RESULTS Act
Sponsored By: Senator Thomas Tillis
Introduced
Summary
Centers private-payor final payment data from a qualified independent claims database to set Medicare Part B rates for clinical diagnostic laboratory tests. This bill would create a contract-driven, auditable data system so payment rates reflect final private-payor payments and to improve the accuracy and transparency of rate-setting.
Show full summary
- Medicare beneficiaries and patients: Would aim to stabilize access to clinical diagnostic laboratory tests under Part B by basing rates on comprehensive final-payment data and making rate calculations more transparent.
- Clinical laboratories and test developers: Would change how rates are determined by defining a statutory “final payment rate,” requiring payor-level rates and volumes when available, and adding cross-walking, gap-filling, and a Consumer Price Index for All Urban Consumers (CPI-U) default when QCCD data are absent.
- Private payors, data organizations, and CMS: Would require the Secretary to contract with a Qualifying Independent Claims Data Entity and use a Qualifying Comprehensive Claims Database that holds at least 50 billion claims and covers more than 50 payors, and would require public, auditable explanations of payment rates while protecting privacy.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 0 benefits, 0 costs, 2 mixed.
Fallback Medicare lab payments using CPI
This bill would set a fallback when private-payor data are missing. For widely available tests, payment would equal last year's Medicare payment increased by the annual CPI-U change. The fallback starts for reporting periods that begin Jan 1, 2028 and lasts through the qualified rate period. For rare tests the Secretary would cross-walk to similar tests or gap-fill payments if no data exist. The bill also adjusts some percentage caps and review timing, including a 5% rule for 2029 and later.
New private-payor data for Medicare labs
This bill would require Medicare to use audited private-payor claims databases for many lab tests. The Secretary would have to pick and contract with a national nonprofit data entity soon after enactment. The database must have at least 50 billion claims and data from over 50 payors. Data collection rules would start for periods beginning Jan 1, 2027 and broaden on Jan 1, 2028. The Secretary would use the reported final payment rates in weighted-median calculations and publish explanations labs can review.
Sponsors & CoSponsors
Sponsor
Thomas Tillis
NC • R
Cosponsors
Raphael Warnock
GA • D
Sponsored 9/10/2025
Ted Budd
NC • R
Sponsored 12/10/2025
Peter Welch
VT • D
Sponsored 12/10/2025
Roger Marshall
KS • R
Sponsored 1/6/2026
Jim Banks
IN • R
Sponsored 1/15/2026
Alex Padilla
CA • D
Sponsored 1/15/2026
John Curtis
UT • R
Sponsored 2/11/2026
Jeanne Shaheen
NH • D
Sponsored 2/11/2026
Roll Call Votes
No roll call votes available for this bill.
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