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To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program.
Introduced Jul 15, 2026 · Last action Jul 15, 2026 — 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.
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Summary
This legislation is called the To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program. It is being reviewed by a committee.
Full bill text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9693 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 9693
To amend title XVIII of the Social Security Act to modify certain
physician payments under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 15, 2026
Mr. Joyce of Pennsylvania (for himself, Ms. Schrier, Mr. Murphy, Mr.
Bera, Mr. Dunn of Florida, Mr. Conaway, Mr. Harris of Maryland, Ms.
Morrison, Mrs. Miller-Meeks, Ms. Dexter, Mrs. Harshbarger, Mr. Veasey,
Mr. Carter of Georgia, Ms. Sewell, Mr. Onder, Ms. DelBene, Mr. Babin,
Mr. Panetta, Mr. McCormick, Mr. Suozzi, Mrs. Biggs of South Carolina,
Mrs. Fletcher, Mr. Bilirakis, Mrs. Trahan, Mrs. Miller of West
Virginia, Mr. LaHood, Ms. Kelly of Illinois, and Mr. Van Drew)
introduced the following bill; which was 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
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to modify certain
physician payments under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patients First Act of 2026''.
TITLE I--STRENGTHENING REIMBURSEMENT AND PATIENT ACCESS
SEC. 101. MODIFYING THE CONVERSION FACTOR UPDATES APPLICABLE TO
PHYSICIANS' SERVICES UNDER THE MEDICARE PROGRAM.
(a) In General.--Section 1848(d) of the Social Security Act (42
U.S.C. 1395w-4(d)) is amended--
(1) in paragraph (1)(A), in the second sentence, by
inserting ``or (21)'' after ``paragraph (20)'';
(2) in paragraph (20)--
(A) in the header, by striking ``and subsequent
years''; and
(B) by striking ``and each subsequent year''; and
(3) by adding at the end the following new paragraph:
``(21) Update for 2027 and subsequent years.--
``(A) In general.--For 2027 and each subsequent
year, the update to the nonqualifying APM conversion
factor established under paragraph (1)(A) is, subject
to subparagraph (B), the Secretary's estimate of the
percentage increase in the MEI (as defined in section
1842(i)(3)) for the year, less 1 percentage point, and
the update to the qualifying APM conversion factor
established under such paragraph is the update to the
nonqualifying APM conversion factor for the year,
increased by 0.5 percentage point.
``(B) Floor and ceiling on nonqualifying apm
conversion factor update.--In the case that the update
to the nonqualifying APM conversion factor for a year
as calculated under subparagraph (A) is--
``(i) less than 25 percent of the
Secretary's estimate of the percentage increase
in the MEI (as defined in section 1842(i)(3))
for the year, such update shall be deemed to be
equal to 25 percent of such estimate; or
``(ii) more than 75 percent of such
estimate, such update shall be deemed to be
equal to 75 percent of such estimate.''.
(b) Reports.--The Secretary of Health and Human Services shall, for
2027 and each year thereafter, submit to Congress a report on the
updates to the qualifying APM conversion factor and nonqualifying APM
conversion factor under section 1848(d) of the Social Security Act (42
U.S.C. 1395w-4(d)) for such year. Such report shall include an analysis
of the impact of such updates on Medicare beneficiaries' access to
services under the Medicare program and on the consolidation of
physician practices.
SEC. 102. HYBRID PAYMENT MODEL FOR PRIMARY CARE SERVICES.
Part E of title XVIII of the Social Security Act (42 U.S.C. 1395x
et seq.) is amended by inserting after section 1866G the following new
section:
``SEC. 1866H. HYBRID PAYMENT MODEL FOR PRIMARY CARE SERVICES.
``(a) In General.--The Secretary shall, for 2027 and each
subsequent year through 2031, carry out a hybrid payment model for
primary care services (in this section referred to as the `model')
under which the Secretary shall make a monthly payment to each
qualifying supplier for each individual attributed to such practice for
such year in lieu of payment for any designated primary care services
furnished by such supplier to such individuals during such year that
would otherwise be made under the payment schedule established under
section 1848 (or on the basis of such schedule).
``(b) Payment Amount.--
``(1) In general.--The monthly amount payable to a
qualifying supplier for a year under the model is equal to one-
twelfth of the national average amount that the Secretary
estimates will be payable under the payment basis established
under section 1848 for designated primary care services
furnished during such year (so estimated as if no cost sharing
requirements applied to individuals enrolled under part B),
adjusted by a geographic index determined appropriate by the
Secretary and risk adjusted in a manner determined appropriate
by the Secretary.
``(2) Nonapplication of cost sharing.--No cost sharing
requirement shall apply with respect to a monthly payment made
under the model to a qualifying supplier for an individual
attributed to such supplier.
``(c) Attribution Process.--
``(1) In general.--The Secretary shall establish a process
under which, for each year of the model, individuals enrolled
under part B who are not enrolled under an MA plan under part C
may designate a qualifying supplier as such individual's
primary care provider for such year.
``(2) Attribution based on prior claims.--In the case of an
individual described in paragraph (1) who fails to make a
designation for a year but for whom the Secretary determines,
based on claims history of items and services furnished under
this title, that such individual has a primary care provider
who is a qualifying supplier, the Secretary may designate such
supplier as such individual's primary care provider for such
year.
``(3) Treated as attributed.--For purposes of this section,
each individual who makes a designation under paragraph (1) (or
for whom such a designation is made under paragraph (2)) with
respect to a qualifying supplier for a year shall be treated as
attributed to such supplier for such year.
``(d) No Effect on PFS Budget Neutrality.--Section 1848(c)(2)(B)
shall be applied for 2027 and each subsequent year as if the model had
never applied.
``(e) Funding.--Payments under the model shall be made from the
Federal Supplementary Medical Insurance Trust Fund established under
section 1841.
``(f) Definitions.--In this section:
``(1) Designated health care practitioner.--The term
`designated health care practitioner' means a physician
assistant, a nurse practitioner, a clinical nurse specialist, a
physical therapist, an occupational therapist, or such other
health care practitioner as the Secretary may specify.
``(2) Designated primary care services.--The term
`designated primary care services' means--
``(A) care management services;
``(B) behavioral health integration services;
``(C) office-based evaluation and management
services (whether furnished in person or via
telehealth); and
``(D) communications such as telephone calls,
emails and patient portals between patients and their
care givers.
