Stability for Medicare laboratories and beneficiaries?

Awaiting Vote
Bill Summary

The “Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act,” or RESULTS Act, seeks to amend title XVIII of the Social Security Act for the purpose of providing long-term stability for Medicare beneficiaries’ access to clinical diagnostic laboratory tests. To do this, the bill would improve the accuracy and feasibility of data collection for these tests and other purposes, strengthening reimbursement rates under Medicare’s private payor-based fee schedule. In addition, this bill would ensure a reduced administrative burden on labs, establish guardrails to avoid destabilizing cuts, and provide timeline updates for patients, providers, and payers. Sponsor: Rep. Richard Hudson (Republican, North Carolina, District 9)
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Opponents say

•      At the time of research and publication, no official opposing statements have been identified.  This does not mean that nobody opposes the bill, nor does it mean that opposing statements will not be made in the future.


Proponents say

•      "As organizations representing laboratories, physicians, hospitals and health systems, health care providers, laboratory professionals, and diagnostic manufacturers, we respectfully urge Congress to protect patient access to clinical laboratory services by enacting needed reforms to the Medicare Clinical Laboratory Fee Schedule (CLFS). The CLFS represents less than one percent of total Medicare spending, while clinical laboratory services inform 70 percent of clinical decision making. Timely access to innovative clinical laboratory tests is critical to the prevention, early detection, therapy selection, and effective management of chronic and life- threatening diseases. CLFS reform can be achieved through the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act (S. 2761 / H.R. 5269), bipartisan, bicameral legislation that would: 1) ensure the CLFS rate-setting process is based on up-to-date, comprehensive commercial market data representative of independent, hospital outreach, and physician office labs (POLs); 2) reduce the administrative data collection and reporting burden on clinical laboratories and reduce the administrative burden on the Centers for Medicare & Medicaid Services (CMS); and 3) promote diagnostic innovation by providing stability in Medicare payment. Importantly, action by Congress on the RESULTS Act would prevent deep pending payment cuts for clinical laboratory services." Source: American Clinical Laboratory Association (ACLA) and 30+ Leading Provider Organizations


•      "The RESULTS Act is a critical piece of legislation for millions of patients who rely on laboratory testing to make sound medical decisions. Ensuring facilities remain accessible to patients is key to getting services into the hands of those who need it. The current, flawed system, if not fixed, will place a huge burden on labs and could force many of them to close their doors. Additionally, if Congress does not act, more than 800 laboratory tests will be subject to payment cuts of up to 15 percent on January 1, 2026. This not only hurts patients, but it also stifles innovation as our member companies work on the next generation of laboratory tests. We look forward to working with Congress to get this bipartisan legislation over the finish line this year." Source: Scott Whitaker, President and CEO of AdvaMed, and Zach Rothstein, Executive Director of AdvaMedDx


•      "ASCP has joined with a coalition of 13 other pathology and laboratory medicine organizations in support of The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act (The RESULTS Act; S. 2761 / H.R. 5269), a bipartisan, bicameral bill to reform the Medicare Clinical Laboratory Fee Schedule. In 2014, Congress passed The Protecting Access to Medicare Act (PAMA), which established a single national fee schedule that was intended to reflect market rates from all types of laboratories serving Medicare beneficiaries. Unfortunately, the system adopted by the Centers for Medicare & Medicaid Services (CMS) underrepresented market rates due to CMS’s narrowly crafted methodology that over-relied on data from large independent laboratories. Using data from less than 1 percent of clinical laboratories, CMS developed payment rates that cut nearly $4 billion from the CLFS in the first three years.  The RESULTS Act would modify PAMA by using a third-party medical claims collector to handle data collection and reporting requirements. Among the benefits of the RESULTS Act are that it would: provide long-term stability to the Medicare CLFS and for clinical laboratories, improve the accuracy of private payor-based Medicare CLFS rates, prevent a fourth round of deep cuts to Medicare rates, and dramatically reduce PAMA data reporting requirements on laboratories." Source: American Society for Clinical Pathology (ASCP)