Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025; RESULTS Act
Summary
The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025 (RESULTS Act) aims to amend Title XVIII of the Social Security Act. It seeks to improve the accuracy and feasibility of data collection for private payor-based fee schedule payment rates applied under the Medicare program for clinical diagnostic laboratory tests. The bill introduces changes to how data is acquired and used for determining Medicare payment rates for these tests, particularly focusing on widely available non-advanced diagnostic laboratory tests (non-ADLTs).
Expected Effects
The likely effect of this bill is a shift in how Medicare payment rates for clinical diagnostic laboratory tests are determined, with a greater emphasis on data collected from qualifying comprehensive claims databases. This could lead to more accurate and market-based payment rates. It also aims to provide long-term stability for Medicare beneficiary access to these tests.
Potential Benefits
- Improved accuracy of Medicare payment rates for clinical diagnostic laboratory tests.
- Enhanced data collection methods for determining payment rates.
- Long-term stability for Medicare beneficiary access to clinical diagnostic laboratory tests.
- Increased transparency in payment rate calculations.
- Potential for more market-based and updated payment rates.
Most Benefited Areas:
Potential Disadvantages
- Potential for increased administrative burden on laboratories and data entities.
- Possible challenges in establishing contracts with qualifying independent claims data entities.
- Risk of payment disruptions if data is unavailable or contracts are not in place.
- Complexity in implementing the new data collection and reporting requirements.
- Uncertainty regarding the actual impact on payment rates for specific tests.
Constitutional Alignment
The bill appears to align with the general welfare clause of the US Constitution, as it aims to improve the Medicare program and ensure access to clinical diagnostic laboratory tests for beneficiaries. Specifically, it falls under Congress's power to legislate on matters related to healthcare and social security, as outlined in Article I, Section 8, which grants Congress the power to collect taxes and provide for the general welfare of the United States. The amendments to Title XVIII of the Social Security Act are within the scope of Congress's authority to regulate and modify existing federal programs.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).