``(3) Excluded practice.--
``(A) In general.--The term `excluded practice'
means, subject to subparagraph (B), any practice--
``(i) in which any entity that is not a
physician or designated health care
practitioner or a professional corporation,
professional association, limited liability
company, or other professional body that is
majority owned and controlled by physicians or
designated health care practitioners has an
ownership interest;
``(ii) in which any entity described in
subparagraph (A) exercises de facto control
over employment decisions (including rates of
pay and terms of employment), clinical staffing
levels, amount of time spent between a supplier
and a patient, diagnostic or procedural coding
decisions, clinical standards or policy,
billing and collection, prices for items and
services, contracting with third party payors,
or controlling or restricting the practice's
assets;
``(iii) in which physicians or designated
health care practitioners hold 50 percent or
less of voting shares or membership interests;
``(iv) that has a governing board in which
physicians or designated health care
practitioners constitute less than 50 percent
of the members; or
``(v) in the case such practice is a
corporation or professional association, that
permits the removal of directors or officers
that are physicians or designated health care
practitioners except by majority vote of
stakeholders that are physicians or designated
health care practitioners.
``(B) Exception.--The term `excluded practice' does
not include any practice consisting of 15 or fewer
designated health care practitioners.
``(4) Specified practitioner.--The term `specified
practitioner' means--
``(A) a physician with a primary specialty or
practice area of family medicine, internal medicine,
geriatric medicine, or pediatric medicine; or
``(B) a physician assistant, a nurse practitioner,
or a clinical nurse specialist.
``(5) Qualifying supplier.--The term `qualifying supplier'
means, with respect to a year, a specified practitioner--
``(A) who is not part of an excluded practice;
``(B) who furnished items and services under this
title during the preceding year;
``(C) for whom, with respect to payments under this
title for all items and services furnished by such
practitioner during the preceding year, at least 60
percent of such payments were for designated primary
care services; and
``(D) who has elected to participate in the model
for such year through such process as the Secretary
shall establish.''.
SEC. 103. WORK GEOGRAPHIC FLOOR ADJUSTMENT FOR HIGH INFLATIONARY YEARS.
(a) In General.--Section 1848(e)(1)(E) of the Social Security Act
(42 U.S.C. 1395w-4(e)(1)(E)) is amended--
(1) by striking the header and inserting ``Work geographic
index'';
(2) by striking ``After calculating'' and inserting the
following:
``(i) In general.--After calculating'';
(3) in clause (i) (as so inserted)--
(A) by inserting ``(or 1.025, in the case such year
is a high inflationary year (as defined in clause
(iii)))'' after ``to 1.00''; and
(B) by striking ``2027'' and inserting ``2032'';
and
(4) by adding at the end the following new clauses:
``(ii) Increase in high inflationary years
for other localities.--After calculating the
work geographic index in subparagraph (A)(iii),
for purposes of payment for services furnished
on or after January 1, 2027, and before January
1, 2033, the Secretary shall increase the work
geographic index by .02 points if such year is
a high inflationary year, unless such work
geographic index is subject to an increase
under clause (i) for such year.
``(iii) Definition.--In this subparagraph,
the term `high inflationary year' means a year
if, over the 12-month period ending on the last
day of the preceding year, the consumer price
index for all urban consumers (U.S. city
average) increased by more than 2 percent.
``(iv) Publication.--Medicare
administrative contractors shall publish the
geographically adjusted work relative value
units for both the inflation adjustments under
clauses (i) and (ii) and the work geographic
adjustment for all services on a quarterly
basis effective January 1, 2027, for each of
their geographic areas.''.
(b) Report.--Not later than 1 year after the date of the enactment
of this Act, the Comptroller General of the United States shall submit
to the House Energy and Commerce and Ways and Means Committees and
Senate Finance Committee a study on the economic factors that are
impacting physician choice, by specialty, regarding the geographic area
in which such physicians choose to practice, including salaries,
contract terms, cost of living, availability of capital, volume of
services, and costs to conduct a practice.
TITLE II--POINTS
SEC. 201. IMPLEMENTATION OF THE PATIENT OUTCOME IMPROVEMENT NATIONAL
TABULATION SYSTEM.
(a) In General.--Effective January 1, 2032, there is established
the Patient Outcome Improvement National Tabulation System, which shall
consist of the payment system under section 1848(q) of the Social
Security Act (42 U.S.C. 1395w-4(q)), including as amended by this
section.
(b) References.--Subject to paragraph (3), any reference to the
payment system under section 1848(q) of the Social Security Act (42
U.S.C. 1395w-4(q)), including the terms ``Merit-based Incentive Payment
System'' and ``MIPS'', shall be deemed a reference to the ``Patient
Outcome Improvement National Tabulation System'' and ``POINTS'',
respectively.
(c) Transition.--In order to provide for an orderly transition and
avoid provider confusion, the Secretary of Health and Human Services
shall provide for an appropriate transition in the use of the terms
``Merit-based Incentive Payment System'' (and ``MIPS'') and ``Patient
Outcome Improvement National Tabulation System'' (and ``POINTS'') in
reference to the payment system under section 1848(q) of the Social
Security Act (42 U.S.C. 1395w-4(q)). Before the completion of such
transition, any reference to the ``Patient Outcome Improvement National
Tabulation System'' (or ``POINTS'') shall be deemed to include a
reference to the ``Merit-based Incentive Payment System''.
SEC. 202. PAYMENT REFORM.
