H.R. 8163

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8163 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 8163

To amend title XVIII of the Social Security Act to ensure stability for 
provider payments under the Medicare program.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 30, 2026

Mr. Murphy (for himself, Mr. Schneider, Mr. Joyce of Pennsylvania, Mr. 
Suozzi, Mr. Onder, Mr. Panetta, Mrs. Miller-Meeks, Ms. Schrier, and Ms. 
Kelly 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 ensure stability for 
provider payments under the Medicare program.

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 ``Provider Reimbursement Stability Act 
of 2026''.

SEC. 2. UPDATING THE BUDGET NEUTRALITY THRESHOLD.

Section 1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C. 
1395w-4(c)(2)(B)(ii)(II)) is amended--
(1) by striking ``Subject to'' and inserting the following:
``(aa) In general.--Subject 
to'';
(2) in item (aa), as inserted by paragraph (1), by striking 
``$20,000,000'' and inserting ``the amount specified in item 
(bb) for such year''; and
(3) by adding at the end the following new items:
``(bb) Amount specified.--
For purposes of item (aa), 
subject to item (cc), the 
amount specified in this item 
is--

``(AA) for years 
before 2027, 
$20,000,000;

``(BB) for 2027, 
$54,300,000; and

``(CC) for 2028 and 
each subsequent year, 
the amount specified in 
this item for the 
preceding year.

``(cc) Indexing limitation 
on annual adjustments.--For 
2032 and every subsequent fifth 
year, the Secretary shall 
increase the amount specified 
in item (bb) for such year by 
the cumulative percentage 
increase in the MEI (as defined 
in section 1842(i)(3)) 
applicable to physicians' 
services for each year 
occurring during the 5-year 
period ending on the last day 
of the preceding year.''.

SEC. 3. BUDGET NEUTRALITY CORRECTIONS RELATING TO ESTIMATED 
UTILIZATION.

(a) In General.--Section 1848(c)(2)(B) of the Social Security Act 
(42 U.S.C. 1395w-4(c)(2)(B)) is amended by adding at the end the 
following new clause:
``(vii) Budget neutrality corrections 
relating to estimated utilization.--
``(I) In general.--In the case of a 
budget neutrality adjustment applied 
pursuant to clause (ii)(II) for a year 
(beginning with 2027) that is 
determined in part using estimated 
utilization (as defined in subclause 
(II)(bb)) with respect to a specified 
service (as defined in subclause 
(II)(cc)), the Secretary shall, as part 
of the final rule establishing the 
physician fee schedule under this 
section for the assumption correction 
period (as defined in subclause 
(II)(aa)) with respect to such year--
``(aa) determine the 
difference between expenditures 
for such service in such year 
using estimated utilization and 
actual utilization for such 
service (in a manner determined 
appropriate by the Secretary); 
and
``(bb) in the case that the 
Secretary determines the 
difference described in item 
(aa) is greater than the 
threshold amount (as defined in 
subclause (II)(dd)) for such 
year, adjust the conversion 
factor under this section for 
such assumption correction 
period by such amount to 
reconcile such difference 
(which may be positive or 
negative), as determined by the 
Secretary.
``(II) Definitions.--For purposes 
of this clause:
``(aa) Assumption 
correction period.--The term 
`assumption correction period' 
means, with respect to a year, 
the second year beginning after 
such year.
``(bb) Estimated 
utilization.--The term 
`estimated utilization' means 
an estimate of utilization used 
for purposes of applying clause 
(ii)(II).
``(cc) Specified service.--
The term `specified service' 
means, with respect to a year, 
a service--

``(AA) with 
expected expenditures 
for such year under 
this part based on 
estimated utilization 
that exceed the 
threshold amount (as 
defined in item (dd)) 
for such year; and

``(BB) for which 
payment had been 
bundled into payment 
for another service 
during the preceding 
year and for which a 
separate payment or 
add-on payment is made 
during such year.

``(dd) Threshold amount.--
The term `threshold amount' 
means, with respect to a year, 
0.1 percent of the total 
estimated expenditures under 
this part for services 
furnished under this section 
during such year.''.
(b) Nonapplication of Budget Neutrality to Reconciliation 
Adjustments.--Section 1848(c)(2)(B) of the Social Security Act (42 
U.S.C. 1395w-4(c)(2)(B)) is amended--
(1) in clause (iv)--
(A) in subclause (V), by striking ``and'' at the 
end;
(B) in subclause (VI), by striking the period and 
inserting ``; and''; and
(C) by adding at the end the following new 
subclause:
``(VII) clause (vii)(I)(bb) for an 
assumption correction period (as 
defined in clause (vii)(II)) shall not 
be taken into account in applying 
clause (ii)(II) with respect to such 
period.''; and
(2) in clause (v), by adding at the end the following new 
subclause:
``(XII) Reductions attributable to 
an assumption correction.--For an 
assumption correction period (as 
defined in clause (vii)(II)), reduced 
expenditures attributable to 
application of clause (vii)(I)(bb) with 
respect to such period.''.

SEC. 4. TIMELY UPDATES TO DIRECT COSTS USED TO CALCULATE PRACTICE 
EXPENSE RVUS.

Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by section 3, is further amended by adding at 
the end the following new clause:
``(viii) Timely updates to direct costs 
used to calculate practice expense relative 
value units.--
``(I) Simultaneous updates to 
direct cost inputs at least once every 
5 years.--The Secretary shall, not less 
often than every 5 years, update the 
prices and rates, as applicable, on a 
category-wide basis for each of the 
categories of direct cost inputs 
described in subclause (II) used in the 
methodology for calculating the 
practice expense relative value units 
under this subsection for physicians' 
services. Updates made pursuant to the 
previous sentence shall be made in the 
same year for all categories of direct 
cost inputs described in such 
subclause.
``(II) Direct cost inputs 
categories described.--For purposes of 
this clause, the categories of direct 
cost inputs described in this subclause 
are clinical staff wage rates, prices 
of medical supplies, prices of 
equipment, and any other category of 
such inputs used in the methodology 
described in subclause (I) (as 
specified by the Secretary).
``(III) Consultation.--In making 
the updates under this clause, the 
Secretary shall consult with relevant 
stakeholders, including physician 
specialty societies.''.

SEC. 5. LIMITATION ON YEAR-TO-YEAR CONVERSION FACTOR VARIANCE.

Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by sections 3 and 4, is further amended by 
adding at the end the following new clause:
``(ix) Limitation on conversion factor 
variance.--
``(I) In general.--Beginning with 
2027, the Secretary may not, for 
purposes of complying with clause 
(ii)(II), apply a budget neutrality 
adjustment to a conversion factor 
established under subsection (d) for 
such year that would cause such factor, 
not taking into account any adjustment 
to such factor for such year provided 
under such subsection, to vary by more 
than 2.5 percent compared to such 
factor so established for the preceding 
year.
``(II) Continued applicability of 
budget neutrality requirement.--Nothing 
in subclause (I) may be construed to 
alter the requirement described in 
clause (ii)(II).''.
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