This bill, called the RESULTS Act, changes how Medicare pays for lab tests by improving the data used to set those payment rates. Right now, Medicare relies on labs to report what private insurance companies paid them for various tests, and Medicare uses that information to set its own payment amounts. The problem is this data can be incomplete or inaccurate, especially for less common tests.

Starting in 2028, the bill creates a new system where Medicare will get lab test pricing data directly from a large independent nonprofit database that collects claims information from private insurance companies. This database will need to have at least 50 billion claims from over 50 different insurers to be considered reliable. For common lab tests that are widely available, Medicare will use this comprehensive database instead of relying solely on what individual labs report. For rare or specialized tests, Medicare will still use the old reporting system, but with better backup plans if data isn't available.

The bill also extends the timeline for these changes and creates safeguards so that if Medicare can't get good data for a particular test, payment rates won't drop dramatically—they'll just increase by the inflation rate instead. Additionally, Medicare must now publicly explain how it calculated payment rates for lab tests so that labs can verify the numbers are correct. Overall, this is meant to make Medicare's lab test payments more stable and accurate by using better data sources, which should help ensure labs can continue offering these tests to Medicare patients.