RESULTS Act
Latest action (10 Sep 2025): Introduced
What this bill does
The RESULTS Act would amend how Medicare sets payment rates for clinical diagnostic laboratory tests under the Protecting Access to Medicare Act framework. Currently, independent laboratories must periodically report private-payor payment rate data to Medicare, which uses that data to set fee-schedule rates; this reporting has been infrequent and burdensome. The bill would change the timing and source of this data collection, most notably by requiring Medicare, for "widely available" non-advanced lab tests, to obtain private-payor rate and volume data from a qualifying independent nonprofit entity's large claims database, rather than relying solely on laboratory self-reporting. It sets detailed criteria for what counts as a qualifying database and entity, adjusts definitions of "applicable laboratory" and "final payment rate," updates data collection period timelines starting in 2027-2028, excludes certain Medicaid managed care rates from the data used, requires public explanation of payment rates, and revises limits on how much rates can drop year-to-year, including a phased-down cap after 2028. It also establishes default payment rules (tied to inflation or cross-walking to comparable tests) when no adequate data is available.
The bill primarily affects clinical laboratories that perform Medicare-covered diagnostic tests, private insurers whose claims data feeds into rate-setting, the nonprofit entity that would supply claims data, and ultimately Medicare beneficiaries, whose access to lab testing depends on stable and adequately funded payment rates. The Centers for Medicare & Medicaid Services (Secretary of Health and Human Services) would be responsible for implementing the new data collection and contracting requirements, including issuing new rules by the end of 2026.
The bill was introduced in the Senate on September 10, 2025, by Senator Thom Tillis, with Senator Warnock as a cosponsor, and referred to the Senate Committee on Finance. It has not yet been voted on; committee consideration, potential amendment, and votes in the Senate and House would be required before it could become law.
Plain-English summary generated by Bill100 AI from the official record. Always verify against the source below.
Official summary
This bill is in the first stage of the legislative process. It was introduced into Congress on September 10, 2025. It will typically be considered by committee next before it is possibly sent on to the House or Senate as a whole.
Common questions
- What does S. 2761 do?
- The RESULTS Act would amend how Medicare sets payment rates for clinical diagnostic laboratory tests under the Protecting Access to Medicare Act framework. Currently, independent laboratories must periodically report private-payor payment rate data to Medicare, which uses that data to set fee-schedule rates; this reporting has been infrequent and burdensome. The bill would change the timing and source of this data collection, most notably by requiring Medicare, for "widely available" non-advanced lab tests, to obtain private-payor rate and volume data from a qualifying independent nonprofit entity's large claims database, rather than relying solely on laboratory self-reporting. It sets detailed criteria for what counts as a qualifying database and entity, adjusts definitions of "applicable laboratory" and "final payment rate," updates data collection period timelines starting in 2027-2028, excludes certain Medicaid managed care rates from the data used, requires public explanation of payment rates, and revises limits on how much rates can drop year-to-year, including a phased-down cap after 2028. It also establishes default payment rules (tied to inflation or cross-walking to comparable tests) when no adequate data is available. The bill primarily affects clinical laboratories that perform Medicare-covered diagnostic tests, private insurers whose claims data feeds into rate-setting, the nonprofit entity that would supply claims data, and ultimately Medicare beneficiaries, whose access to lab testing depends on stable and adequately funded payment rates. The Centers for Medicare & Medicaid Services (Secretary of Health and Human Services) would be responsible for implementing the new data collection and contracting requirements, including issuing new rules by the end of 2026. The bill was introduced in the Senate on September 10, 2025, by Senator Thom Tillis, with Senator Warnock as a cosponsor, and referred to the Senate Committee on Finance. It has not yet been voted on; committee consideration, potential amendment, and votes in the Senate and House would be required before it could become law.
- Has S. 2761 become law?
- Not yet. As of 10 Sep 2025, S. 2761 is introduced.
- Who sponsored S. 2761?
- S. 2761 was sponsored by Sen. Thom Tillis [R-NC] (Republican-NC), with 13 cosponsors.
- What's the latest action on S. 2761?
- Introduced (10 Sep 2025).
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