H.R. 7863

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7863 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 7863

To amend title XVIII of the Social Security Act to align payment under 
Medicare for specified surgical procedures with high-cost supplies 
furnished in office-based facilities, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 9, 2026

Mr. Bilirakis (for himself, Mr. Ruiz, Mr. Murphy, and Mr. Davis of 
Illinois) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, 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

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to align payment under 
Medicare for specified surgical procedures with high-cost supplies 
furnished in office-based facilities, and for other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Promoting Fairness for Medicare 
Providers Act of 2026''.

SEC. 2. ALIGNING PAYMENT UNDER MEDICARE FOR SPECIFIED HIGH SUPPLY COST 
SURGICAL PROCEDURES FURNISHED IN OFFICE-BASED FACILITIES.

(a) Coverage of Facility Services.--Section 1832(a)(2)(F) of the 
Social Security Act (42 U.S.C. 1395k(a)(2)(F)) is amended--
(1) in the matter preceding clause (i), by striking 
``specified by the Secretary'';
(2) in clause (i)--
(A) by inserting ``specified by the Secretary'' 
before ``pursuant''; and
(B) at the end, by striking ``or'';
(3) in clause (ii)--
(A) by inserting ``specified by the Secretary'' 
before ``pursuant''; and
(B) at the end, by striking the semicolon and 
inserting ``, or''; and
(4) by adding at the end the following new clause:
``(iii) that are specified high supply cost 
surgical procedures (as defined in section 
1834(bb)(4) with respect to a year (beginning 
with 2027) and furnished during such year in an 
office-based facility (as defined in section 
1834(bb)(5));''.
(b) Payment Rules.--
(1) Payment for facility services.--Section 1833(a)(1) of 
the Social Security Act (42 U.S.C. 1395l(a)) is amended--
(A) by striking ``and (HH)'' and inserting 
``(HH)''; and
(B) by inserting before the semicolon at the end 
the following ``, and (II) with respect to facility 
services furnished in connection with a specified high 
supply cost surgical procedure (as defined in section 
1834(bb)(4)) with respect to a year (beginning with 
2027) furnished to an individual in an office-based 
facility (as defined in section 1834(bb)(5)) during 
such year, the amounts paid shall be, subject to 
section 1834(bb)(3), 80 percent of the payment amount 
determined under section 1834(bb) for such facility 
services furnished in connection with such procedure at 
such office-based facility''.
(2) Payment determination for specified high supply cost 
surgical procedures furnished in office-based facilities.--
Section 1834 of the Social Security Act (42 U.S.C. 1395l(a)) is 
amended by adding at the end the following new subsection:
``(bb) Payment for Specified High Supply Cost Surgical Procedures 
Furnished in Office-Based Facilities.--
``(1) In general.--In the case of a specified high supply 
cost surgical procedure furnished in an office-based facility 
during 2027 or a subsequent year, subject to paragraphs (2) and 
(3), payment for such procedure shall be determined under this 
part in the same manner as payment would be determined under 
this part if such procedure had been furnished in an ambulatory 
surgical center and not considered office-based under section 
1833(i)(1)(B), except that payment for facility services 
furnished in connection with such procedure shall be equal to 
90 percent of the amount that would be payable for facility 
services furnished in connection with such procedure under 
section 1833(i) for such year if such procedure had been 
furnished in an ambulatory surgical center and treated as a 
service commonly furnished in such a center.
``(2) Application in case of device-intensive procedures.--
In applying paragraph (1) in the case of a specified high 
supply cost surgical procedure that is a device-intensive 
procedure (as described in section 416.171(b)(2) of title 42, 
Code of Federal Regulations (or any successor regulation)), 
instead of the payment amount applied under such paragraph, the 
payment amount for the facility services with respect to such 
procedure shall be the amount that would be calculated under 
section 416.172(h)(2)(ii) of title 42, Code of Federal 
Regulations (or any successor regulation) with respect to a 
procedure that has been assigned device-intensive status, 
except that in applying such calculation the non-device portion 
described in paragraph (B) of such section shall be equal to 90 
percent of the amount that would otherwise be calculated for 
such portion.
``(3) Limitation on copayment amount to inpatient hospital 
deductible amount.--
``(A) In general.--In no case shall the amount of 
