H.R. 5269: RESULTS Act
Sponsor
Richard Hudson
Republican · NC-9
Bill Progress
Latest Action · Sep 10, 2025
Referred to Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
Congress wants steadier Medicare lab test prices
Why it matters
A single pricing database in this bill would need at least 50,000,000,000 claims, and Medicare lab payment cuts would be capped at 5% starting in 2029. The pitch is simple: use broader private insurance data, avoid sharp reimbursement drops, and make routine lab testing more stable for Medicare patients.
H.R. 5269 changes the way Medicare collects pricing data for clinical laboratory tests under Part B. Starting with reporting periods on or after January 1, 2027, labs would report payment data for each test that received a final Medicare payment during the collection period.
The bigger shift starts with reporting periods on or after January 1, 2028. For common non-advanced lab tests, Medicare would stop leaning only on direct lab reporting and instead use a national private claims database run by an independent nonprofit contractor.
That database has to be huge. The bill says it must contain at least 50,000,000,000 claims from more than 50 private payors and claims administrators, represent all 50 states and D.C., and use validation and version control so Medicare is looking at final paid amounts.
The bill also builds in a backup plan. If HHS cannot get the contract in place quickly enough, or if the database has no usable data for a widely available test, Medicare would keep the prior year's payment rate and increase it by inflation using CPI-U.
For tests that are not considered widely available and still lack usable data, Medicare could price them by comparing them with an existing test or by using a gapfilling process. Beginning in 2029, payment reductions would be limited to 5% a year, which would reduce the chance of steeper annual cuts.
The bill also requires public explanations of payment rates and the data behind them, and it would reopen pricing decisions to more administrative and court review starting in 2029.
What does H.R. 5269 do?
Common lab tests move to a national claims database
For widely available non-advanced lab tests, Medicare would use data from a qualifying private claims database starting with reporting periods on or after January 1, 2028, instead of relying only on direct reporting from labs.
The database has to be nationwide and massive
The contractor's database must include at least 50,000,000,000 claims from more than 50 private payors and claims administrators, represent all 50 states and D.C., and include validation and version control for final payment amounts.
Routine tests get a clearer definition
A non-advanced lab test counts as widely available if more than 100 providers or suppliers were paid for it during the first 6 months of the previous year.
Missing data triggers an inflation-based fallback
If HHS cannot secure the claims-data contract quickly enough, or the database has no usable data for a widely available test, Medicare would pay the prior year's rate plus CPI-U inflation for that year.
Future payment cuts are limited to 5%
Starting in 2029, Medicare could not reduce payment rates for covered lab tests by more than 5% in a year.
Medicare has to show its work
The bill requires public explanations of payment rates and the supporting data used to set them, giving labs and outside reviewers more visibility into how prices are determined.
Who benefits from H.R. 5269?
Medicare patients who need routine lab work
If your care depends on common blood tests or diagnostic screening, the bill aims to make payment changes less abrupt so labs are less likely to face sudden reimbursement shocks.
Community and independent laboratories
These labs would get more protection against steep year-to-year Medicare cuts, with a 5% cap starting in 2029 and an inflation-based fallback when pricing data is missing.
A nonprofit with a national claims database
An independent nonprofit that already maintains a large private-payor claims database could win the federal contract if it meets the bill's certification, privacy, and data-quality standards.
Researchers, watchdogs, and providers tracking Medicare pricing
They would get more public detail on how Medicare set each payment rate and what data supported it.
Who is affected by H.R. 5269?
HHS and CMS
The agencies would have to write rules by December 31, 2026, certify a qualified nonprofit data entity, build a new collection process, and shift major parts of lab pricing to claims-based data in 2028.
Laboratories reporting payment data
Labs would still report under the old approach before 2027, then move to test-by-test reporting for Medicare-paid lab services starting with reporting periods on or after January 1, 2027.
Private payors and claims administrators
Their claims data becomes central to Medicare pricing because the new database must draw from more than 50 private payors and administrators across the country.
Tests without enough usable market data
If a test lacks enough claims data, its Medicare rate would be set through the bill's fallback paths instead of the main database-driven method.