(a) In General.--Section 1848(q) of the Social Security Act (42
U.S.C. 1395w-4(q)) is amended--
(1) in paragraph (1)(D)(i)(II), by striking ``(iv)'' and
inserting ``(v)'';
(2) in paragraph (2)--
(A) in subparagraph (A)--
(i) in clause (iii), by striking ``Clinical
practice'' and inserting ``For performance
periods beginning before January 1, 2032,
clinical practice'';
(ii) in clause (iv), by striking
``Meaningful use'' and inserting ``For
performance periods before January 1, 2032,
meaningful use''; and
(iii) by adding at the end the following
new clause:
``(v) For performance periods beginning on
or after January 1, 2032, care efficiency.'';
(B) in subparagraph (B)--
(i) in clause (ii)--
(I) by striking ``subparagraph
(A)(ii), the measurement'' and
inserting the following: ``subparagraph
(A)(ii)--
``(I) for performance periods
beginning before January 1, 2032, the
measurement''; and
(II) by striking the period at the
end and inserting the following: ``;
and
``(II) for performance periods
beginning on or after January 1, 2032,
the measurement described in subclause
(I) and any resource use measures
included in the final measures list
published under subparagraph (D)(i) for
such period.''; and
(ii) by inserting after clause (iv) the
following new clause:
``(v) Care efficiency.--For the performance
category described in subparagraph (A)(v), care
efficiency measures (such as measures relating
to reductions in avoidable hospitalizations,
reductions in medication burden (when
clinically appropriate), reductions in
complications from chronic diseases, and
referral patterns to the lowest-cost clinically
appropriate settings) included in the final
measures list published under subparagraph
(D)(i) for such period.'';
(C) in subparagraph (D)--
(i) in the header, by striking ``quality'';
(ii) in clause (i)--
(I) in the matter preceding
subclause (I), by inserting ``(or, with
respect to performance periods
beginning on or after January 1, 2032,
an annual final list of quality
measures, resource use measures (if
determined appropriate by the
Secretary), and care efficiency
measures)'' after ``quality measures'';
and
(II) in subclause (II)--
(aa) in item (aa), by
striking ``quality measures''
and inserting ``measures'';
(bb) in item (bb), by
inserting ``(or, with respect
to a final list for a
performance period beginning on
or after January 1, 2032, new
quality measures, resource use
measures, or care efficiency
measures)'' after ``quality
measures''; and
(cc) in item (cc), by
striking ``quality measures''
and inserting ``measures'';
(iii) in clause (ii)--
(I) in the header, by striking
``quality''; and
(II) in subclause (I)--
(aa) by inserting ``(or,
with respect to such an annual
list for a performance period
beginning on or after January
1, 2032, quality measures,
resource use measures, and care
efficiency measures)'' after
``submit quality measures'';
and
(bb) by striking ``quality
measures published'' and
inserting ``measures
published'';
(iv) in clause (iii)--
(I) in the matter preceding
subclause (I), by striking ``quality'';
(II) in subclause (I), by striking
``and'' at the end;
(III) in subclause (II)--
(aa) by striking ``ensure
that'' and inserting ``with
respect to such an annual final
list for a performance period
beginning before January 1,
2032, ensure that''; and
(bb) by striking the period
at the end and inserting ``;
and''; and
(IV) by adding at the end the
following new subclause:
``(III) with respect to such an
annual final list for a performance
period beginning on or after January 1,
2032, provide that--
``(aa) no quality measure
applicable to a medical
specialty is included on such
list if--
``(AA) the task
force established under
subparagraph (E) has
issued recommendations
on quality measures for
use under this
subsection with respect
to such specialty; and
``(BB) the quality
measure does not have
in effect such a
recommendation; and
``(bb) no resource use
measure or care efficiency
measure is included on such
list unless such measure has in
effect a recommendation from
such task force.'';
(v) in clause (v), in the matter preceding
subclause (I), by inserting ``for a performance
period beginning before January 1, 2032,''
after ``published under clause (i)'';
(vi) in clause (vi), by striking ``under
clauses (i), (iv), and (v)'' and inserting
``under this subparagraph''; and
(vii) in clause (vii)(II), by striking
``shall be'' and inserting ``subject to clause
(iii)(III)(aa), shall be'';
(3) in paragraph (5)--
(A) in subparagraph (B)--
(i) in clause (ii)--
(I) in subclause (I)--
(aa) by striking
``encourage'' and inserting
``with respect to a performance
period beginning before January
1, 2032, encourage''; and
(bb) by striking ``and'' at
the end;
(II) in subclause (II), by striking
the period and inserting ``; and''; and
(III) by adding at the end the
following new subclause:
``(III) with respect to a
performance period beginning on or
after January 1, 2032, with respect to
a year, provide that in the case of a
MIPS eligible professional who fails to
report on an applicable quality measure
through the use of certified EHR
technology or clinical data registries,
the professional shall be treated as
achieving the lowest potential score
applicable to such measure.''; and
(ii) by adding at the end the following new
clause:
``(iii) Incentive to report on certain
measures.--
``(I) In general.--With respect to
performance periods for years beginning
on or after January 1, 2027, in the
case a MIPS eligible professional
elects to report on a measure for such
period that, with respect to such
professional and such period, is a new
measure described in subclause (II), a
substantively changed measure described
in subclause (III), or a measure
described in paragraph (2)(B)(i) for
which the Secretary is unable to
establish a benchmark, such
professional shall be treated as
achieving the highest possible score
with respect to such measure.
``(II) New measures.--For purposes
of subclause (I), a new measure
described in this subclause, with
respect to a MIPS eligible professional
and performance period for a year, is a
measure applicable to such professional
with respect to the performance
category described in paragraph
(2)(A)(i) that is included in the final
list of quality measures published
under paragraph (2)(D)(i) (or the list
of quality measures described in
paragraph (2)(D)(vi) used by qualified
clinical data registries under
subsection (m)(3)(E)) for such year but
was not included in such final list
under paragraph (2)(D)(i) (or list
under paragraph (2)(D)(vi)) for any of
the previous 3 years.
``(III) Substantively changed
measure.--For purposes of subclause
(I), a substantively changed measure
described in this subclause, with
respect to a MIPS eligible professional
and performance period for a year, is a
measure applicable to such professional
with respect to the performance
category described in paragraph
(2)(A)(i) that is included in the final
list of quality measures published
under paragraph (2)(D)(i) (or the list
of quality measures described in
paragraph (2)(D)(vi) used by qualified
clinical data registries under
subsection (m)(3)(E)) for such year and
each of the previous three years but
that underwent a substantive change (as
defined by the Secretary) during any of
such previous three years.''; and
(B) in subparagraph (E)--
(i) in clause (i)--
(I) in subclause (I)(aa), by
inserting ``(or, with respect to 2032
and subsequent years, 65 percent)''
after ``thirty percent'';
(II) in subclause (II)(aa), by
inserting ``(or, with respect to 2032
and subsequent years, 20 percent)''
after ``thirty percent'';
(III) in subclause (III), by
inserting ``(or, with respect to 2032
and subsequent years, 0 percent)''
after ``fifteen percent'';
(IV) in subclause (IV), by
inserting ``(or, with respect to 2032
and subsequent years, 0 percent)''
after ``twenty-five percent''; and
(V) by adding at the end the
following new subclause:
``(V) Care efficiency.--With
respect to 2032 and subsequent years,
15 percent of such score shall be based
on performance with respect to the
category described in clause (v) of
paragraph (2)(A).''; and
(ii) in clause (ii), by inserting ``(before
2032)'' after ``In any year'';
(4) in paragraph (11)(A)(i), by striking ``clauses (i)
through (iv) of''; and
(5) in paragraph (12)(A)(i)(II), by striking ``and (iv)''
and inserting ``through (v)''.
(b) Improvements to Resource Use Performance Category.--Section
1848(r) of the Social Security Act (42 U.S.C. 1395w-4(r)) is amended--
(1) in paragraph (2)(H), by adding at the end the following
new sentence: ``In making such revisions for 2027 and
subsequent years, the Secretary shall revise care episode
groups and patient condition groups without regard to any
target described in subparagraph (D)(i)(I).''; and
(2) in paragraph (5)(C)(i)--
(A) by inserting ``, for years before 2027,'' after
``shall''; and
(B) by inserting ``and shall, for 2027 and
subsequent years, use such care episode codes and
patient condition codes'' before the period.
