‘‘(v) provides for version control of 
claims to enable the collation and submis-
sion, for purposes of this section, of only 
claims representative of final payment 
amounts; and 
‘‘(vi) includes claims data with respect 
to widely available non-ADLT clinical diag-
nostic laboratory tests. 
‘‘(E) WIDELY AVAILABLE NON-ADLT CLIN-
ICAL
DIAGNOSTIC
LABORATORY
TEST.—The 
term ‘widely available non-ADLT clinical diag-
nostic laboratory test’ means, with respect to a 
reporting period, a clinical diagnostic laboratory 
test that is not an advanced diagnostic labora-
tory test and for which, during the first 6 
months of the year immediately preceding the 
data collection period for such reporting period, 
the number of providers of services and sup-
pliers receiving payments under this section (as 
determined by the Secretary using the national 
provider identifier of the provider of services or 
supplier on the claim submitted for payment 
under this part for such test) exceeds 100.’’; 
(3) in paragraph (5)— 
(A) by inserting ‘‘final’’ after ‘‘The’’; and 
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(B) by inserting ‘‘or from a qualifying 
comprehensive claims database pursuant to 
paragraph (1)(A)(ii)’’ after ‘‘reported by a lab-
oratory under this subsection’’; 
(4) in paragraph (6)— 
(A) by inserting ‘‘(or, with respect to a 
widely available non-ADLT clinical diagnostic 
laboratory test, the qualifying comprehensive 
claims database of the qualifying independent 
claims data entity with a contract under para-
graph (1)(A)(ii))’’ after ‘‘In the case where an 
applicable laboratory’’; 
(B) by striking ‘‘payment rate’’ each place 
it appears and inserting ‘‘final payment rate’’; 
(C) by inserting ‘‘(and such different pay-
ment rates do not relate to the same claim)’’ 
after ‘‘for the same payor for the same test’’; 
and 
(D) by inserting ‘‘or qualifying inde-
pendent claims data entity, as applicable,’’ after 
‘‘the applicable laboratory’’; 
(5) in paragraph (9)(A), by inserting ‘‘required 
to be reported by such laboratory’’ after ‘‘in report-
ing information’’; 
(6) in paragraph (10)— 
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(A) by striking ‘‘by a laboratory’’ after 
‘‘information disclosed’’; and 
(B) by inserting ‘‘by a laboratory or the 
qualifying independent claims data entity with a 
contract under paragraph (1)(A)(ii)’’ after 
‘‘under this subsection’’; and 
(7) in paragraph (12)— 
(A) by striking ‘‘REGULATIONS.—Not later 
than June 30, 2015,’’ and inserting ‘‘REGULA-
TIONS.— 
‘‘(A) FOR DATA COLLECTION PERIODS BE-
FORE 2027.—Not later than June 30, 2015, for 
data collection periods beginning before Janu-
ary 1, 2027,’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(B) FOR DATA COLLECTION PERIODS BE-
GINNING WITH 2027.—Not later than December 
31, 2026, the Secretary shall establish through 
notice and comment rulemaking parameters for 
data collection periods beginning on or after 
January 1, 2027.’’. 
(b) INCORPORATING DATA COLLECTION IMPROVE-
MENTS INTO PRIVATE PAYOR-BASED MEDICARE PAY-
MENT RATES FOR CLINICAL DIAGNOSTIC LABORATORY 
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TESTS THAT ARE NOT ADVANCED DIAGNOSTIC LABORA-
TORY TESTS.— 
(1) CALCULATION OF WEIGHTED MEDIAN OF 
PRIVATE
PAYOR-BASED
RATES.—Section 
1834A(b)(2) of the Social Security Act (42 U.S.C. 
1395m–1(b)(2)) is amended— 
(A) by inserting ‘‘and, in the case of widely 
available non-ADLT clinical diagnostic labora-
tory tests, with respect to data collection peri-
ods for reporting periods beginning on or after 
January 1, 2028, for each such test furnished 
by an applicable laboratory with respect to 
which there is applicable information made 
available to the Secretary pursuant to para-
graph (1)(A)(ii)) of such subsection’’ after 
‘‘under subsection (a) for a data collection pe-
riod’’; and 
(B) by inserting ‘‘final’’ before ‘‘payment 
rates reported’’. 
