H.R. 5269 — RESULTS Act

This section revises data reporting requirements for the Medicare clinical diagnostic laboratory test (CDLT) payment system under SSA §1834A, which bases payment rates on median private payer rates reported by applicable laboratories (generally those with >$50,000 in annual Medicare CDLT revenue). (1) Requires applicable laboratories to report applicable information on a per-test basis (instead of aggregate) for data collection periods beginning on or after January 1, 2027; (2) extends the initial data collection period through 2027 (from 2025), the subsequent data collection period to January 1–March 31, 2028 (from 2026), and the associated non-enforcement period to four years (from three years); (3) for reporting periods beginning on or after January 1, 2028, directs the Secretary to contract with a qualifying independent claims data entity (i.e., a certified national nonprofit maintaining a qualifying comprehensive claims database with at least 50 billion private payer claims, compliant with privacy laws and quality standards) to collect applicable information on widely available non-advanced diagnostic laboratory tests (non-ADLTs), rather than from applicable laboratories; and (4) redefines "applicable laboratory" for such periods as any laboratory billing Medicare Part B for CDLTs (per 42 CFR 414.502 as of May 1, 2025, excluding paragraph (3)).