SEC. 203. QUALITY REFORM TASK FORCE.
Section 1848(q)(2) of the Social Security Act (42 U.S.C. 1395w-
4(q)(2)) is amended by adding at the end the following new
subparagraph:
``(E) Quality reform task force.--
``(i) In general.--Not later than 6 months
after the date of the enactment of this
subparagraph, the Secretary shall establish a
Quality Reform Task Force (in this subparagraph
referred to as the `Task Force') for purposes
of issuing recommendations with respect to the
use of quality, resource use, and care
efficiency measures under this subsection.
``(ii) Membership.--
``(I) In general.--Members of the
Task Force shall be appointed by the
Secretary and shall include--
``(aa) representatives of
the Department of Health and
Human Services;
``(bb) representatives of
eligible professional
organizations (as defined in
subparagraph (D)(ii)(II)); and
``(cc) other experts
determined appropriate by the
Secretary.
``(II) Appropriate
representation.--In making appointments
under subclause (I), the Secretary
shall ensure that--
``(aa) each medical
specialty or subspecialty as
determined appropriate by the
Secretary in which a MIPS
eligible professional may
practice is adequately
represented on the Task Force
through a relevant organization
described in subclause (I)(bb)
if a measure relating to such
specialty or subspecialty is
under consideration;
``(bb) a majority of the
Task Force is comprised of
designated health care
practitioners (as defined in
section 1866H(f)) or
representatives of designated
health care professional-led
professional organizations
described in subclause (I)(bb);
``(cc) not more than 3
members of the Task Force are
representatives of group health
plans, health insurance
issuers, or Medicare Advantage
organizations; and
``(dd) at least 1
designated health care
practitioner who is not part of
an excluded practice (as
defined in section 1866H(f))
who practices in a medical
specialty or subspecialty is
included on the Task Force when
the Task Force is considering
measures relating to such
specialty or subspecialty.
``(III) Maximum number of
members.--The number of members of the
Task Force may not exceed 25.
``(iii) Duties.--
``(I) In general.--The Task Force
shall, with respect to each performance
period beginning on or after January 1,
2032--
``(aa) issue
recommendations on quality,
resource use, and care
efficiency measures for use
under this subsection; and
``(bb) update any
recommendations previously
issued by the Task Force as
determined appropriate by the
Task Force.
``(II) Requirements.--The Task
Force--
``(aa) shall ensure that
any measure recommended under
subclause (I) conforms with
applicable clinical guidelines
developed by a professional
organization representing the
medical specialty or
subspecialty to be subject to
such measure and is designed to
promote quality of care,
improve resource use, or reduce
costs;
``(bb) may only recommend a
quality measure to the extent
that data for such measure can
be submitted through certified
EHR technology, administrative
or billing claims, or a
qualified clinical data
registry;
``(cc) shall take into
account the circumstances of
practitioners in specialty
types that furnish services
that do not typically involve
face-to-face interaction with
patients (or that typically
involve such interaction only
at the direction of another
practitioner ordering such
services);
``(dd) shall, in reviewing
measures and making
recommendations, take into
account--
``(AA) how the
measure relates to an
episode of care or a
continuum of health
care, as applicable,
involved;
``(BB) the context
of the respective
performance category of
such measure and how
the measure may serve
to complement or align
with measures
applicable in other
performance categories
under this subsection;
``(CC) measures
developed by qualified
clinical data
registries; and
``(DD) consult with
such registries as
necessary in the
development and
evaluation of measures;
and
``(ee) ensure that the role
of qualified clinical data
registries in the development,
maintenance, and refinement of
measures is preserved or
strengthened.
``(iv) Secretarial response to
recommendations.--
``(I) In general.--Not later than
120 days after the Task Force issues
recommendations with respect to
measures for a performance period, the
Secretary shall transmit to the Task
Force and to the Committee on Ways and
Means and the Committee on Energy and
Commerce of the House of
Representatives and the Committee on
Finance of the Senate a formal written
response that, with respect to each
such recommendation, affirmatively
states one of the following:
``(aa) The Secretary will
implement the recommendation as
issued.
``(bb) The Secretary will
implement the recommendation
with specified modifications,
accompanied by a written
explanation of the
modifications and the clinical,
administrative, or program
integrity basis for each such
modification.
``(cc) The Secretary will
implement the recommendation in
part, accompanied by a written
explanation of which elements
will be implemented and the
basis for declining the
remainder.
``(dd) The Secretary
declines to implement the
recommendation, accompanied by
a detailed written explanation
of the clinical,
administrative, or program
integrity basis for the
decision.
``(II) Inclusion of measures.--
``(aa) In general.--The
Secretary shall include a
measure receiving a
recommendation from the Task
Force for a performance period
in the final measures list
published under subparagraph
(D)(i) for such performance
period unless the Secretary,
not later than 90 days after
receiving the recommendation,
publishes in the Federal
Register a written
determination explaining the
specific clinical,
administrative, or program
integrity basis for excluding
the measure.
``(bb) Further requirements
for certain recommendations.--
Notwithstanding item (aa), with
respect to any measure
recommended by the Task Force
for a performance period with
the support of not fewer than
75 percent of the members of
the Task Force, the Secretary
may not exclude such measure
from the final measures list
published under subparagraph
(D)(i) for such performance
period unless the Secretary--
``(AA) consults
with the task force
regarding such proposed
exclusion; and
``(BB) includes in
the written
determination under
subclause (I) a
response to the Task
Force's position and a
specific finding that
the basis for exclusion
outweighs the clinical
judgment of the Task
Force.
``(III) Annual report.--Not later
than March 1 of each year beginning
with the first calendar year after the
Task Force issues its initial
recommendations, the Secretary shall
submit to the Committee on Ways and
Means and the Committee on Energy and
Commerce of the House of
Representatives and the Committee on
Finance of the Senate, and shall make
publicly available on the website of
the Centers for Medicare & Medicaid
Services, a report that includes, for
each recommendation issued by the Task
Force during the preceding calendar
year--
``(aa) the text of the
recommendation and the vote of
the Task Force;
``(bb) the Secretary's
response under subclause (I);
``(cc) the outcome with
respect to the final measures
list published under
subparagraph (D)(i), including
whether the recommended measure
was included, included with
modifications, or excluded; and
``(dd) if the measure was
excluded or modified, the
written justification provided
under subclause (I).''.
SEC. 204. MODIFICATION OF MIPS PAYMENT ADJUSTMENTS.
