Medicare Physician Data-driven Performance Payment System Act of 2026

Bill Number: H.R. 8622
Origin Chamber: House
Congress: 119th Congress, Session 2
Policy Area: Health
Status: Introduced
Latest Action: 2026-04-30: 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.
Last Updated: 2026-07-07T08:05:53Z

AI-Generated Summary

Purpose

The Medicare Physician Data-driven Performance Payment System Act of 2026 aims to rename and reform the existing Merit-based Incentive Payment System (MIPS) under Medicare's physician payment rules into a simplified "Data-driven Performance Payment System" (DPPS). This change seeks to make payments more predictable, data-focused, and supportive of small or under-resourced practices while maintaining overall budget neutrality.

Key Provisions

Implementation and Naming (Effective January 1, 2027): Replaces MIPS with DPPS under section 1848(q) of the Social Security Act; includes a transition period to avoid confusion, during which old and new names are used interchangeably.
Payment Adjustment Factors:
Before 2028: Retains current MIPS rules.
From 2028 onward: Fixed multipliers applied to Medicare payments based on a physician's composite performance score relative to a threshold:

| Score Relative to Threshold | Adjustment Factor | |-----------------------------|-------------------| | Above threshold | +25% (1.25) | | Equal to threshold | 0% (1.0) | | Below threshold (not lowest)| -25% (0.75) | | Lowest possible score | -50% (0.5) |

Exemptions: No adjustment if overall payment update is negative or if physicians lack timely quarterly feedback reports on claims-based measures (e.g., patient attribution, services contributing to performance).
"Hold harmless" rule: Protects patients from higher coinsurance or deductibles due to physician penalties.
Performance Thresholds:
Capped at 75 points for 2028–2033 (extendable for emergencies like disasters or cyberattacks).
Post-2033: New methodology recommended by the Government Accountability Office (GAO) by December 31, 2029, considering impacts on small, rural, or underserved practices; includes optional gradual transition.
Budget Neutrality: From 2028, reduces bonuses for high performers to match penalties from low performers, ensuring no net cost increase to Medicare.
Incentives for Under-resourced Practices (from 2028):
Lump-sum payments to small practices (15 or fewer professionals) that submit data and attest to size.
Priority for rural areas, health professional shortage areas, medically underserved areas, or low-scoring practices.
Funded by "savings" from penalties exceeding bonuses; used for care improvements, electronic health records, or value-based care models.

Significant Changes to Existing Law

Simplification of Adjustments: Shifts from complex, score-scaled adjustments to fixed positive/negative multipliers starting 2028.
Threshold Reforms: Replaces mean/median-based thresholds with a cap and future data-driven methodology; adds emergency flexibility.
New Incentives: Introduces targeted funding for small practices from penalty savings, not previously available.
Feedback Requirements: Ties penalties to receipt of timely (within 60 days post-quarter) confidential reports on performance data.
Conforming updates to related Medicare payment formulas.

Potential Impacts

Government Agencies (HHS, Medicare): Requires rulemaking for thresholds/methodologies, feedback reports, and incentive distribution; maintains budget neutrality but adds administrative tasks like GAO consultations.
Physicians/Practices: More predictable rewards/penalties; small/rural practices gain extra support, potentially easing value-based care adoption.
Citizens (Medicare Beneficiaries): Possible quality/cost improvements via incentives; no direct cost increases due to neutrality and hold-harmless protections.
No International Relations Impact: Purely domestic Medicare policy.

Main Stakeholders

Physicians and Practices: Especially small (≤15 professionals), rural, shortage-area, or underserved providers who benefit from incentives and simplified rules.
Medicare Beneficiaries: Affected by physician performance incentives.
Federal Agencies: HHS Secretary (implements rules/feedback), GAO (recommends threshold methodology).
Congressional Committees: Energy and Commerce, Ways and Means (oversight).
Physician Organizations: Consulted on new methodologies.

Notable Legal, Constitutional, or Political Implications

Legal: Amends Social Security Act (title XVIII) to codify changes; relies on HHS rulemaking and GAO input for flexibility, reducing litigation risk via stakeholder consultations.
Constitutional: None identified; standard congressional authority over federal spending programs.
Political: Promotes "data-driven" shift to value-based care, supports small practices (potential rural/underserved voter appeal), and ensures no new spending via neutrality.

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

Sponsor

Rep. Miller-Meeks, Mariannette [R-IA-1]

Cosponsors (3)

Rep. Conaway, Herbert C. [D-NJ-3], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Morelle, Joseph D. [D-NY-25]

Recent Actions

2026-04-30: 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.
2026-04-30: 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.
2026-04-30: Introduced in House
2026-04-30: Introduced in House

Bill Versions

Medicare Physician Data-driven Performance Payment System Act of 2026 — issued 2026-04-30 — PDF (23 pages)