coinsurance for facility services furnished in 
connection with a specified high supply cost surgical 
procedure in an office-based facility during a year 
exceed the amount of the inpatient hospital deductible 
established under section 1813(b) for that year.
``(B) Maintaining payment to provider.--In the case 
that an individual enrolled under this part would, 
without application of subparagraph (A), be subject to 
an amount of coinsurance for facility services 
furnished in connection with a specified high supply 
cost surgical procedure in an office-based facility 
during a year that exceeds the amount of the inpatient 
hospital deductible established under section 1813(b) 
for that year, the Secretary shall increase the amount 
paid to the office-based facility as specified under 
section 1833(a)(1)(II) for such facility services by 
the amount by which--
``(i) the coinsurance payable by the 
individual for such facility services without 
application of this paragraph; exceeds
``(ii) the coinsurance payable by the 
individual for such facility services with 
application of this paragraph.
``(4) Specified high supply cost surgical procedure 
defined.--
``(A) In general.--For purposes of this part, 
subject to subparagraphs (B) and (C), the term 
`specified high supply cost surgical procedure' means a 
surgical procedure that as of 2023--
``(i) when performed in an ambulatory 
surgical center, was payable under section 
1833(i); and
``(ii) when performed in a physician's 
office--
``(I) was payable under section 
1848 at the practice expense relative 
value unit-based amount for non-
facility sites of service; and
``(II) included a HCPCS code with a 
supply item for which the price input 
for such supply item, used for 
determining the practice expense 
relative value units for such code, was 
greater than $500.
``(B) Review and revisions to specified services.--
``(i) In general.--For each year (beginning 
with 2028), the Secretary shall review the 
procedures included in the definition of 
specified high supply cost surgical procedures 
under this paragraph and, based on such review 
and through rulemaking--
``(I) shall add a surgical 
procedure (not described in 
subparagraph (A)) for inclusion in such 
definition if the procedure, with 
respect to such year, satisfies the 
criteria specified in clause (ii); and
``(II) may remove a surgical 
procedure from inclusion in such 
definition if the procedure, with 
respect to such year, satisfies the 
criteria specified in clause (iii).
``(ii) Criteria for required inclusion.--
For purposes of clause (i)(I), a surgical 
procedure satisfies the criteria specified in 
this clause, with respect to a year, if--
``(I) when performed in an 
ambulatory surgical center, the 
procedure is payable under section 
1833(i); and
``(II) when performed in a 
physician's office, the procedure--
``(aa) would be, without 
application of this subsection 
or section 1833(a)(i)(II), 
payable under section 1848 at 
the practice expense relative 
value unit-based amount for 
non-facility sites of services; 
and
``(bb) includes a HCPCS 
code with a supply item for 
which the price input for such 
supply item, used for 
determining the practice 
expense relative value units 
for such code, is greater than 
the threshold specified in 
clause (iv) for such year.
``(iii) Criteria for permissive removal.--
For purposes of clause (i)(II), a surgical 
procedure satisfies the criteria described in 
this clause, with respect to a year, if, when 
performed in a physician's office, the 
procedure includes a HCPCS code with a supply 
item for which the price input for such supply 
item, used for determining the practice expense 
relative value units for such code, does not 
exceed the amount equal to 80 percent of the 
threshold specified in clause (iv) for such 
year.
``(iv) Dollar amount threshold specified.--
For purposes of clauses (ii) and (iii), the 
threshold specified in this clause is--
``(I) with respect to 2028, the 
dollar amount specified in subparagraph 
(A)(ii), reduced by the percentage 
increase in the MEI (as defined in 
section 1842(i)(3)) over the 3-year 
period ending with 2028; or
``(II) with respect to a subsequent 
year, the amount specified in this 
clause for the preceding year reduced 
by the percentage increase in the MEI 
(as defined in section 1842(i)(3)) for 
such subsequent year.
``(C) Special rule for use of more than one of the 
same supply item in a procedure.--In the case of a 
surgical procedure that requires the use of more than 
one of the same supply item in such procedure--
``(i) in applying subparagraph (A)(ii)(II), 
if as of 2023 the sum of the price inputs 
described in such subparagraph of all of such 
same supply items exceeds the dollar amount 
specified in such subparagraph, then the 