(2) DEFAULT ADJUSTMENT IN CASES OF WIDE-
LY
AVAILABLE
NON-ADLT
CLINICAL
DIAGNOSTIC 
LABORATORY
TESTS
FOR
PERIODS
FOR
WHICH 
THERE IS NO CONTRACT WITH A QUALIFYING INDE-
PENDENT CLAIMS ENTITY OR NO APPLICABLE IN-
FORMATION
IN
THE
QUALIFYING
COMPREHENSIVE 
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CLAIMS DATABASE.—Section 1834A(b) of the Social 
Security Act (42 U.S.C. 1395m–1(b)) is amended— 
(A) in paragraph (1)(A), by striking 
‘‘paragraph (3)’’ and inserting ‘‘paragraphs (3) 
and (6)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(6) DEFAULT PAYMENT FOR WIDELY AVAIL-
ABLE NON-ADLT CLINICAL DIAGNOSTIC LABORATORY 
TESTS FOR PERIODS FOR WHICH THERE IS NO CON-
TRACT WITH AN INDEPENDENT ENTITY OR WITH 
RESPECT TO WHICH THERE IS NO DATA.— 
‘‘(A) IN GENERAL.—With respect to data 
collection periods for reporting periods begin-
ning on or after January 1, 2028, in the case 
of a widely available non-ADLT clinical diag-
nostic laboratory test with respect to which sub-
section (c) does not apply, if a circumstance de-
scribed in subparagraph (B) applies with re-
spect to such a reporting period and such a 
clinical diagnostic laboratory test, payment for 
such test under this section for a year begin-
ning during the qualified rate period described 
in subparagraph (C), shall be equal to the 
amount of payment for such clinical diagnostic 
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laboratory test under this section for the pre-
vious year, increased by the percentage increase 
in the Consumer Price Index for all urban con-
sumers (all items; United States city average) 
over the previous year. 
‘‘(B) CIRCUMSTANCES
DESCRIBED.—For 
purposes of subparagraph (A), with respect to 
a data collection period and a widely available 
non-ADLT clinical diagnostic laboratory test, 
the circumstances described in this subpara-
graph are if the Secretary— 
‘‘(i) is not able to enter into a con-
tract under subsection (a)(1)(A)(ii) with a 
qualifying independent claims data entity 
with respect to such data collection period; 
or 
‘‘(ii) determines that there is no appli-
cable information with respect to such clin-
ical diagnostic laboratory test and data col-
lection period in the qualifying comprehen-
sive claims database of such qualifying 
independent claims data entity. 
‘‘(C) 
QUALIFIED
RATE
PERIOD
DE-
SCRIBED.—For purposes of subparagraph (A), 
the qualified rate period, with respect to a data 
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collection period and a widely available non- 
ADLT clinical diagnostic test to which a cir-
cumstance described in subparagraph (B) ap-
plies, is the period— 
‘‘(i) beginning on the first day of the 
second year following the first data collec-
tion period with respect to which such cir-
cumstance applies with respect to such 
test; and 
‘‘(ii) ending with the last day of the 
year following the first data collection pe-
riod with respect to which such cir-
cumstance no longer applies with respect 
to such test.’’. 
(3) PAYMENT IN CASES IN WHICH THERE IS NO 
REPORTED
APPLICABLE
INFORMATION
FOR
NON- 
WIDELY AVAILABLE NON-ADLTS.—Section 1834A of 
the Social Security Act (42 U.S.C. 1395m–1), is 
amended— 
(A) in subsection (b), as amended by para-
graph (2)— 
(i) in paragraph (1)(A), by striking 
‘‘paragraphs (3) and (6)’’ and inserting 
‘‘paragraphs (3), (6), and (7)’’; and 
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(ii) by adding at the end the following 
new paragraph: 
‘‘(7) PAYMENT
FOR
NON-WIDELY
AVAILABLE 
NON-ADLT
CLINICAL
DIAGNOSTIC
LABORATORY 
TESTS FOR WHICH THERE IS NO APPLICABLE IN-
FORMATION.— 
‘‘(A) IN GENERAL.—For determining pay-
ment under this subsection for a year in the 
case of a non-widely available non-ADLT clin-
ical diagnostic laboratory test with respect to 
which subsection (c) does not apply, if the Sec-
retary determines that no applicable informa-
tion has been reported under subsection 
(a)(1)(A)(i) by any applicable laboratory for 
such test with respect to the most recent data 
collection period (beginning with data collection 
periods for reporting periods beginning on or 
after January 1, 2028), payment for such test 
under this section for such year shall be deter-
mined as follows: 
‘‘(i) In the case that a process de-
scribed in subparagraph (B) was not ap-
plied pursuant to this subparagraph for de-
termining payment for such test for a pre-
vious year with respect to such data collec-
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tion period, payment for such test and year 
shall be determined using such a process. 
