Sponsors (4)
The bill reallocates Medicare payment to reward higher-performing clinicians and provides targeted incentives for some small practices, while imposing steep payment cuts and threshold-driven penalties that could financially strain lower-performing and resource-limited providers and introduce complexity for beneficiaries.
Medicare clinicians and hospitals that score above the performance threshold will receive a 25% higher DPPS multiplier beginning in 2028, increasing Medicare pay for higher-performing providers.
Small or under‑resourced practices that qualify in DPPS savings years will receive lump‑sum incentive payments to invest in care management, EHRs, and social‑needs supports.
Clinicians and practices will have a defined, predictable adjustment‑factor structure (fixed multipliers) for 2028 onward, improving payment transparency and helping practices plan budgets.
Medicare clinicians and practices scoring below the threshold face steep payment reductions — a 25% cut for some and up to a 50% payment rate for those treated as lowest scoring — which could threaten the financial viability of small or resource‑limited providers.
Linking conversion‑factor updates to the adjustment multipliers can reduce the effective update to physician fees and complicate beneficiary cost‑sharing calculations (despite a coinsurance hold‑harmless when the update is negative), potentially shifting costs to Medicare beneficiaries and taxpayers.
Capping the performance threshold at 75 points from 2028–2033 and using hard cutoffs may sharply penalize providers who fall just below the threshold and limit upward mobility for those close to the cutoff.
Based on analysis of 2 sections of legislative text.
Replaces MIPS with a DPPS framework and sets fixed performance multiplier rates for Medicare clinician payment adjustments starting in 2028.
Official title: To amend title XVIII of the Social Security Act to transform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule, and for other purposes.
Introduced April 30, 2026 by Mariannette Miller-Meeks · Last progress April 30, 2026
Establishes a new Data-driven Performance Payment System (DPPS) to replace the Merit-based Incentive Payment System (MIPS) for Medicare payment adjustments to clinicians, effective January 1, 2027. It requires the Department of Health and Human Services to treat existing references to MIPS as references to DPPS during a transition and changes how performance adjustment multipliers are set beginning for 2028 and later years. The bill restructures statutory language governing payment adjustments, renumbers subclauses for clarity, and replaces the previously used adjustment formula with a fixed multiplier schedule tied to composite performance scores (1.25, 1.0, 0.75, 0.5). Additional technical edits narrow the application window for some prior rules through 2027 and adjust statutory wording related to adjustment factors.