(a) In General.--Section 1848(q)(6)(B) of the Social Security Act
(42 U.S.C. 1395w-4(q)(6)(B)) is amended--
(1) in clause (iii), by striking ``and'' at the end;
(2) in clause (iv), by amending such clause to read as
follows:
``(iv) for 2022 and subsequent years
(through 2026), 9 percent;''; and
(3) by adding at the end the following new clauses:
``(v) for 2027 through 2031, 2 percent;
``(vi) for 2032, 3 percent;
``(vii) for 2033, 4 percent; and
``(viii) for 2034, 5 percent.''.
(b) No Reduction in Case of Failure To Provide Feedback.--
(1) In general.--Section 1848(q)(6) of the Social Security
Act (42 U.S.C. 1395w-4(q)(6)) is amended by adding at the end
the following new subparagraph:
``(G) No reduction in payments in case of failure
to provide feedback.--Notwithstanding the preceding
provisions of this paragraph, in the case that the
Secretary fails to provide a MIPS eligible professional
feedback required under paragraph (12) with respect to
the performance of such professional for a performance
period with respect to a year for administrative
claims-based measures included in the performance
categories described in subparagraph (A)(i)(II) of such
paragraph, if application of subparagraph (E) would
result in a negative adjustment to payment for covered
professional services furnished by such professional
during such year, the product otherwise determined
under such subparagraph for such professional and year
shall be deemed to be zero.''.
(2) Modification of feedback requirements.--Section
1848(q)(12) of the Social Security Act (42 U.S.C. 1395w-
4(q)(12)) is amended--
(A) in subparagraph (A)(i)(II), by inserting
``(and, beginning with 2032, shall, on a quarterly
basis and with respect to administrative claims-based
measures in accordance with clause (vi))'' after
``may''; and
(B) by adding at the end the following new clause:
``(vi) Feedback on administrative-claims
based measures.--With respect to quarters
beginning on or after January 1, 2032, the
Secretary shall, not later than 60 days after
each such quarter, provide to each MIPS
eligible professional, with respect to
administrative claims-based measures included
in the performance categories described in
subparagraph (A)(i)(II), feedback on such
professional's performance, including--
``(I) a description of the patients
and episodes attributed with respect to
such measures for purposes of assessing
the performance of such professional
during such quarter;
``(II) an identification of the
items and services furnished by such
professional or another individual that
will contribute to the assessment of
the performance of such professional
during such quarter with respect to
such measures; and
``(III) an identification of
whether each item or service identified
under subitem (BB) for the quarter was
furnished by such professional or
another individual (and, in the case
that the performance of such
professional for such quarter with
respect to such measures is assessed
based on participation in a group
practice or other group, whether each
such item or service was furnished by
such professional, another individual
in such group, or another individual
outside of such group).''.
(c) Extension of Additional Incentive Payments for Certain
Professionals.--Section 1848(q)(6) of the Social Security Act (42
U.S.C. 1395w-4(q)(6)) is amended--
(1) in subparagraph (C)--
(A) by inserting ``and for 2032 and each subsequent
year'' after ``2024,''; and
(B) by inserting ``(other than, with respect to
2032 and each subsequent year, such a professional that
is part of an excluded practice (as defined in section
1866H(f)))'' after ``MIPS eligible professional''; and
(2) in subparagraph (F)(iv)(I), by inserting ``and for 2032
and each subsequent year'' before the period.
(d) Reduction in Positive Adjustments for Certain Professionals.--
Section 1848(q)(6) of the Social Security Act (42 U.S.C. 1395w-
4(q)(6)), as amended by paragraph (1), is further amended by adding at
the end the following new subparagraph:
``(H) Reduction in positive adjustments for certain
professionals.--The Secretary shall reduce each
positive MIPS adjustment factor otherwise determined
under this paragraph for a year (beginning with 2032)
for a MIPS eligible professional who is part of an
excluded practice (as defined in section 1866H(f)) by
50 percent. The preceding sentence shall be applied in
a budget neutral manner.''.
SEC. 205. MODIFYING REQUIREMENTS AND APPROVAL PERIODS FOR QUALIFIED
CLINICAL DATA REGISTRIES.
Section 1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w-
4(m)(3)(E)) is amended--
(1) in clause (i), by adding at the end the following:
``Beginning January 1, 2027, such requirements shall include a
requirement that the entity--
``(I) be established and operated
by a professional society that is
controlled or led by a designated
practitioner (as defined in section
1866H) and that has demonstrated
expertise in developing evidence-based
clinical practice guidelines and
quality measures for improving patient
outcomes;
``(II) demonstrates adherence to
data quality and fidelity standards,
including standards relating to data
elements, data completeness, and
validation processes;
``(III) demonstrates capacity to
generate timely, actionable feedback to
participating practitioners to support
continuous quality improvement and
track practitioner use of such
feedback;
``(IV) demonstrate transparency in
measure development (including the
methodology used in such measures and
any risk adjustment used in such
measures); and
``(V) has established self-audit or
review processes focusing on data
accuracy, measure integrity, and
appropriate use of results.''; and
(2) in clause (v), by adding the following flush matter at
the end:
``A determination or designation made under
this clause on or after January 1, 2027, shall
be effective for a period of 3 years. At the
end of such period, the Secretary (or, in the
case of a designation made by an organization,
such organization) may extend such
determination or designation (as applicable)
for subsequent 3-year periods based on a
showing by such entity that such entity
continues to meet the requirements of clause
(i).''.
SEC. 206. EXPANDED ACCESS TO CLAIMS DATA TO FACILITATE RESEARCH AND
QUALITY IMPROVEMENT.
(a) In General.--Not later than January 1, 2027, the Secretary of
Health and Human Services shall establish a process to allow a
qualified clinical data registry under section 1848(m)(3)(E) of the
Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)) or a clinician-led
clinical data registry under section 4005 of the 21st Century Cures Act
(Public Law 114-255) to request claims data described in subsection (b)
(in a form and manner determined to be appropriate by the Secretary)
for the purposes of--
(1) linking such data with clinical outcomes data;
(2) conducting quality assessments and quality improvement
activities of providers of services (as defined in subsection
(u) of section 1861 of the Social Security Act (42 U.S.C.
1395x) and suppliers (as defined in subsection (d) of such
section)), reporting the results of such assessments and
activities to such providers and suppliers, and performing
risk-adjusted, scientifically valid analyses and research to
support quality improvement or patient safety; and
(3) publishing research and quality improvement analyses,
which may include deidentified combined claims and clinical
outcomes data.