What Congress Is Saying
H.R. 5269 hasn't been debated on the floor yet.
This section updates when a legislator speaks about it on the floor or in committee.
HR5269 Legislative Journey
House: Committee Action
Sep 10, 2025
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
About the Sponsor
Richard Hudson
Republican, North Carolina's 9th congressional district · 13 years in Congress
Committees: Energy and Commerce
View full profile →
Cosponsors (76)
This bill has 76 cosponsors: 40 Democrats, 36 Republicans, reflecting bipartisan support. Cosponsors represent 29 states: Alabama, Arizona, California, and 26 more.
Scott Peters
Democrat · CA
Gus Bilirakis
Republican · FL
Raja Krishnamoorthi
Democrat · IL
Brian Fitzpatrick
Republican · PA
Earl Carter
Republican · GA
John Joyce
Republican · PA
Juan Ciscomani
Republican · AZ
Donald Davis
Democrat · NC
Sharice Davids
Democrat · KS
Deborah Ross
Democrat · NC
Troy Balderson
Republican · OH
Terri Sewell
Democrat · AL
Committee Sponsors
Ways and Means Committee
18 of 45 committee members cosponsored
Energy and Commerce Committee
28 of 54 committee members cosponsored
29 Republicans across these committees haven't cosponsored yet. Mobilize their constituents
H.R. 5269 Quick Facts
- Committee
- Ways and Means
- Chamber
- House
- Policy
- Health
- Introduced
- Sep 10, 2025
Referred to Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
Sep 10, 2025
Official Sources
The official Congress.gov page tracks the bill’s text, sponsors, committees, and status.
This CMS page covers the Medicare Clinical Laboratory Fee Schedule that the bill would revise.
The bill amends section 1834A of the Social Security Act, codified at 42 U.S.C. 1395m-1, which governs Medicare lab test payment reporting and rates.
The bill explicitly references the regulatory definition of applicable laboratory in 42 CFR 414.502.
The bill uses CPI-U inflation as a fallback update when claims data is unavailable for certain tests.
This regulation subpart contains Medicare clinical laboratory fee schedule rules relevant to the reporting and payment changes in the bill.
H.R. 5269 Common Questions
What does H.R. 5269 do?
H.R. 5269 rewrites how Medicare sets payment rates for many clinical lab tests. It moves common tests toward a national private-claims database, adds fallback pricing rules, and caps annual cuts at 5% starting in 2029.
Has H.R. 5269 passed yet?
No. H.R. 5269 was introduced by Rep. Richard Hudson and referred to the House Energy and Commerce and Ways and Means committees. It has not moved beyond committee yet.
How much could Medicare lab payments be cut under H.R. 5269?
Beginning in 2029, H.R. 5269 would limit annual Medicare payment reductions for covered lab tests to 5%. That is meant to reduce sharper year-to-year reimbursement drops.
When would the new Medicare lab reporting rules start?
The bill sets reporting windows of January 1 through March 31, 2027, and January 1 through March 31, 2028. After that, the reporting cycle would shift from every 3 years to every 4 years.
What counts as a widely available lab test in H.R. 5269?
A non-advanced lab test would count as widely available if more than 100 providers or suppliers were paid for it during the first 6 months of the previous year.
How large does the new lab claims database have to be?
Very large. H.R. 5269 says the database must include at least 50,000,000,000 claims from more than 50 private payors and claims administrators, with representation from all 50 states and D.C.
What happens if Medicare cannot get enough claims data?
For a widely available test, Medicare would fall back to the prior year's payment rate plus CPI-U inflation if HHS cannot secure the contract or the database has no usable data.
Would H.R. 5269 make Medicare lab pricing more transparent?
Yes. The bill would require public explanations of the payment rates Medicare sets and the data used to support them.
Based on H.R. 5269 bill text
H.R. 5269 Bill Text
“To amend title XVIII of the Social Security Act to provide long-term stability for Medicare beneficiary access to clinical diagnostic laboratory tests by improving the accuracy of, and feasibility of data collection for, the private payor-based fee schedule payment rates applied under the Medicare program for such tests, and for other purposes.”
Source: U.S. Government Publishing Office
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