Efficiency Adjustment Delay Act
- Bill Number
- H.R. 7520
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-02-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-07-01T08:09:12Z
AI-Generated Summary
Purpose
The Efficiency Adjustment Delay Act (H.R. 7520) aims to postpone a planned reduction in Medicare payments to physicians by delaying an "efficiency adjustment" to work relative value units (RVUs)—a measure used to calculate physician payment rates under the Medicare program—until at least 2030. This gives time for further review and ensures any future changes are evidence-based and consultative.
Key Provisions
- Delay of Efficiency Adjustment: Prohibits the Secretary of Health and Human Services (HHS) from implementing the efficiency adjustment policy (from a November 5, 2025, final rule) before January 1, 2030. This adjustment would reduce RVUs and update time estimates for certain physician services to reflect efficiencies gained from technology or practice changes.
- Congressional Report: Within two years of enactment, HHS must submit a report to key congressional committees (Energy and Commerce, Ways and Means in the House; Finance in the Senate) assessing the need for a one-time, across-the-board RVU adjustment for services not recently reviewed (within the prior 10 years). The report must include supporting evidence.
- Conditions for Future Implementation: If the report supports the adjustment, it can only proceed on or after January 1, 2030, under these rules:
- Consultation with affected physician specialty groups.
- Exclusion of services revalued or reviewed in the prior 10 years.
- Use of a calculation method that avoids certain productivity factors unless Medicare payment updates keep pace with inflation (measured by the Consumer Price Index for urban consumers).
- The adjustment can only be applied once.
- Preservation of Other Updates: The delay does not stop HHS from revaluing inaccurate service codes or assigning values to new or revised services.
- Conversion Factor Adjustments: Modifies annual updates to Medicare's conversion factors (multipliers that determine overall payment levels):
- For 2026: Qualifying Alternative Payment Model (APM) conversion factor update increases to 1.24%; nonqualifying to 0.74%.
- For 2027 and later: Qualifying APM update at 0.75%; nonqualifying at 0.25%.
Significant Changes to Existing Law
- Amends Section 1848(c) of the Social Security Act (governing the Medicare physician fee schedule) by adding a new paragraph delaying the 2025 rule's efficiency adjustment and imposing safeguards for any future version.
- Revises Section 1848(d)(20) to alter conversion factor update percentages for 2026 onward, effectively increasing short-term payment updates compared to prior law (which set lower rates like 0.75% and 0.25% starting in 2026). This offsets some payment reductions that would have occurred without the delay.
Potential Impacts
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS, part of HHS) faces delayed implementation of cost-saving measures, potentially increasing short-term Medicare spending by billions (as the adjustment aimed to curb payment growth). CMS must produce a detailed report and consult stakeholders, adding administrative workload.
- On Citizens: Medicare beneficiaries (primarily older adults and disabled individuals) may see stable or slightly higher physician access in the short term, as delayed cuts could prevent service reductions. However, long-term Medicare solvency might be affected if efficiencies are not eventually applied.
- On International Relations: No direct impacts, as this is a domestic healthcare funding issue.
Main Stakeholders Affected
- Physicians and Healthcare Providers: Primary beneficiaries of the delay, especially those in specialties with high-volume services (e.g., primary care, surgery) that would face payment cuts from the adjustment. Medical associations like the American Medical Association may influence consultations.
- Medicare Beneficiaries: Indirectly affected through potential changes in physician participation and service availability.
- Government Entities: CMS/HHS for implementation and reporting; congressional committees for oversight.
- Taxpayers: Bear costs of higher Medicare expenditures until 2030 or beyond.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens congressional oversight of administrative rulemaking by mandating reports and conditions, potentially limiting executive discretion under the Social Security Act. The "rule of construction" clause preserves CMS's authority for routine code updates, avoiding broader challenges to fee schedule flexibility.
- Constitutional: No direct issues; aligns with Congress's spending power under Article I and does not infringe on separation of powers, though it constrains agency action post-rulemaking.
- Political: Reflects bipartisan support (introduced by Reps. Estes and Suozzi) amid debates over Medicare sustainability versus provider reimbursements. Could influence future healthcare budget negotiations, as delaying cuts provides temporary relief but requires evidence for permanence, possibly sparking specialty-specific lobbying.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (12)
Rep. Suozzi, Thomas R. [D-NY-3], Rep. Mann, Tracey [R-KS-1], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Schmidt, Derek [R-KS-2], Rep. Foushee, Valerie P. [D-NC-4], Rep. Murphy, Gregory F. [R-NC-3], Rep. Correa, J. Luis [D-CA-46], Rep. Bean, Aaron [R-FL-4], Rep. Davis, Donald G. [D-NC-1], Rep. Salazar, Maria Elvira [R-FL-27], Rep. Pocan, Mark [D-WI-2], Rep. Rouzer, David [R-NC-7]
Recent Actions
- 2026-02-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-02-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-02-12: Introduced in House
- 2026-02-12: Introduced in House
Bill Versions
- Efficiency Adjustment Delay Act — issued 2026-02-12 — PDF (5 pages)