(b) Claims Data Described.--For purposes of subsection (a), the
claims data described in this subsection--
(1) are--
(A) claims data under the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.); and
(B) if the Secretary determines appropriate, claims
data under the Medicaid program under title XIX of such
Act (42 U.S.C. 1396 et seq.) and the State Children's
Health Insurance Program under title XXI of such Act
(42 U.S.C. 1397aa et seq.); and
(2) may include provider-specific claims data, clinical
specialty-specific claims data, State-specific claims data, or
nationwide claims data.
(c) Treatment of Qualified Clinical Data Registries and Clinician-
Led Clinical Data Registries.--For the purposes of this section,
qualified clinical data registries and clinician-led clinical data
registries shall not be required to be qualified entities, as defined
in section 1874(e)(2) of the Social Security Act (42 U.S.C.
1395kk(e)(2)), or quasi-qualified entities, to access claims data
pursuant to subsection (a).
(d) Fee.--Data described in subsection (b) shall be made available
to a qualified clinical data registry or clinician-led clinical data
registry under this section at a reasonable fee equal to the cost of
making such data available. Any fee collected pursuant to the preceding
sentence shall be deposited into the Centers for Medicare & Medicaid
Services Program Management Account.
SEC. 207. MODIFICATION OF APPROPRIATE USE CRITERIA DATA COLLECTION FOR
APPLICABLE IMAGING SERVICES.
(a) In General.--Section 1834(q) of the Social Security Act (42
U.S.C. 1395m(q)) is amended--
(1) in paragraph (3)(B)(ii)--
(A) in subclause (IV), by striking ``generates and
provides to the ordering professional a certification
or documentation that''; and
(B) by adding at the end the following new
subclause:
``(VIII) Beginning January 1, 2027,
the mechanism provides to the
Secretary--
``(aa) the information
described in subclauses (III)
and (IV);
``(bb) the information
described in paragraph (4)(B);
and
``(cc) such other
information as the Secretary
determines to be appropriate,
at such time, and in such form
and manner, as the Secretary
may specify.'';
(2) in paragraph (4)--
(A) in subparagraph (A), by striking clause (ii)
and inserting the following:
``(ii) beginning January 1, 2027, comply
with such requirements as the Secretary may
establish.'';
(B) in subparagraph (B)--
(i) in the heading, by striking
``furnishing professional'' and inserting
``qualified clinical decision support
mechanism'';
(ii) in the matter preceding clause (i)--
(I) by striking ``with January 1,
2017'' and inserting ``January 1,
2027''; and
(II) by striking ``payment for such
service may only be made if the claim
for the service includes'' and
inserting ``the qualified decision
support mechanism shall maintain and
report to the Secretary under
subparagraph (F)''; and
(iii) in clause (iii), by striking ``(if
different from the furnishing professional)'';
(C) in subparagraph (C), by adding at the end the
following new clauses:
``(iv) Clinical trials.--An applicable
imaging service that is ordered for an
individual as part of a clinical trial.
``(v) Small and rural practices.--An
applicable imaging service ordered by an
ordering professional practicing in a small
practice (consisting of 15 or fewer ordering
professionals), or a practice in a health
professional shortage area (as designated under
section 332(a)(1)(A) of the Public Health
Service Act) located in a rural area.
``(vi) Specified exemptions.--The following
types of applicable imaging services:
``(I) A mammography.
``(II) A lung cancer screening
performed using computed tomography.
``(III) A colonography performed
using computed tomography.
``(IV) Such a service furnished to
treat an emergency medical condition or
a suspected emergency medical
condition.
``(V) Such other preventive or
screening imaging services as the
Secretary determines appropriate.'';
(D) in subparagraph (D), by adding at the end the
following new clause:
``(iv) Any other payment system determined
appropriate by the Secretary.''; and
(E) by adding at the end the following new
subparagraphs:
``(E) Furnishing professional requirement.--
Beginning January 1, 2027, with respect to an
applicable imaging service furnished in an applicable
setting and paid for under an applicable payment system
(as defined in subparagraph (D)), the furnishing
professional shall include the national provider
identifier of the ordering professional (if different
from the furnishing professional) on the claim for the
service.
``(F) Reporting requirements.--The Secretary shall
provide, through guidance or rulemaking, information on
appropriate ways that each qualified clinical decision
support mechanism may report the information maintained
under subparagraph (B) to the Secretary to support the
Secretary in implementing paragraphs (5) and (6).'';
(3) in paragraph (5)--
(A) in the heading, by striking ``outlier'' and
inserting ``low compliant'';
(B) by striking subparagraphs (A) and (B) and
inserting the following:
``(A) In general.--With respect to applicable
imaging services furnished on or after January 1, 2027,
the Secretary shall determine on an annual basis the
total number of ordering professionals who are
designated as low compliant ordering professionals
under subparagraph (B).
``(B) Low compliant ordering professionals.--The
Secretary shall designate ordering professionals with a
compliance rate (as determined under subparagraph (D))
lower than an amount determined by the Secretary as low
compliant ordering professionals.'';
(C) in paragraph (C), by striking ``outlier'' and
inserting ``low compliant'';
(D) by striking subparagraph (D) and inserting the
following:
``(D) Determination of compliance rate.--
``(i) In general.--
``(I) Compliance rates.--For
applicable imaging services furnished
on or after January 1, 2027, the
Secretary shall determine a compliance
rate (as defined in clause (ii)) for
each ordering professional for a period
specified by the Secretary.
``(II) Use of data.--In determining
a compliance rate for an ordering
professional under subclause (I), the
Secretary shall use data made available
to the Secretary by qualified clinical
decision support mechanisms published
in the list under paragraph (3)(C) that
were consulted by the ordering
professional for the period specified
by the Secretary under subclause (I).
``(ii) Definition of compliance rate.--
``(I) In general.--In this
subparagraph, the term `compliance
rate' means, with respect to the
requirement under paragraph (4)(A) that
an order from an ordering professional
for an applicable imaging service was
the subject of consultation with a
qualified decision support mechanism,
the ratio (expressed as a percentage)
of--
``(aa) the number of orders
from such ordering professional
included in a report from one
or more qualified decision
support mechanisms described in
paragraph (3)(B); and
``(bb) the aggregate number
of such orders from such
ordering professional for such
period.