‘‘(ii) In the case that a process de-
scribed in subparagraph (B) was applied 
pursuant to this subparagraph for deter-
mining payment for such test for a pre-
vious year with respect to such data collec-
tion period, payment for such test and year 
shall be equal to the amount of payment 
for such test under this section for the pre-
vious year. 
‘‘(B) PROCESS DESCRIBED.—For purposes 
of subparagraph (A), a process described in this 
subparagraph, with respect to a non-widely 
available non-ADLT clinical diagnostic labora-
tory test for which there is no reported data (as 
described in such subparagraph) with respect to 
a data collection period, is— 
‘‘(i) cross-walking (as described in 
section 414.508(a) of title 42, Code of 
Federal Regulations, or any successor reg-
ulation) to the most appropriate clinical di-
agnostic laboratory test under the fee 
schedule under this section during that pe-
riod; or 
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‘‘(ii) if no other clinical diagnostic lab-
oratory test is comparable to the test for 
which there is no reported applicable infor-
mation, according to the gapfilling process 
described in subsection (c)(2).’’; and 
(B) in subsection (c)(3), by inserting ‘‘or 
subsection (b)(7)’’ after ‘‘under this sub-
section’’. 
(4) PUBLICLY
AVAILABLE
EXPLANATION
OF 
PAYMENT RATES.—Section 1834A(b) of the Social 
Security Act (42 U.S.C. 1395m–1(b)), as amended 
by paragraphs (2) and (3)(A), is amended by adding 
at the end the following new paragraph: 
‘‘(8) EXPLANATION
OF
PAYMENT
RATES.—In 
the case of a clinical diagnostic laboratory test for 
which payment is made under this subsection, the 
Secretary shall make available to the public an ex-
planation of the payment rate for such test, includ-
ing any supporting data as may be necessary for a 
laboratory to assess the accuracy of the calcula-
tions.’’. 
(5) TECHNICAL CORRECTION CLARIFYING PE-
RIOD OF APPLICATION OF MARKET RATES.—Section 
1834A(b)(4)(A) of the Social Security Act (42 
U.S.C. 1395m–1(b)(4)(A)) is amended by striking 
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‘‘until the year following’’ and inserting ‘‘through 
the year following’’. 
(c) ADDITIONAL IMPROVEMENTS TO ENSURE UP-
DATED, ACCURATE MARKET-BASED DATA FOR CLINICAL 
DIAGNOSTIC LABORATORY TESTS.— 
(1) UPDATES TO APPLICABLE INFORMATION TO 
BETTER REFLECT FINAL PAYMENT RATES.—Section 
1834A(a)(3) of the Social Security Act (42 U.S.C. 
