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 moves to cap Medicare's cuts to lab payments
Why it matters
Medicare's cap on annual lab-payment cuts — 15% a year — is set to expire after 2028, which would leave the rates labs depend on with no statutory floor. H.R. 5269 would make the cap permanent and tighten it to 5% starting in 2029, and rebuild how Medicare sets those rates using a private-claims database the bill says must hold at least 50 billion claims. It has drawn 76 bipartisan cosponsors and sits in the House Energy and Commerce and Ways and Means committees.
Medicare prices most clinical lab tests using a system built in 2014: labs report what private insurers pay them, and Medicare averages that into its own rate. The bill's sponsors argue the reporting has skewed toward large national labs, producing rates that don't reflect the broader market. H.R. 5269, the RESULTS Act, rebuilds the data source.
Starting with reporting periods on or after January 1, 2028, Medicare would stop relying on lab self-reporting for common tests and instead pull pricing from a national private-claims database run by an independent nonprofit. A test counts as "widely available" — and moves to the database — if more than 100 providers or suppliers were paid for it in the first half of the prior year.
The database has to be enormous. The bill requires at least 50 billion claims from more than 50 private payors and claims administrators, coverage of all 50 states and D.C., version control so only final paid amounts are used, and validation by an entity with no ties to government, insurers, or providers.
Before that, a transition: for reporting periods on or after January 1, 2027, labs would report payment for each test that received a final Medicare payment, and the reporting cycle stretches from every 3 years to every 4. HHS has until December 31, 2026, to write the rules.
There's a backstop. If HHS can't get the contract in place or the database has no usable data for a widely available test, Medicare would hold the prior year's rate and bump it by CPI-U inflation instead of cutting. Tests that aren't widely available and lack data get priced by comparison to a similar test or through a gapfilling process.
The bill also makes Medicare's cut limit permanent. Current law caps annual reductions at 15% through 2028 and then lets the limit lapse; H.R. 5269 replaces that with a 5% cap for 2029 and every year after. It adds public explanations of each rate and the data behind it, and reopens pricing decisions to administrative and court review for determinations on or after January 1, 2029.
H.R. 5269 Bill Summary
What H.R. 5269 actually does.
Routine lab tests get priced from a 50-billion-claim database
For widely available non-advanced tests, Medicare would set rates from a qualifying private-claims database starting with reporting periods on or after January 1, 2028, instead of relying only on labs reporting their own payments.
Medicare's cut limit becomes permanent at 5%
Current law caps annual payment reductions at 15% through 2028 and then ends the limit. The bill replaces that with a 5% cap for 2029 and every subsequent year.
A clear line for which tests count as "widely available"
A non-advanced lab test qualifies if more than 100 providers or suppliers were paid for it during the first 6 months of the year before the data collection period.
Missing data triggers an inflation bump, not a cut
If HHS can't secure the claims-data contract or the database lacks usable data for a widely available test, Medicare pays the prior year's rate increased by CPI-U inflation.
Medicare has to publish how it set each rate
The Secretary must release a public explanation of each payment rate, including the supporting data a lab would need to check the math.
Pricing decisions can be challenged again
The bill ends the bar on administrative and judicial review of these payment determinations for decisions made on or after January 1, 2029.
Who benefits from H.R. 5269?
Community, rural, and independent labs
These labs carry the most exposure if the 15% cut cap lapses after 2028. A permanent 5% cap and an inflation-based fallback give them a predictable floor instead of open-ended reductions.
Medicare patients who rely on routine bloodwork
When payment cuts push a local lab to stop offering a test, patients are the ones who lose access — most acutely in rural areas where there may be only one lab within reach.
The independent nonprofit that qualifies
An organization that already runs a large, validated private-payor claims database — and that has no ties to government, insurers, or providers — could win the federal data contract.
Researchers and labs auditing Medicare's math
Public rate explanations plus restored court review give outside parties a way to see, and contest, how each price was calculated starting in 2029.
Who is affected by H.R. 5269?
HHS and CMS
The agencies must write rules by December 31, 2026, certify a qualifying nonprofit, stand up a new data-collection process, and shift major lab tests onto claims-based pricing in 2028.
Labs that report payment data
Labs keep reporting under the current method through 2026, move to test-by-test reporting in 2027, then hand widely available tests over to the database in 2028.
Large national labs
The bill's sponsors argue the current system over-weights big labs' reported rates. Sourcing prices from a broad claims database instead changes whose payments drive Medicare's rates.
Private payors and claims administrators
Their claims data becomes the backbone of Medicare lab pricing, since the database must draw from more than 50 payors and administrators across every state.
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, 76 cosponsors, committees, and status.
The entire bill amends section 1834A of the Social Security Act, codified at 42 U.S.C. 1395m-1, which governs Medicare clinical lab test payment reporting and rates.
CMS's page for the Medicare Clinical Laboratory Fee Schedule, the payment system the bill would revise.
The CMS resource for the private payor rate data reporting and timeline that the bill restructures by sourcing prices from a national claims database.
CMS fact sheet on the rule that established the private payor-based payment methodology under section 1834A that this bill amends.
The bill requires the claims-data nonprofit to be a certified qualified entity under section 1874(e); this CMS page describes that program.
The bill explicitly ties the post-2028 meaning of "applicable laboratory" to the definition in 42 CFR 414.502 as in effect on May 1, 2025.
H.R. 5269 Common Questions
What does H.R. 5269 do?
It changes how Medicare prices clinical lab tests. Common tests would be priced from a national private-claims database, a 5% cap on annual cuts becomes permanent in 2029, and an inflation-based rate kicks in when data is missing.
Has H.R. 5269 passed?
No. Rep. Richard Hudson introduced it and it was referred to the House Energy and Commerce and Ways and Means committees. With 76 bipartisan cosponsors it has broad support, but it hasn't moved out of committee.
Does H.R. 5269 stop Medicare from cutting lab payments?
It doesn't end cuts, it caps them. Today's 15% annual limit expires after 2028; the bill makes a limit permanent and lowers it to 5% a year starting in 2029, so rates can still fall, just not sharply.
When would the new Medicare lab rules take effect?
HHS must write rules by December 31, 2026. Test-by-test reporting starts with reporting periods on or after January 1, 2027, and the shift to the claims database starts on or after January 1, 2028. The reporting cycle moves from every 3 years to every 4.
What is a "widely available" lab test under H.R. 5269?
A non-advanced test that more than 100 providers or suppliers were paid for during the first 6 months of the year before the data collection period. Those tests get priced from the claims database; others use fallback methods.
Why does the database need 50 billion claims?
The bill requires at least 50 billion claims from more than 50 private payors, covering all 50 states and D.C. Sponsors say a database that large is needed for rates to reflect the national market rather than a narrow slice of labs.
What happens if the claims data isn't available?
For a widely available test, Medicare would hold the prior year's payment rate and increase it by CPI-U inflation if HHS can't secure the contract or the database has no usable data for that test.
Why is Congress changing how Medicare prices lab tests?
The bill's sponsors argue the 2014 reporting system skewed toward large national labs and produced rates that don't match the broader market, leading to cuts that hit smaller and rural labs hardest. H.R. 5269 is their fix.
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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