``(II) Exclusion of excepted
orders.--In calculating the compliance
rate for an ordering professional under
subclause (I), the Secretary shall
exclude from the total number of orders
in item (bb) of such subclause any
order for an applicable imaging service
described in paragraph (4)(C).''; and
(E) in subparagraph (E), by striking ``outlier''
and inserting ``low compliant'';
(4) by striking paragraph (6) and inserting the following:
``(6) Study and report on low compliant ordering
professionals and utilization of applicable imaging services.--
``(A) In general.--Not later than January 1, 2031,
and every 5 years thereafter, the Secretary shall
conduct a study regarding the compliance rates
calculated under paragraph (5) and submit a report to
Congress that--
``(i) discusses--
``(I) such rates and compliance
with this subsection;
``(II) the impact this subsection
has on the utilization of applicable
imaging services; and
``(III) potential mechanisms for
improving compliance with this
subsection, including--
``(aa) prior authorization
for applicable imaging services
ordered by low compliant
ordering professionals;
``(bb) any payment
adjustment related to the
services, or a subset of
services, that the Secretary
may designate under the fee
schedule under section 1848; or
``(cc) other mechanisms
determined appropriate by the
Secretary; and
``(ii) proposes alternative compliance rate
thresholds for low compliant ordering
professionals for purposes of paragraph
(5)(B).''; and
(5) by adding at the end the following new paragraph:
``(8) Specialty society endorsement.--In specifying
applicable appropriate use criteria for applicable imaging
services under paragraph (2) and qualified clinical decision
support mechanisms under paragraph (3), the Secretary shall
substantially adhere to the approach described in section
414.94 of title 42, Code of Federal Regulations (as in effect
on January 1, 2023).''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to items and services furnished on or after January
1, 2027.
SEC. 208. RULES OF CONSTRUCTION.
(a) In General.--None of the amendments made by this title may be
construed to--
(1) transfer ownership of a measure developed by a
qualified clinical data registry to the Secretary or any other
entity without the authorization of the qualified clinical data
registry; or
(2) require a qualified clinical data registry to
relinquish intellectual property rights as a condition of
having a measure considered for inclusion in the annual final
list of measures.
(b) IP.--The Secretary of Health and Human Services shall recognize
that measures developed by qualified clinical data registries are the
intellectual property of such registries, including any specifications,
methodologies, scoring algorithms, specialty or subspecialty
guidelines, and related materials associated with such measures.
Nothing in this title shall prohibit a qualified clinical data registry
from voluntarily licensing a measure to the Secretary or other entities
under terms agreed to by such registry.
TITLE III--APM IMPROVEMENT
SEC. 301. QUALIFYING APM PARTICIPANT THRESHOLD FREEZE.
(a) In General.--Section 1833(z)(2) of the Social Security Act (42
U.S.C. 1395l(z)(2)) is amended--
(1) in subparagraph (B)--
(A) in the header, by striking ``2026 and 2028''
and inserting ``2029''; and
(B) in the matter preceding clause (i), by striking
``2026 and 2028'' and inserting ``2029''; and
(2) in subparagraph (C)--
(A) in the header, by striking ``2027 and 2029''
and inserting ``2030''; and
(B) in the matter preceding clause (i), by striking
``2027 and 2029'' and inserting ``2030''.
(b) Conforming Amendments.--Section 1848(q)(1)(C)(iii) of the
Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(iii)) is amended--
(1) in subclause (II), in the matter preceding item (aa),
by striking ``2026 and 2028'' and inserting ``2029''; and
(2) in subclause (III), the matter preceding item (aa), by
striking ``2027 and 2029'' and inserting ``2030''.
(c) Authority To Modify Thresholds.--Section 1848(q)(1)(C)(iii) of
the Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(iii)) is amended--
(1) in subclause (II)--
(A) in item (aa), by inserting ``(or such lower
percentage as may be specified by the Secretary)''
after ``40 percent''; and
(B) in item (bb), by inserting ``(or such lower
percentages as may be specified by the Secretary)''
after ``respectively''; and
(2) in subclause (III)--
(A) in item (aa), by inserting ``(or such lower
percentage as may be specified by the Secretary)''
after ``50 percent''; and
(B) in item (bb), by inserting ``(or such lower
percentages as may be specified by the Secretary)''
after ``respectively''.
SEC. 302. CMI MODEL REQUIREMENTS.
Section 1115A of the Social Security Act (42 U.S.C. 1315a) is
amended--
(1) in subsection (b)(3)(B), by inserting ``, pursuant to
notice-and-comment rulemaking,'' after ``The Secretary shall'';
(2) in subsection (c), in the flush matter at the end, by
adding at the end the following new sentence: ``The Secretary
may terminate a model expanded under this subsection prior to
the date set for such termination at the time of such expansion
only pursuant to notice and comment rulemaking.''; and
(3) in subsection (g), by adding at the end the following
new sentence: ``Each such report submitted in 2027 or a
subsequent year shall contain, with respect to each model
tested under subsection (b), a description of any savings
generated by such model.''.
SEC. 303. REPORT ON BARRIERS TO PARTICIPATION IN VALUE-BASED PAYMENT
MODELS.
Not later than December 31, 2029, the Comptroller General of the
United States, in consultation with the Medicare Payment Advisory
Commission, shall submit to the Committees on Energy and Commerce and
Ways and Means of the House of Representatives, and the Committee on
Finance of the Senate, a report on ongoing barriers to participation in
value-based payment models for specialty providers under the Medicare
program. Such report shall contain specific policy recommendations to
reduce such barriers.
TITLE IV--PHYSICIAN PAYMENT IMPROVEMENTS
SEC. 401. UPDATING THE BUDGET NEUTRALITY THRESHOLD.
Section 1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C.
1395w-4(c)(2)(B)(ii)(II)) is amended--
(1) by striking ``Subject to'' and inserting the following:
``(aa) In general.--Subject
to'';
(2) in item (aa), as inserted by paragraph (1), by striking
``$20,000,000'' and inserting ``the amount specified in item
(bb) for such year''; and
(3) by adding at the end the following new items:
``(bb) Amount specified.--
For purposes of item (aa),
subject to item (cc), the
amount specified in this item
is--
``(AA) for years
before 2028,
$20,000,000;
``(BB) for 2028,
$57,640,000; and
``(CC) for 2029 and
each subsequent year,
the amount specified in
this item for the
preceding year.
``(cc) Indexing limitation
on annual adjustments.--For
2033 and every subsequent fifth
year, the Secretary shall
increase the amount specified
in item (bb) for such year by
the cumulative percentage
increase in the MEI (as defined
in section 1842(i)(3))
applicable to physicians'
services for each year
occurring during the 5-year
period ending on the last day
of the preceding year.''.
SEC. 402. BUDGET NEUTRALITY CORRECTIONS RELATING TO ESTIMATED
UTILIZATION.
