RESULTS Act

This bill aims to keep Medicare patients’ access to lab tests stable by making how Medicare sets lab test prices more accurate and predictable. It has Medicare use “final” private insurance payment data (not denied or appealed payments) to set rates, starting with data collected in 2027 and reported in early 2028 . For common lab tests, Medicare would get pricing data from a large, independent nonprofit that maintains a nationwide claims database with strict privacy and quality standards (at least 50 billion claims from 50+ payors, covering all states) . If there’s no contract with that data source, or no usable data, payments for those common tests would default to last year’s amount plus inflation (CPI) until new data is available . For less common tests without data, Medicare would match them to a similar test (“crosswalk”) or set a rate using a fallback process (“gapfill”), and keep that rate until new data appears . The bill also requires public explanations of how each test’s payment rate was set, so labs can check the math . Finally, it lowers how much payments can be cut in a year going forward, limiting future annual reductions to 5% starting in 2029 to avoid big swings .

Overall, this is meant to reduce sudden drops in payments, improve transparency, and use better real-world data, which can help keep local labs open and patients’ tests available under Medicare .

• Who is affected: Medicare patients who need lab tests; clinical labs that run those tests; and private insurers whose final payments are used as benchmarks .
• What changes: Uses final private payor rates from a qualified national claims database; adds a CPI-based default when data are missing; creates a fallback for rare tests; requires public explanations of payment rates; and tightens annual cut limits to 5% starting in 2029 .
• When: New data rules apply to collection periods beginning in 2027 and reporting in early 2028; the 5% annual cut limit starts in 2029 .