Medicare Payment Integrity Enhancement Act of 2026
- Bill Number
- H.R. 8804
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-05-13: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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
- 2026-06-24T15:51:12Z
AI-Generated Summary
Medicare Payment Integrity Enhancement Act of 2026 (H.R. 8804)
Purpose
This legislation amends the Social Security Act to expand the authority of recovery audit contractors under the Medicare program. It allows these contractors to conduct prepayment reviews of claims in addition to their existing postpayment activities, with the goal of preventing improper payments before they occur.
Key Provisions
- Expansion of Contractor Roles: Recovery audit contractors may now perform prepayment reviews of Medicare claims for payment under title XVIII.
- Payment Methodology: Contractors receive compensation based on a Secretary-established system that accounts for the amount of improper payments prevented and incentivizes timely, accurate reviews without undue focus on specific claim types.
- Contract Requirements: New contracts for prepayment reviews must be established no later than one year after enactment.
- Reporting and Oversight: The Secretary must evaluate contractor performance on prepayment reviews, and annual reports to Congress will include data on these activities.
- Funding Mechanism: Payments for prepayment reviews are funded through transfers from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to the Centers for Medicare & Medicaid Services Program Management Account, allocated based on relative improper payments prevented under Medicare Parts A and B.
- Regulatory Implementation: The Secretary must issue rules within one year describing the payment methodology and how savings from prepayment reviews are calculated.
Significant Changes to Existing Law
- Section 1893(h) of the Social Security Act is modified to include prepayment review authority, altering existing language on overpayment recoupment to encompass prevention of payments.
- Payment structures for contractors are updated to shift from postpayment focus to include incentives tied to prevented improper payments.
- New paragraph (11) is added to address dedicated funding for prepayment activities, and paragraph (7) is expanded to cover prepayment reviews in overpayment definitions.
- Existing timelines and reporting requirements are extended to cover the new prepayment functions.
Potential Impacts
- Government Agencies: Increases administrative responsibilities for the Department of Health and Human Services and the Centers for Medicare & Medicaid Services in contracting, oversight, and funding allocation.
- Citizens: May affect Medicare beneficiaries and providers through earlier claim reviews, potentially reducing delays or denials for certain payments while aiming to curb improper expenditures.
- International Relations: No direct effects identified in the legislation.
Main Stakeholders Affected
- Recovery audit contractors, who gain expanded contractual opportunities.
- Medicare providers and suppliers, whose claims may undergo prepayment scrutiny.
- The Centers for Medicare & Medicaid Services and trust fund administrators, responsible for implementation and funding.
- Medicare beneficiaries, indirectly through program integrity measures.
Notable Legal, Constitutional, or Political Implications
- The bill introduces performance-based incentives for contractors, which could raise questions about administrative discretion in payment methodologies.
- Funding transfers between trust funds are authorized based on relative savings, requiring proportional allocation determinations by the Secretary.
- No explicit constitutional issues are addressed in the text; the legislation operates within existing Medicare statutory framework under title XVIII.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2026-05-13: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2026-05-13: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2026-05-13: Introduced in House
- 2026-05-13: Introduced in House
Bill Versions
- Medicare Payment Integrity Enhancement Act of 2026 — issued 2026-05-13 — PDF (5 pages)