Sponsors (31)
Official title: To amend title XVIII of the Social Security Act to modify certain physician payments under the Medicare program.
Introduced July 15, 2026 by John Joyce · Last progress July 15, 2026
The bill increases payment predictability, transparency, and quality measurement support for Medicare while constraining payment growth and adding eligibility and reporting rules that could reduce provider revenue, raise federal costs, increase administrative burdens, and risk reduced access for some patients.
Medicare beneficiaries and clinicians will face more stable, predictable Medicare payment rates and provider revenue (monthly primary-care payments and caps on year-to-year conversion-factor changes), reducing sudden payment swings that can disrupt access and practice finances.
Medicare beneficiaries attributed to qualifying primary care suppliers will experience lower out-of-pocket costs for primary care because monthly payments to qualifying suppliers are not subject to cost sharing during 2027–2031.
CMS, HHS, GAO and MedPAC reporting requirements and new disclosure rules will increase transparency about payment changes, model savings, and measure selection—giving Congress, providers, and the public more information about impacts and rationale for adjustments.
Medicare beneficiaries risk losing in-office fee-for-service access if their provider opts into the monthly primary-care payment model and stops billing for designated services, potentially reducing choice and access to traditional visit-based care.
Physicians and other clinicians face lower Medicare payment growth and expanded negative adjustments (conversion-factor caps, MEI minus 1 adjustments, and more aggressive adjustment phases), which could squeeze provider revenue and accelerate consolidation.
Eliminating patient cost sharing for monthly payments shifts more costs onto the Part B SMI Trust Fund and federal spending, which could increase pressure on Part B premiums or long-term trust fund solvency.
Based on analysis of 5 sections of legislative text.
Reforms Medicare physician payment updates, creates a 2027–2031 hybrid monthly primary care payment, replaces MIPS with POINTS in 2032, and changes budget-neutrality and practice-expense rules.
Changes how Medicare updates the physician fee schedule conversion factor, creates a temporary hybrid monthly payment for primary care, replaces MIPS with a new outcomes-focused reporting system (POINTS) in 2032, and revises budget-neutrality and practice-expense rules. It also delays and adds conditions to advanced payment-model participation thresholds, increases reporting and rulemaking requirements for CMMI, and requires GAO reporting on specialty participation barriers. Major implementation dates include 2027 (conversion-factor update rules, hybrid primary care payment, practice-expense caps) and 2032 (POINTS replaces MIPS). The bill adds new reporting, measurement and reconciliation processes intended to stabilize payment updates and shift Medicare further toward value and prospective primary care payments while preserving overall budget neutrality rules with new limits and correction mechanisms.