H.R. 8163 · In committee · Health
Provider Reimbursement Stability Act of 2026
Sponsor: Gregory F. Murphy (R-NC)
What it does
- Raises the threshold for annual Medicare physician fee schedule adjustments from a $20 million expenditure difference to $54.3 million beginning in 2027, with inflation adjustments every five years from 2032.
- Requires CMS to compare estimated and actual utilization for certain services and reconcile any difference exceeding a set share of total spending through payment adjustments the following year.
- Applies that reconciliation to services bundled with another service that had a separate or add-on payment the prior year.
- Requires CMS to update the prices and rates for each category of direct costs affecting payments, such as equipment, at least every five years.
Official summary
Provider Reimbursement Stability Act of 2026 This 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…
Latest action
May 21, 2026: Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 44 - 0.
Committee: House Ways and Means