(a) In General.--Section 1848(c)(2)(B) of the Social Security Act
(42 U.S.C. 1395w-4(c)(2)(B)) is amended by adding at the end the
following new clause:
``(vii) Budget neutrality corrections
relating to estimated utilization.--
``(I) In general.--In the case of a
budget neutrality adjustment applied
pursuant to clause (ii)(II) for a year
(beginning with 2029) that is
determined in part using estimated
utilization (as defined in subclause
(II)(bb)) with respect to a specified
service (as defined in subclause
(II)(cc)), the Secretary shall, as part
of the final rule establishing the
physician fee schedule under this
section for the assumption correction
period (as defined in subclause
(II)(aa)) with respect to such year--
``(aa) determine the
difference between expenditures
for such service in such year
using estimated utilization and
actual utilization for such
service (in a manner determined
appropriate by the Secretary);
and
``(bb) in the case that the
Secretary determines the
difference described in item
(aa) is greater than the
threshold amount (as defined in
subclause (II)(dd)) for such
year, adjust the conversion
factor under this section for
such assumption correction
period by such amount to
reconcile such difference
(which may be positive or
negative), as determined by the
Secretary.
``(II) Definitions.--For purposes
of this clause:
``(aa) Assumption
correction period.--The term
`assumption correction period'
means, with respect to a year,
the second year beginning after
such year.
``(bb) Estimated
utilization.--The term
`estimated utilization' means
an estimate of utilization used
for purposes of applying clause
(ii)(II).
``(cc) Specified service.--
The term `specified service'
means, with respect to a year,
a service--
``(AA) with
expected expenditures
for such year under
this section based on
estimated utilization
that exceed the
threshold amount (as
defined in item (dd))
for such year; and
``(BB) for which
payment had been
bundled into payment
for another service
during the preceding
year and for which a
separate payment or
add-on payment is made
during such year.
``(dd) Threshold amount.--
The term `threshold amount'
means, with respect to a year,
0.1 percent of the total
estimated expenditures under
this part for services
furnished under this section
during such year.''.
(b) Nonapplication of Budget Neutrality to Reconciliation
Adjustments.--Section 1848(c)(2)(B) of the Social Security Act (42
U.S.C. 1395w-4(c)(2)(B)) is amended--
(1) in clause (iv)--
(A) in subclause (V), by striking ``and'' at the
end;
(B) in subclause (VI), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(VII) clause (vii)(I)(bb) for an
assumption correction period (as
defined in clause (vii)(II)) shall not
be taken into account in applying
clause (ii)(II) with respect to such
period.''; and
(2) in clause (v), by adding at the end the following new
subclause:
``(XII) Reductions attributable to
an assumption correction.--For an
assumption correction period (as
defined in clause (vii)(II)), reduced
expenditures attributable to
application of clause (vii)(I)(bb) with
respect to such period.''.
SEC. 403. TIMELY UPDATES TO DIRECT COSTS USED TO CALCULATE PRACTICE
EXPENSE RVUS.
Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by section 3, is further amended by adding at
the end the following new clause:
``(viii) Timely updates to direct costs
used to calculate practice expense relative
value units.--
``(I) Simultaneous updates to
direct cost inputs at least once every
5 years.--The Secretary shall, not less
often than every 5 years, update the
prices and rates, as applicable, on a
category-wide basis for each of the
categories of direct cost inputs
described in subclause (II) used in the
methodology for calculating the
practice expense relative value units
under this subsection for physicians'
services. Updates made pursuant to the
previous sentence shall be made in the
same year for all categories of direct
cost inputs described in such
subclause.
``(II) Direct cost inputs
categories described.--For purposes of
this clause, the categories of direct
cost inputs described in this subclause
are clinical staff wage rates, prices
of medical supplies, prices of
equipment, and any other category of
such inputs used in the methodology
described in subclause (I) (as
specified by the Secretary).
``(III) Consultation.--In making
the updates under this clause, the
Secretary shall consult with relevant
stakeholders, including physician
specialty societies.''.
SEC. 404. LIMITATION ON YEAR-TO-YEAR CONVERSION FACTOR VARIANCE.
Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by sections 3 and 4, is further amended by
adding at the end the following new clause:
``(ix) Limitation on conversion factor
variance.--
``(I) In general.--Beginning with
2027, the Secretary may not, for
purposes of complying with clause
(ii)(II), apply a budget neutrality
adjustment to a conversion factor
established under subsection (d) for
such year that would cause such factor,
not taking into account any adjustment
to such factor for such year provided
under such subsection, to vary by more
than 2.5 percent compared to such
factor so established for the preceding
year.
``(II) Continued applicability of
budget neutrality requirement.--Nothing
in subclause (I) may be construed to
alter the requirement described in
clause (ii)(II).''.
<all>Official legislative text sourced from the public record (cached on CivicsHQ).
Official source
View the original bill, actions, and full legislative record on Congress.gov.
Status
In Committee
- 1Introduced
- 2Committee
- 3Floor
- 4Passed
- 5Signed
Timeline reflects current normalized status only. Full action history is not yet stored in the API.
Sponsors
- Rep. Joyce, John [R-PA-13]RHousePA
Cosponsors
- Rep. Babin, Brian [R-TX-36]
- Rep. Barragán, Nanette Diaz [D-CA-44]
- Rep. Bera, Ami [D-CA-6]
- Rep. Biggs, Sheri [R-SC-3]
- Rep. Bilirakis, Gus M. [R-FL-12]
- Rep. Carter, Earl L. "Buddy" [R-GA-1]
- Rep. Conaway, Herbert C. [D-NJ-3]
- Rep. DelBene, Suzan K. [D-WA-1]
- Rep. Dexter, Maxine [D-OR-3]
- Rep. Dunn, Neal P. [R-FL-2]
- Rep. Fletcher, Lizzie [D-TX-7]
- Rep. Harris, Andy [R-MD-1]
- Rep. Harshbarger, Diana [R-TN-1]
- Rep. Kelly, Robin L. [D-IL-2]
- Rep. LaHood, Darin [R-IL-16]
- Rep. Landsman, Greg [D-OH-1]
- Rep. McCormick, Richard [R-GA-7]
- Rep. Miller-Meeks, Mariannette [R-IA-1]
- Rep. Miller, Carol D. [R-WV-1]
- Rep. Morrison, Kelly [D-MN-3]
- Rep. Murphy, Gregory F. [R-NC-3]
- Rep. Onder, Robert F. [R-MO-3]
- Rep. Panetta, Jimmy [D-CA-19]
- Rep. Schrier, Kim [D-WA-8]
- Rep. Sewell, Terri A. [D-AL-7]
- Rep. Suozzi, Thomas R. [D-NY-3]
- Rep. Trahan, Lori [D-MA-3]
- Rep. Van Drew, Jefferson [R-NJ-2]
- Rep. Van Duyne, Beth [R-TX-24]
- Rep. Veasey, Marc A. [D-TX-33]
Votes
Voting records are not yet available for this bill.