H.R. 5269: Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025
This bill, titled the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025 (RESULTS Act), aims to amend the Social Security Act to enhance the process by which Medicare determines payment rates for clinical diagnostic laboratory tests. Here’s a summary of the key components of the bill:
1. Improved Accuracy in Payment Rates
The bill seeks to ensure that payment rates for clinical diagnostic laboratory tests under Medicare are based on accurate and comprehensive data derived from a private payor-based system. It proposes to acquire data for widely available non-advanced diagnostic laboratory tests from a large, independent claims database maintained by a qualified nonprofit entity.
2. New Data Collection Framework
The legislation establishes new requirements and frameworks for data collection that aim to improve the feasibility and accuracy of data used in determining payment rates. Key provisions include:
- The Secretary of Health and Human Services (HHS) is tasked to enter into contracts with independent claims data entities to gather relevant payment data.
- A provision for defining what constitutes as “widely available non-advanced diagnostic laboratory tests,” focusing on the number of providers involved.
- Implementation of specific timeframes and conditions under which data must be collected and reported.
3. Payment Rate Adjustments
The bill also includes mechanisms for adjusting payment rates based on updated data collection. For instance, if a specific laboratory test lacks reported information for the most recent data collection period, there are alternative methods outlined for calculating payments based on previous years’ data or other comparable tests.
4. Public Reporting of Payment Rates
The bill mandates that HHS provide public access to explanations regarding how payment rates are set, ensuring transparency in the process. This will include supporting data to help laboratories understand how their payments are calculated.
5. Technical Corrections and Sunset Review
The legislation also includes various technical corrections to ensure clarity and proper enforcement of payment adjustments. Additionally, it specifies a requirement for periodic review of the payment rate settings before 2029 to address emerging issues effectively.
6. Implementation Timeline
Some sections of the bill introduce specific timelines for implementation, including a phased approach for data collection beginning in January 2027, allowing stakeholders to adapt to these new requirements.
Relevant Companies
- CMED - This laboratory services provider could see changes in how Medicare reimbursements are calculated based on the new data collection and assessment methodologies proposed in the bill.
- LH - LabCorp, as a major clinical laboratory, would be directly impacted by changes to payment structures and requirements set forth in the bill, affecting its revenue and operations.
- BDX - Becton Dickinson, which provides various laboratory diagnostic products, may experience shifts in demand and pricing structures as a result of the new regulations on laboratory testing.
This is an AI-generated summary of the bill text. There may be mistakes.
Sponsors
48 bill sponsors
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TrackRichard Hudson
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TrackJake Auchincloss
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TrackTroy Balderson
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TrackGus M. Bilirakis
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TrackRobert Bresnahan
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TrackJulia Brownley
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TrackMike Carey
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TrackEarl L. "Buddy" Carter
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TrackJuan Ciscomani
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TrackSteve Cohen
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TrackAngie Craig
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TrackDan Crenshaw
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TrackSharice Davids
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TrackDanny K. Davis
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TrackDonald G. Davis
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TrackSuzan K. DelBene
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TrackDebbie Dingell
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TrackNeal P. Dunn
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TrackBrian K. Fitzpatrick
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TrackLizzie Fletcher
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TrackJosh Gottheimer
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TrackSteven Horsford
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TrackJohn Joyce
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TrackThomas H. Kean, Jr.
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TrackMike Kennedy
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TrackRaja Krishnamoorthi
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TrackNicholas A. Langworthy
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TrackMike Levin
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TrackZoe Lofgren
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TrackSarah McBride
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TrackBlake D. Moore
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TrackTim Moore
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TrackKevin Mullin
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TrackEleanor Holmes Norton
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TrackJimmy Panetta
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TrackScott H. Peters
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TrackBrittany Pettersen
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TrackDeborah K. Ross
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TrackDavid Rouzer
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TrackTerri A. Sewell
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TrackThomas R. Suozzi
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TrackLinda T. Sánchez
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TrackClaudia Tenney
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TrackShri Thanedar
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TrackMike Thompson
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TrackLori Trahan
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TrackEugene Vindman
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TrackRandy K. Weber, Sr.
Co-Sponsor
Actions
2 actions
| Date | Action |
|---|---|
| Sep. 10, 2025 | Introduced in House |
| 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. |
Corporate Lobbying
3 companies lobbying
