YourVoice.Now Summary
Average Household ImpactTransparency & AccountabilityMedicare's physician pay formula would get a higher adjustment trigger and a 2.5% cap on year-to-year swings.
Average Household Impact
- Budget-neutrality trigger threshold — Raised from $20 million to $54.3 million beginning in 2027
- Year-to-year conversion factor swings — Capped at 2.5 percent from budget-neutrality adjustments
Transparency & Accountability
- Mandatory repricing cycle — All direct cost inputs must be updated together at least every 5 years
- Utilization reconciliation — Medicare must true up estimated against actual use two years later
The details
Medicare's physician payment formula would be reworked to smooth out yearly swings. By law, changes to what Medicare pays for one service must be offset elsewhere so total spending stays flat. That offset kicks in once the change tops $20 million, a threshold set in 1989 and never raised. The bill lifts it to $54.3 million for 2027, holds it there, then indexes it every fifth year starting in 2032 to medical cost growth. Three other changes follow. Medicare would have to compare its projected use of a newly separated service against what actually happened, and correct the difference two years later. That correction would not itself trigger another offset. Medicare would also have to reprice all its direct cost inputs together — clinical staff wages, supply prices, and equipment prices — at least once every five years, after consulting specialty societies. Finally, no budget-neutrality adjustment could move the conversion factor more than 2.5 percent from one year to the next. For patients, the practical stake is whether physician practices can predict their Medicare revenue well enough to keep taking Medicare patients.
Congressional Summary
Provider Reimbursement Stability Act of 2026This bill allows for larger annual adjustments to the Medicare physician fee schedule. It also requires the Centers for Medicare & Medicaid Services (CMS) to make certain corrections to compensate for expenditures under the fee schedule that exceed a certain amount in a given year, and it limits how much certain adjustment factors may vary each year.Current law prohibits annual adjustments to the Medicare physician fee schedule that would result in a more than $20 million difference between the adjusted amount and the non-adjusted amount of total expenditures. The bill increases this threshold to $54.3 million beginning in 2027, with adjustments for inflation every five years beginning in 2032.Additionally, for certain services, the bill requires the CMS to determine the difference between expenditures based on estimated utilization of the service and expenditures based on actual utilization. If this difference exceeds a certain percentage of total expenditures under the fee schedule, the CMS must reconcile this difference by adjusting payments for the following year. This requirement applies to services for which payment was bundled with another service and there was a separate or add-on payment during the previous year.Finally, the CMS must update the prices and rates of each category of direct costs that affect payments (e.g., prices of equipment) at least every five years, with updates made to each category in the same year. The bill also prohibits the CMS from varying a certain adjustment factor by more than 2.5% each year.
Legislative Subjects
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2026-03-30
- Date Added
- 2026-07-29
- Source
- Congress.gov →
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