1395m–1(a)(3)) is amended— 
(A) in the heading, by inserting ‘‘AND 
FINAL PAYMENT RATE’’ after ‘‘INFORMATION’’; 
(B) in subparagraph (A)— 
(i) in the heading, by striking ‘‘IN 
GENERAL’’ and inserting ‘‘DATA COLLEC-
TION PERIODS BEFORE JANUARY 1, 2027’’; 
and 
(ii) in the matter preceding clause 
(i)— 
(I) by striking ‘‘subparagraph 
(B)’’ and inserting ‘‘subparagraph 
(C)’’; and 
(II) by inserting ‘‘beginning be-
fore January 1, 2027’’ after ‘‘for a 
data collection period’’; 
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(C) by redesignating subparagraph (B) as 
subparagraph (C); 
(D) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) SUBSEQUENT DATA COLLECTION PE-
RIODS.—In this section, subject to subpara-
graph (C), for a data collection period begin-
ning on or after January 1, 2027, the term ‘ap-
plicable information’ means— 
‘‘(i) with respect to a widely available 
non-ADLT clinical diagnostic laboratory 
test furnished during such period— 
‘‘(I) the final payment rate (as 
determined in accordance with para-
graph (5) and defined in subpara-
graph (D)) that was paid by each pri-
vate payor for the test during the year 
in which such period occurs; and 
‘‘(II) the volume, for each such 
payor, of such test for which final 
payment was made during such year; 
and 
‘‘(ii) with respect to a non-widely 
available non-ADLT clinical diagnostic lab-
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oratory test or an advanced diagnostic lab-
oratory test— 
‘‘(I) the final payment rate (as 
determined in accordance with para-
graph (5) and defined in subpara-
graph (D)) that was paid by each pri-
vate payor for the test during the 
data collection period; and 
‘‘(II) the volume, for each such 
payor, of such test for which final 
payment was made during such pe-
riod.’’; and 
(E) by inserting after subparagraph (C), 
the following new subparagraph: 
‘‘(D) FINAL PAYMENT RATE.—In this sec-
tion, for a data collection period beginning on 
or after January 1, 2027, the term ‘final pay-
ment rate’— 
‘‘(i) means— 
‘‘(I) with respect to a widely 
available non-ADLT clinical diag-
nostic laboratory test furnished during 
a data collection period, the last pay-
ment made for a test during the year 
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in which the data collection period oc-
curs; and 
‘‘(II) with respect to a non-widely 
available non-ADLT clinical diag-
nostic laboratory test or an advanced 
diagnostic laboratory test paid during 
a data collection period, the last pay-
ment made during the data collection 
period; and 
‘‘(ii) does not include— 
‘‘(I) denied payments; 
‘‘(II) payments under appeal or 
under review by the private payor; 
‘‘(III) payments made in error; 
or 
‘‘(IV) payments that are re-
couped by the private payor.’’. 
(2) UPDATING DATA COLLECTION PERIODS.— 
Section 1834A(a)(4)(B) of the Social Security Act 
(42 U.S.C. 1395m–1(a)(4)(B)) is amended— 
(A) by striking ‘‘January 1, 2019’’ and in-
serting ‘‘January 1, 2027’’; 
(B) by striking ‘‘June 30, 2019’’ and in-
serting ‘‘June 30, 2027’’; and 
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(C) by adding at the end the following new 
sentence: ‘‘In the case of the reporting period 
after the reporting period described in para-
graph (1)(B)(ii) and each subsequent reporting 
period with respect to clinical diagnostic labora-
tory tests that are not advanced diagnostic lab-
oratory tests, the term ‘data collection period’ 
means the 6-month period beginning January 
1st of the year preceding the year during which 
such reporting period begins.’’. 
(3) ENSURING DATA IS MARKET-BASED BY EX-
CLUDING RATES OF MEDICAID MANAGED CARE OR-
GANIZATIONS.—Section 1834A(a)(8)(C) of the So-
cial Security Act (42 U.S.C. 1395m–1(a)(8)(C)) is 
amended by striking ‘‘A medicaid managed care or-
ganization’’ and inserting ‘‘With respect to data col-
lection periods for reporting periods beginning before 
January 1, 2028, a medicaid managed care organi-
zation.’’. 
(4) MODIFICATIONS
TO
LIMITS
ON
PAYMENT 
REDUCTIONS.—Section 1834A(b)(3) of the Social 
Security Act (42 U.S.C. 1395m–1(b)(3)) is amend-
ed— 
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(A) in subparagraph (A), by striking ‘‘each 
of 2017 through 2028’’ and inserting ‘‘2017 
and each subsequent year’’; 
(B) in subparagraph (B)— 
(i) in clause (ii), by striking ‘‘2025’’ 
and inserting ‘‘2028’’; and 
(ii) in clause (iii), by striking ‘‘for 
each of 2026 through 2028, 15 percent’’ 
and inserting ‘‘for 2029 and each subse-
quent year, 5 percent’’; and 
(C) in subparagraph (C)(ii), by inserting 
‘‘laboratory’’ after ‘‘advanced diagnostic’’. 
(5) SUNSETTING
REVIEW
LIMITATIONS.—Sec-
tion 1834A(h)(1) of the Social Security Act (42 
U.S.C. 1395m–1(h)(1)) is amended by inserting 
‘‘before January 1, 2029’’ before the period at the 
end. 
Æ 
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