S-5180 — Provider Reimbursement Stability Act of 2026

YourVoice.Now Summary

Corporate BenefitsTransparency & Accountability

Medicare's doctor-payment formula would get guardrails — no more than a 2.5 percent swing a year.

Corporate Benefits

Steadier Medicare pay for doctors — yearly swings capped from 2028

Starting in 2028, the rebalancing math could not move Medicare's base payment rate more than 2.5 percent up or down from the year before.

Trigger point for across-the-board Medicare cuts — raised to $57.6 million

Today Medicare must rebalance all of its rates when a change shifts more than $20 million. That trip wire would rise to about $57.6 million in 2028, then adjust every five years starting in 2033.

Transparency & Accountability

Correction when Medicare's spending estimates miss — reconciled two years later

When Medicare guesses how often a newly separate service will be used and the guess is off by enough, it would have to true up the rate two years later.

More about this bill

Most people on Medicare would not notice a change at the doctor's office. The bill reworks how Medicare sets what it pays doctors. The goal is to keep that rate from swinging sharply year to year. From 2028, the yearly change could not move the base rate more than 2.5 percent. The dollar trigger that forces Medicare to reset every rate would rise from $20 million to about $57.6 million. Medicare would also have to fix its spending guesses two years later, and update its cost figures at least every five years.

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 $57.64 million beginning in 2028, with adjustments for inflation every five years beginning in 2033.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.

Details

Congress: 119th
Chamber: Senate
Status: summarized
Action: Introduced in Senate
Action Date: 2026-07-30
Date Added: 2026-08-25
Source: Congress.gov →

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