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HealthH.R. 5269Not Yet VotedComments

RESULTS Act

Official title: 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.

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How Congress Voted

What Happened in Congress?

Pending

Not yet voted on the floor.

Where the Bill Stands

  1. Introduced, done
  2. Committee, current stage
  3. Floor Vote, not yet
  4. Outcome, not yet

What This Bill Does

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.

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Related Documents

Bill on Congress.govWeb Page ↗ (opens in a new tab)

Timeline

  1. Library of CongressIntroduced in House
  2. House floor actionsReferred 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.
  3. Introduced
  4. Committee

Comments

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