Provider Reimbursement Stability Act of 2026

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8163 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 8163

To amend title XVIII of the Social Security Act to ensure stability for
             provider payments under the Medicare program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             March 30, 2026

Mr. Murphy (for himself, Mr. Schneider, Mr. Joyce of Pennsylvania, Mr.
Suozzi, Mr. Onder, Mr. Panetta, Mrs. Miller-Meeks, Ms. Schrier, and Ms.
Kelly of Illinois) 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 ensure stability for
             provider 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 ``Provider Reimbursement Stability Act
of 2026''.

SEC. 2. 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 2027,
                                                $20,000,000;

                                                    ``(BB) for 2027,
                                                $54,300,000; and

                                                    ``(CC) for 2028 and
                                                each subsequent year,
                                                the amount specified in
                                                this item for the
                                                preceding year.

                                            ``(cc) Indexing limitation
                                        on annual adjustments.--For
                                        2032 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. 3. 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 2027) 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 part 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. 4. 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. 5. 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).''.
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