Provider Reimbursement Stability Act of 2026

Bill Number

H.R. 8163

Origin Chamber

House

Congress

119th Congress, Session 2

Policy Area

Health

Status

Introduced

Latest Action

2026-05-21: Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 44 - 0.

Last Updated

2026-06-26T20:06:53Z

AI-Generated Summary

Purpose

The Provider Reimbursement Stability Act of 2026 (H.R. 8163) aims to stabilize payments to healthcare providers under Medicare Part B, which covers physician services. It addresses fluctuations in payments caused by budget neutrality rules—requirements that keep total Medicare spending unchanged by adjusting payment rates if new services or estimates increase costs.

Key Provisions

• Updated Budget Neutrality Threshold (Sec. 2): Raises the threshold for triggering budget neutrality adjustments from $20 million to $54.3 million in 2027. The amount stays the same for 2028 and later years until 2032, then adjusts every fifth year based on the Medicare Economic Index (MEI), a measure of inflation in physicians' practice costs.
• Corrections for Estimated vs. Actual Utilization (Sec. 3): Starting in 2027, if estimated use of certain "specified services" (newly unbundled payments exceeding 0.1% of total Medicare spending) differs significantly from actual use, Medicare adjusts the payment conversion factor (a multiplier setting dollar amounts for services) two years later. These fixes are excluded from future budget neutrality calculations.
• Timely Updates to Practice Expense Costs (Sec. 4): Medicare must update prices for direct costs—like clinical staff wages, medical supplies, and equipment—used to calculate practice expense relative value units (RVUs, resource measures for payment) at least every 5 years, simultaneously across categories, after consulting physician groups.
• Limit on Annual Payment Swings (Sec. 5): From 2027, budget neutrality adjustments cannot cause the conversion factor to change by more than 2.5% from the prior year, though overall neutrality requirements remain.

Significant Changes to Existing Law

• Increases and indexes the budget neutrality threshold, previously fixed at $20 million.
• Introduces a new two-year correction process for utilization estimate errors, with exclusions from neutrality calculations.
• Mandates synchronized, periodic updates to practice expense inputs, which were previously less structured.
• Adds a 2.5% cap on year-to-year conversion factor changes due to neutrality, providing a buffer against sharp cuts.

Potential Impacts

• Government Agencies: Centers for Medicare & Medicaid Services (CMS) faces added administrative tasks for utilization corrections, cost updates, and capped adjustments, potentially increasing workload but improving payment accuracy.
• Citizens (Medicare Beneficiaries): Indirect benefits through more predictable provider payments, which may help maintain access to physician services without abrupt disruptions.
• Healthcare Providers: Greater payment stability reduces risk of large annual cuts, aiding financial planning for physician practices.
• No notable impacts on international relations.

Main Stakeholders Affected

• Physicians and Providers: Primary beneficiaries of stabilized Medicare reimbursements.
• CMS and HHS Secretary: Responsible for implementing changes, consultations, and calculations.
• Medicare Beneficiaries: Elderly and disabled patients relying on physician services.
• Physician Specialty Societies: Involved in consultations for cost updates.

Notable Legal, Constitutional, or Political Implications

• Legal: Amends Section 1848 of the Social Security Act (Medicare physician fee schedule rules) without altering core budget neutrality; ensures compliance through targeted fixes and caps.
• Constitutional: No apparent issues; operates within Congress's spending authority under Medicare.
• Political: Supports providers amid frequent payment cut concerns, backed by bipartisan sponsors; may reduce annual payment disputes but could pressure long-term Medicare spending neutrality.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Murphy, Gregory F. [R-NC-3]

Cosponsors (67)

Rep. Schneider, Bradley Scott [D-IL-10], Rep. Joyce, John [R-PA-13], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Onder, Robert F. [R-MO-3], Rep. Panetta, Jimmy [D-CA-19], Rep. Miller-Meeks, Mariannette [R-IA-1], Rep. Schrier, Kim [D-WA-8], Rep. Kelly, Robin L. [D-IL-2], Rep. Conaway, Herbert C. [D-NJ-3], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Miller, Carol D. [R-WV-1], Rep. Davis, Donald G. [D-NC-1], Rep. Scott, David [D-GA-13], Rep. Meuser, Daniel [R-PA-9], Rep. Lieu, Ted [D-CA-36], Rep. Sewell, Terri A. [D-AL-7], Rep. Scholten, Hillary J. [D-MI-3], Rep. Smucker, Lloyd [R-PA-11], Rep. Carbajal, Salud O. [D-CA-24], Rep. Titus, Dina [D-NV-1], Rep. Gonzalez, Vicente [D-TX-34], Rep. Goldman, Daniel S. [D-NY-10], Rep. Thompson, Glenn [R-PA-15], Rep. Babin, Brian [R-TX-36], Rep. Dunn, Neal P. [R-FL-2], Rep. Green, Al [D-TX-9], Rep. Moore, Gwen [D-WI-4], Rep. Miller, Max L. [R-OH-7], Rep. Tenney, Claudia [R-NY-24], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Boyle, Brendan F. [D-PA-2], Rep. Beatty, Joyce [D-OH-3], Rep. Johnson, Julie [D-TX-32], Rep. Estes, Ron [R-KS-4], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Thanedar, Shri [D-MI-13], Rep. Strickland, Marilyn [D-WA-10], Rep. Moore, Blake D. [R-UT-1], Rep. Goodlander, Maggie [D-NH-2], Rep. Jackson, Ronny [R-TX-13], Rep. Thompson, Bennie G. [D-MS-2], Rep. Carson, André [D-IN-7], Rep. Bera, Ami [D-CA-6], Rep. Lofgren, Zoe [D-CA-18], Rep. Bynum, Janelle S. [D-OR-5], Rep. LaHood, Darin [R-IL-16], Rep. Kennedy, Mike [R-UT-3], Rep. Gottheimer, Josh [D-NJ-5], Rep. Randall, Emily [D-WA-6], Rep. Kennedy, Timothy M. [D-NY-26] and 17 more

Recent Actions

• 2026-05-21: Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 44 - 0.
• 2026-05-21: Committee Consideration and Mark-up Session Held
• 2026-03-30: 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.
• 2026-03-30: 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.
• 2026-03-30: Introduced in House
• 2026-03-30: Introduced in House

Bill Versions

• Provider Reimbursement Stability Act of 2026 — issued 2026-03-30 — PDF (10 pages)