RESULTS Act

The RESULTS Act (HR 5269) changes how Medicare calculates payment rates for clinical diagnostic laboratory tests. It requires Medicare to collect data on private payor rates for widely available non-Advanced Diagnostic Laboratory Tests (non-ADLTs) from a qualifying independent claims data entity (a national nonprofit organization meeting specific criteria) rather than relying on data reported directly by laboratories. For tests where data is unavailable, the bill establishes default payment rates based on previous years' rates adjusted for inflation. The law also requires Medicare to publicly explain payment rates with supporting data, affecting Medicare beneficiaries, clinical laboratories, and private payors that provide services covered by Medicare.