follows:
                            ``(i) In the case that a process described
                        in subparagraph (B) was not applied pursuant to
                        this subparagraph for determining payment for
                        such test for a previous year with respect to
                        such data collection period, payment for such
                        test and year shall be determined using such a
                        process.
                            ``(ii) In the case that a process described
                        in subparagraph (B) was applied pursuant to
                        this subparagraph for determining payment for
                        such test for a previous year with respect to
                        such data collection period, payment for such
                        test and year shall be equal to the amount of
                        payment for such test under this section for
                        the previous year.
                    ``(B) Process described.--For purposes of
                subparagraph (A), a process described in this
                subparagraph, with respect to a non-widely available
                non-ADLT clinical diagnostic laboratory test for which
                there is no reported data (as described in such
                subparagraph) with respect to a data collection period,
                is--
                            ``(i) cross-walking (as described in
                        section 414.508(a) of title 42, Code of Federal
                        Regulations, or any successor regulation) to
                        the most appropriate clinical diagnostic
                        laboratory test under the fee schedule under
                        this section during that period; or
                            ``(ii) if no other clinical diagnostic
                        laboratory test is comparable to the test for
                        which there is no reported applicable
                        information, according to the gapfilling
                        process described in subsection (c)(2).''; and
                    (B) in subsection (c)(3), by inserting ``or
                subsection (b)(7)'' after ``under this subsection''.
            (4) Publicly available explanation of payment rates.--
        Section 1834A(b) of the Social Security Act (42 U.S.C. 1395m-
        1(b)), as amended by paragraphs (2) and (3)(A), is amended by
        adding at the end the following new paragraph:
            ``(8) Explanation of payment rates.--In the case of a
        clinical diagnostic laboratory test for which payment is made
        under this subsection, the Secretary shall make available to
        the public an explanation of the payment rate for such test,
        including any supporting data as may be necessary for a
        laboratory to assess the accuracy of the calculations.''.
            (5) Technical correction clarifying period of application
        of market rates.--Section 1834A(b)(4)(A) of the Social Security
        Act (42 U.S.C. 1395m-1(b)(4)(A)) is amended by striking ``until
        the year following'' and inserting ``through the year
        following''.
    (c) Additional Improvements To Ensure Updated, Accurate Market-
Based Data for Clinical Diagnostic Laboratory Tests.--
            (1) Updates to applicable information to better reflect
        final payment rates.--Section 1834A(a)(3) of the Social
        Security Act (42 U.S.C. 1395m-1(a)(3)) is amended--
                    (A) in the heading, by inserting ``and final
                payment rate'' after ``information'';
                    (B) in subparagraph (A)--
                            (i) in the heading, by striking ``In
                        general'' and inserting ``Data collection
                        periods before january 1, 2027''; and
                            (ii) in the matter preceding clause (i)--
                                    (I) by striking ``subparagraph
                                (B)'' and inserting ``subparagraph
                                (C)''; and
                                    (II) by inserting ``beginning
                                before January 1, 2027'' after ``for a
                                data collection period'';
                    (C) by redesignating subparagraph (B) as
                subparagraph (C);
                    (D) by inserting after subparagraph (A) the
                following new subparagraph:
                    ``(B) Subsequent data collection periods.--In this
                section, subject to subparagraph (C), for a data
                collection period beginning on or after January 1,
                2027, the term `applicable information' means--
                            ``(i) with respect to a widely available
                        non-ADLT clinical diagnostic laboratory test
                        furnished during such period--
                                    ``(I) the final payment rate (as
                                determined in accordance with paragraph
                                (5) and defined in subparagraph (D))
                                that was paid by each private payor for
                                the test during the year in which such
                                period occurs; and
                                    ``(II) the volume, for each such
                                payor, of such test for which final
                                payment was made during such year; and
                            ``(ii) with respect to a non-widely
                        available non-ADLT clinical diagnostic
                        laboratory test or an advanced diagnostic
                        laboratory test--
                                    ``(I) the final payment rate (as
                                determined in accordance with paragraph
                                (5) and defined in subparagraph (D))
                                that was paid by each private payor for
                                the test during the data collection
                                period; and
                                    ``(II) the volume, for each such
                                payor, of such test for which final
                                payment was made during such period.'';
                                and
                    (E) by inserting after subparagraph (C), the
                following new subparagraph:
                    ``(D) Final payment rate.--In this section, for a
                data collection period beginning on or after January 1,
                2027, the term `final payment rate'--
                            ``(i) means--
                                    ``(I) with respect to a widely
                                available non-ADLT clinical diagnostic
                                laboratory test furnished during a data
                                collection period, the last payment
                                made for a test during the year in
                                which the data collection period
                                occurs; and
                                    ``(II) with respect to a non-widely
                                available non-ADLT clinical diagnostic
                                laboratory test or an advanced
                                diagnostic laboratory test paid during
                                a data collection period, the last
                                payment made during the data collection
                                period; and
                            ``(ii) does not include--
                                    ``(I) denied payments;
                                    ``(II) payments under appeal or
                                under review by the private payor;
                                    ``(III) payments made in error; or
                                    ``(IV) payments that are recouped
                                by the private payor.''.
            (2) Updating data collection periods.--Section
        1834A(a)(4)(B) of the Social Security Act (42 U.S.C. 1395m-
        1(a)(4)(B)) is amended--
                    (A) by striking ``January 1, 2019'' and inserting
                ``January 1, 2027'';
                    (B) by striking ``June 30, 2019'' and inserting
                ``June 30, 2027''; and
                    (C) by adding at the end the following new
                sentence: ``In the case of the reporting period after
                the reporting period described in paragraph (1)(B)(ii)
                and each subsequent reporting period with respect to
                clinical diagnostic laboratory tests that are not
                advanced diagnostic laboratory tests, the term `data
                collection period' means the 6-month period beginning
                January 1st of the year preceding the year during which
                such reporting period begins.''.
            (3) Ensuring data is market-based by excluding rates of
        medicaid managed care organizations.--Section 1834A(a)(8)(C) of
        the Social Security Act (42 U.S.C. 1395m-1(a)(8)(C)) is amended
        by striking ``A medicaid managed care organization'' and
        inserting ``With respect to data collection periods for
        reporting periods beginning before January 1, 2028, a medicaid
        managed care organization.''.
            (4) Modifications to limits on payment reductions.--Section
        1834A(b)(3) of the Social Security Act (42 U.S.C. 1395m-
        1(b)(3)) is amended--
                    (A) in subparagraph (A), by striking ``each of 2017
                through 2028'' and inserting ``2017 and each subsequent
                year'';
                    (B) in subparagraph (B)--
                            (i) in clause (ii), by striking ``2025''
                        and inserting ``2028''; and
                            (ii) in clause (iii), by striking ``for
                        each of 2026 through 2028, 15 percent'' and
                        inserting ``for 2029 and each subsequent year,
                        5 percent''; and
                    (C) in subparagraph (C)(ii), by inserting
                ``laboratory'' after ``advanced diagnostic''.
            (5) Sunsetting review limitations.--Section 1834A(h)(1) of
        the Social Security Act (42 U.S.C. 1395m-1(h)(1)) is amended by
        inserting ``before January 1, 2029'' before the period at the
        end.
                                 <all>

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Status

In Committee

  1. 1Introduced
  2. 2Committee
  3. 3Floor
  4. 4Passed
  5. 5Signed

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