What does Preamble of Provider Reimbursement Stability Act of 2026 do?

This bill aims to amend title XVIII of the Social Security Act. The stated purpose is to ensure stability for provider payments under the Medicare program.

What does SHORT TITLE. of Provider Reimbursement Stability Act of 2026 do?

This bill is formally titled the Provider Reimbursement Stability Act of 2026.

What does UPDATING THE BUDGET NEUTRALITY THRESHOLD. of Provider Reimbursement Stability Act of 2026 do?

This section amends Section 1848(c)(2)(B)(ii)(II) of the Social Security Act. It modifies the language related to the budget neutrality threshold. The threshold amount is adjusted based on a tiered system. For years before 2027, the amount is $20,000,000. In 2027, the amount increases to $54,300,000. For subsequent years, the amount equals the amount specified for the preceding year. Beginning in 2032, every fifth year, the Secretary will increase the amount by the cumulative percentage increase in the MEI applicable to physicians' services.

What does BUDGET NEUTRALITY CORRECTIONS RELATING TO ESTIMATED of Provider Reimbursement Stability Act of 2026 do?

This section amends Section 1848(c)(2)(B) of the Social Security Act to address budget neutrality corrections related to estimated utilization. It establishes a process where the Secretary determines the difference between expenditures based on estimated and actual utilization for specified services. If the difference exceeds a threshold amount (0.1% of total estimated expenditures), the Secretary can adjust the conversion factor to reconcile the difference. The 'assumption correction period' is defined as the second year beginning after the year in question. A 'specified service' is one with expected expenditures exceeding the threshold amount, and for which payment was previously bundled but is now separate. The amendments also specify that adjustments made under clause (vii)(I)(bb) should not be considered when applying clause (ii)(II) for the assumption correction period. Reductions attributable to an assumption correction are to be taken into account during the assumption correction period.

What does TIMELY UPDATES TO DIRECT COSTS USED TO CALCULATE PRACTICE of Provider Reimbursement Stability Act of 2026 do?

This section amends Section 1848(c)(2)(B) of the Social Security Act. It requires the Secretary to update prices and rates for direct cost inputs used to calculate practice expense relative value units (RVUs) at least once every 5 years. These updates must be made simultaneously for all categories of direct cost inputs. The categories of direct cost inputs include clinical staff wage rates, prices of medical supplies, and prices of equipment. The Secretary is required to consult with relevant stakeholders, including physician specialty societies, when making these updates.

What does LIMITATION ON YEAR-TO-YEAR CONVERSION FACTOR VARIANCE. of Provider Reimbursement Stability Act of 2026 do?

This section amends Section 1848(c)(2)(B) of the Social Security Act. Beginning in 2027, the Secretary is restricted from applying a budget neutrality adjustment to a conversion factor that would cause it to vary by more than 2.5 percent compared to the factor for the preceding year. This limitation does not alter the existing budget neutrality requirement.

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Provider Reimbursement Stability Act of 2026

Last updated: 3/30/2026 · Introduced: 3/30/2026

Author: Gregory Murphy (R-NC)

TL;DR (AI)

The bill adjusts the budget neutrality threshold for Medicare payments, increasing it to $54.3 million in 2027 and implementing a periodic increase based on the Medicare Economic Index (MEI).
To account for discrepancies between estimated and actual service utilization, the bill establishes a process allowing the Secretary to adjust Medicare conversion factors if the difference exceeds a specified percentage.
The bill mandates that the Secretary update direct cost inputs used to calculate practice expense RVUs, such as clinical staff wages and medical supply prices, at least once every five years.

119th Congressin committeeOfficial page

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Other Sections

Includes provisions on preamble, short title., and 4 more.

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