Provider Reimbursement Stability Act of 2026
This bill stabilizes how much Medicare pays doctors and clinics for patient care by preventing drastic year-to-year payment cuts. Starting in 2027, it caps annual payment rate swings caused by budget rules at 2.5 percent and adjusts future payments if government spending estimates turn out to be inaccurate. It also requires Medicare to update its calculations for medical equipment, supplies, and staff wages at least every five years to keep up with inflation.
What this bill touches.
Who it helps · who it burdens.
Who it helps
- Physicians and healthcare providers billing MedicareReceive more stable and predictable Medicare reimbursement rates through a 2.5 percent cap on annual budget neutrality payment factor changes (Sec. 5), regular 5-year updates to practice expense cost inputs like staff wages and equipment (Sec. 4), inflation adjustments to budget neutrality thresholds (Sec. 2), and reconciliation of utilization estimates (Sec. 3).
- Physician specialty societiesGain a formal consultation role requiring the Secretary of Health and Human Services to consult them when updating direct cost inputs for practice expenses every five years (Sec. 4).
Who it burdens
- Department of Health and Human Services (CMS)Takes on new administrative requirements to reconcile estimated versus actual utilization (Sec. 3), update direct cost inputs across all categories simultaneously at least every five years (Sec. 4), index budget neutrality thresholds to inflation (Sec. 2), and apply a 2.5 percent cap on annual conversion factor adjustments (Sec. 5).
The provisions, in plain language.
Updates the dollar threshold that triggers budget neutrality spending adjustments under the Medicare physician fee schedule, and requires this threshold to increase for inflation every five years starting in 2032.
Requires Medicare to compare estimated physician service use against actual use starting in 2027 and adjust payment rates two years later to pay back or recoup significant differences.
Requires Medicare to update the direct cost data used to calculate practice expenses—including clinical staff wages, medical supply prices, and equipment costs—simultaneously at least once every five years in consultation with medical specialty societies.
Caps annual budget neutrality adjustments to the Medicare physician payment conversion factor at no more than a 2.5 percent change from the prior year, starting in 2027.