SMART Health Care Act

This bill makes several Medicare changes aimed at lowering costs, improving fairness, and helping rural patients. It tells Medicare to use two years of a person’s medical history when setting payments to Medicare Advantage plans starting in 2026, which is meant to make those payments more accurate. It also moves many hospital outpatient clinic prices toward what Medicare pays in a regular doctor’s office, with exceptions for emergency care and many rural hospitals; this begins for services on or after January 1, 2026 . The bill opens the door for more physician‑owned hospitals in rural areas to serve local residents, which could increase access to care close to home. It requires hospitals and clinics that get special drug discounts to pass those savings to patients at the counter and directs the government to enforce and publicly report on this, including adjusting certain Medicare payments to match the change . It also includes steps aimed at improving care quality in skilled nursing facilities.

Key points

• Who is affected: People with Medicare, especially those in Medicare Advantage; patients using hospital outpatient clinics; rural patients and providers; patients getting outpatient drugs from hospitals/clinics that receive drug discounts; residents in skilled nursing facilities .
• What changes: More accurate plan payments using two years of medical data; many hospital clinic services paid the same as in doctor offices (with emergency and rural exceptions); easier for physician‑owned hospitals to serve rural areas; discounted drug prices must be passed to patients, with enforcement and public reporting; actions to improve nursing home care quality .
• When: Most major payment changes start in 2026; the outpatient clinic pricing shift applies to services on or after January 1, 2026.