procedure shall be treated as satisfying the 
requirement of such subparagraph; and
``(ii) in applying subparagraph (B), with 
respect to 2028 or a subsequent year--
``(I) if the sum of the price 
inputs described in clause (ii)(II)(bb) 
of such subparagraph of all of such 
same supply items exceeds the threshold 
specified in clause (iv) of such 
subparagraph for such year, then the 
procedure shall be treated as 
satisfying the criterion described in 
such clause (ii)(II)(bb) with respect 
to such year; and
``(II) if the sum of the price 
inputs described in clause (iii) of 
such subparagraph of all of such same 
supply items does not exceed the amount 
described in such clause for such year, 
then the procedure shall be treated as 
satisfying the criteria described in 
such clause with respect to such year.
``(5) Office-based facility defined.--For purposes of this 
part, the term `office-based facility' means a physician's 
office that, with respect to facility services furnished in 
connection with specified high supply cost surgical 
procedures--
``(A) meets health, safety, and other standards 
specified by the Secretary in regulations; and
``(B) has entered into an agreement with the 
Secretary under which the physician's office--
``(i) accepts the payment amount determined 
under this subsection as full payment for such 
facility services;
``(ii) accepts an assignment described in 
section 1842(b)(3)(B)(ii) with respect to 
payment for all such facility services 
furnished by the office to individuals enrolled 
under this part; and
``(iii) participates under this part and is 
paid as an office-based facility with respect 
to all such procedures.''.
(3) Conforming amendments.--
(A) For services furnished in an ambulatory 
surgical center.--Section 1833(i)(2) of the Social 
Security Act (42 U.S.C. 1395l(i)(2)) is amended by 
adding at the end the following new subparagraph:
``(F) For purposes of determining payment under 
this subsection for a specified high supply cost 
surgical procedure (as defined in section 1834(bb)(4) 
with respect to a year (beginning with 2027)) furnished 
in an ambulatory surgical center during such year, such 
procedure shall be treated as a service commonly 
furnished in an ambulatory surgical center.''.
(B) For services furnished in an off-campus 
outpatient department of a provider.--Section 
1833(t)(21)(C) of the Social Security Act (42 U.S.C. 
1395l(t)(21)(C)) is amended by adding at the end the 
following new sentence: ``In applying the previous 
sentence in the case of a specified high supply cost 
surgical procedure (as defined in section 1834(bb)(4) 
with respect to a year) furnished by an off-campus 
outpatient department of a provider, payment shall be 
determined under section 1834(bb).''.
(C) For clarification on applicable payment for obf 
facility services.--Section 1833(a)(4) of the Social 
Security Act (42 U.S.C. 1395l(a)(4)) is amended by 
inserting ``(other than in clause (iii) of such 
section)'' after ``section 1832(a)(2)(F)''.
(c) Provider Agreement and Medicare Enrollment.--
(1) In general.--Section 1866(e) of the Social Security Act 
(42 U.S.C. 1395cc(e)) is amended--
(A) in paragraph (2), by striking at the end 
``and'';
(B) in paragraph (3), at the end, by striking the 
period and adding ``; and''; and
(C) by adding at the end the following new 
paragraph:
``(4) an office-based facility (as defined in paragraph (5) 
of section 1834(bb)), but only with respect to the furnishing 
during a year of specified high supply cost surgical procedures 
(as defined in paragraph (4) of such section with respect to 
such year).''.
(2) Consultation with state agencies regarding conditions 
of participation.--Section 1863 of the Social Security Act (42 
U.S.C. 1395z) is amended by striking ``or by ambulatory 
surgical centers under section 1832(a)(2)(F)(i)'' and inserting 
``by ambulatory surgical centers under section 
1832(a)(2)(F)(i), or by office-based facilities (as defined in 
section 1834(bb)(5)) with respect to furnishing specified high 
supply cost surgical procedures (as defined in section 
1834(bb)(4))''.
(3) Use of state agencies to determine compliance with 
conditions of participation.--Section 1864(a) of the Social 
Security Act (42 U.S.C. 1395aa(a)) is amended--
(A) in the first sentence, by inserting ``or 
whether a physician's office is an office-based 
facility (as defined in section 1834(bb)(5),'' after 
``standards specified under section 
1832(a)(2)(F)(i),''; and
(B) in the fifth sentence, by inserting ``office-
based facility (as defined in section 1834(bb)(5)) with 
respect to furnishing ambulatory high supply cost 
surgical procedures (as defined in section 
1834(bb)(4)),'' after each occurrence of ``ambulatory 
surgical center,''.
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