HR-9693 — Patients First Act of 2026

YourVoice.Now Summary

Your MoneyCorporate BenefitsTargeted & Unrelated ProvisionsTransparency & AccountabilityCivil Liberties

Medicare would drop the copay on primary care visits from 2027 through 2031, and tie doctors' yearly raises to medical inflation.

Your Money

Your share of doctor bills grows — faster fee raises from 2027

Today's law raises Medicare's doctor fee 0.25 percent a year from 2027, or 0.75 percent for doctors in group payment programs. The bill would tie the raise to a medical cost index minus one point, and you pay 20 percent of that fee, so a bigger fee means a bigger bill for you.

No copay for primary care visits — 2027 through 2031

From 2027 through 2031, Medicare would pay a primary care practice a flat monthly fee for each patient who picks it. Visits, care planning, video visits and phone or email advice from that practice would cost you nothing, if the practice joins and you are not in a Medicare Advantage plan.

Medicare drops planned advance approval for some scans

Current law tells Medicare to require advance approval for scans ordered by doctors who least often follow imaging guidelines. The bill would delete that requirement, replace it with a study due in 2031, and exempt mammograms, lung cancer scans, emergency imaging, and small or rural practices.

Corporate Benefits

Investor-owned practices lose half their Medicare bonus — from 2032

A practice counts as investor-owned if an outside company holds a stake or controls pay, staffing, coding, prices or contracts, unless the practice has 15 or fewer practitioners. From 2032 those practices would get half the bonus other practices get, and they could not join the new primary care payment plan.

Targeted & Unrelated Provisions

Doctors' groups gain control over Medicare quality measures — by 2032

A task force of at most 25 people, with a majority of practitioners and their professional groups and no more than three insurer representatives, would recommend the measures doctors are judged on. From 2032 Medicare could not use a specialty measure the task force has not recommended, and the registries that write measures would keep ownership of them.

Transparency & Accountability

Public comment required before Medicare ends a payment test

Medicare's innovation center would have to take public comment before it ends or changes a payment model it is testing. That gives patients and doctors a say, but it also makes it slower to stop a model that is not working.

Doctors get top marks on untested measures — from 2027

From 2027, a doctor who reports a measure that is new, recently changed, or has no benchmark would be scored as if the result were the best possible. Those scores are published on Medicare's Care Compare site, so a rating could look better than the care behind it.

Civil Liberties

Medicare claims records opened to private registries — by 2027

By 2027 Medicare would have to let doctor-run clinical registries request claims records, including statewide or nationwide files, and Medicaid records if officials agree. They would not have to qualify under the program that now screens outside groups asking for this data.

More about this bill

Medicare patients could stop paying anything out of pocket for primary care. Starting in 2027, family doctors, internists, geriatric doctors and pediatricians could join a new payment plan. Medicare would pay them a set amount each month for every patient who signs up. Office visits, care planning, video visits, and phone or email advice would carry no copay. The plan would run five years and end after 2031. Doctor fees would also grow faster than today's law allows. Current law raises Medicare doctor fees 0.25 percent a year from 2027. Doctors in group payment programs get 0.75 percent. The bill would instead tie the yearly raise to a medical cost index, minus one point. That index is running near 3 percent. You pay 20 percent of most doctor bills, so your share would grow with the fee. A third part would rebuild the scorecard Medicare uses to rate doctors. The program is called MIPS today and would be renamed POINTS in 2032. The most a doctor's pay can swing on that score would drop from 9 percent to 2 percent in 2027. It would climb back to 5 percent by 2034. A new task force, mostly doctors and their trade groups, would pick the measures. Practices owned by outside investors would lose half of any bonus starting in 2032. Medicare would also drop its plan to make some doctors get advance approval for scans. Doctor-run research groups could request Medicare claims records by 2027.

Congressional Summary

Patients First Act of 2026 This bill modifies payments and incentive programs under the Medicare physician fee schedule. The bill establishes a temporary program to provide hybrid payments for certain primary care services. Under the program, payments for services relating to care management, behavioral health integration, office-based evaluation and management (including telehealth), and communications (e.g., phone calls) are made on a monthly basis to providers for each individual that is attributed to the provider's practice. The monthly amount is based on the national average amount for such services. Providers may opt into the model; in order to qualify, providers must be owned or controlled by health care practitioners and must have had the majority of their prior year's payments consist of payments for the covered services. The bill also renames the Merit-based Incentive Payment System (MIPS) and modifies the program to include performance measures relating to care efficiency (e.g., reducing avoidable hospitalizations). (MIPS is an incentive program under Medicare that allows health professionals to receive payment adjustments based on certain performance measures.) The bill generally reduces the program's performance-based payment adjustments, including positive adjustments for providers that are not owned or controlled by health care practitioners. Finally, the bill allows for larger annual adjustments to the Medicare physician fee schedule and bases these adjustments on inflation. It also requires 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.

Details

Congress: 119th
Chamber: House
Status: summarized
Action: Introduced in House
Action Date: 2026-07-15
Date Added: 2026-09-15
Source: Congress.gov →

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