RESULTS Act Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025
Impact
The bill introduces significant changes aimed at making the Medicare reimbursement process for laboratory tests more accurate and fair. One of its major revisions includes a mandate to collect data on widely available non-advanced diagnostic laboratory tests, which will guide payment rates based on real-world usage and outcomes. This data aims to eliminate discrepancies in payment amounts across different payors, potentially leading to fairer pricing for medical tests while ensuring that medical laboratories are reimbursed appropriately for their services.
Summary
SB2761, known as the RESULTS Act, aims to amend Title XVIII of the Social Security Act to enhance stability for Medicare beneficiaries' access to clinical diagnostic laboratory tests. The bill focuses on improving the accuracy and feasibility of data collection related to fee schedule payment rates determined by private payors for these laboratory tests. By establishing a framework for gathering and evaluating claims data from a qualifying independent claims data entity, the Act seeks to ensure that payment structures reflect accurate market conditions and payor behaviors.
Contention
While supporters argue that the RESULTS Act is necessary for creating a fairer payment environment for laboratories and improving access to diagnostic tests for Medicare beneficiaries, there are concerns regarding the administrative burden on small laboratories. Critics fear that the reliance on a comprehensive claims database could disadvantage smaller providers who may struggle to meet the data requirements, potentially leading to unintended gaps in access to essential diagnostics. Additionally, some healthcare advocates express concerns about the implications of the data reporting responsibilities on the private payor landscape overall.
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