H.R. 8622

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8622 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 8622

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.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

April 30, 2026

Mrs. Miller-Meeks (for herself and Mr. Conaway) 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 transform the Merit-
based Incentive Payment System into the Data-driven Performance Payment 
System under the Medicare physician fee schedule, 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 ``Medicare Physician Data-driven 
Performance Payment System Act of 2026''.

SEC. 2. TRANSFORMING THE MERIT-BASED INCENTIVE PAYMENT SYSTEM INTO THE 
DATA-DRIVEN PERFORMANCE PAYMENT SYSTEM.

(a) Implementation of the Data-driven Performance Payment System.--
(1) In general.--Effective January 1, 2027, there is 
established the Data-driven Performance Payment System, which 
shall consist of the payment system under section 1848(q) of 
the Social Security Act (42 U.S.C. 1395w-4(q)), including as 
amended by this section.
(2) References.--Subject to paragraph (3), any reference to 
the payment system under section 1848(q) of the Social Security 
Act (42 U.S.C. 1395w-4(q)), including the terms ``Merit-based 
Incentive Payment System'' and ``MIPS'', shall be deemed a 
reference to the ``Data-driven Performance Payment System'' and 
``DPPS'', respectively.
(3) Transition.--In order to provide for an orderly 
transition and avoid provider confusion, the Secretary of 
Health and Human Services shall provide for an appropriate 
transition in the use of the terms ``Merit-based Incentive 
Payment System'' (and ``MIPS'') and ``Data-driven Performance 
Payment System'' (and ``DPPS'') in reference to the payment 
system under section 1848(q) of the Social Security Act (42 
U.S.C. 1395w-4(q)). Before the completion of such transition, 
any reference to the ``Data-driven Performance Payment System'' 
(or ``DPPS'') shall be deemed to include a reference to the 
``Merit-based Incentive Payment System''.
(b) Reforming Application of Adjustment Factors.--
(1) In general.--Section 1848(q)(6) of the Social Security 
Act (42 U.S.C. 1395w-4(q)(6)) is amended--
(A) in subparagraph (A)--
(i) by inserting ``for years before 2028,'' 
after ``Taking into account paragraph 
(1)(G),'';
(ii) in clause (ii)--
(I) in subclause (I), by striking 
``clause (iii)'' and inserting 
``subclause (III)'';
(II) in subclause (II), by striking 
``clause (iv)'' and inserting 
``subclause (IV)''; and
(III) by redesignating subclauses 
(I) and (II) as items (aa) and (bb), 
respectively, and adjusting the margins 
accordingly;
(iii) in clause (iii), by striking ``clause 
(ii)(I)'' and inserting ``subclause (II)(aa)'';
(iv) in clause (iv)--
(I) by striking ``subclause (II)'' 
and inserting ``item (bb)'';
(II) by striking ``clause 
(ii)(II)'' and inserting ``subclause 
(II)(bb)''; and
(III) by redesignating subclauses 
(I) and (II) as items (aa) and (bb), 
respectively, and adjusting the margins 
accordingly;
(v) by redesignating clauses (i) through 
(iv) as subclauses (I) through (IV) and 
adjusting the margins accordingly;
(vi) by striking ``Taking into account'' 
and inserting the following:
``(i) Adjustment factors for years before 
2028.--Taking into account''; and
(vii) by adding at the end the following 
new clause:
``(ii) Adjustment factors for 2028 and 
subsequent years.--For 2028 and each subsequent 
year, the DPPS adjustment factor specified 
under this subparagraph for a DPPS eligible 
professional for such year shall be equal to--
``(I) subject to subparagraph 
(F)(v), in the case of a DPPS eligible 
professional with a composite 
performance score for such year above 
the performance threshold established 
under subparagraph (D) for such year, 
1.25;
``(II) in the case of a DPPS 
eligible professional with a composite 
performance score for such year equal 
to such performance threshold, 1;
``(III) in the case of a DPPS 
eligible professional not described in 
subclause (IV) with a composite 
performance score for such year below 
such performance threshold, 0.75; and
``(IV) in the case of a DPPS 
eligible professional who is treated 
under paragraph (5)(B)(i) as achieving 
the lowest potential score applicable 
to each applicable measure or activity 
that is required to be reported by the 
professional for such year, 0.5.'';
(B) in subparagraph (B)(iv), by striking ``and 
subsequent years'' and inserting ``and each subsequent 
year through 2027'';
(C) in subparagraph (D)(i), by striking ``that are 
positive, negative, and zero''; and
(D) in subparagraph (E)--
(i) by inserting ``and ending with 2027'' 
after ``beginning with 2019'';
(ii) in clause (ii)--
(I) by striking ``subparagraph 
(A)'' and inserting ``subparagraph 
(A)(i)''; and
(II) by redesignating subclauses 
(I) and (II) as items (aa) and (bb), 
respectively;
(iii) by redesignating clauses (i) and (ii) 
as subclauses (I) and (II), respectively;
(iv) by striking ``In the case of'' and 
inserting the following:
``(i) Application of adjustment factors for 
years before 2028.--In the case of''; and
(v) by adding at the end the following new 
clause:
``(ii) Application of adjustment factors 
for 2028 and subsequent years.--
``(I) In general.--In the case of 
covered professional services (as 
defined in subsection (k)(3)(A)) 
furnished by a DPPS eligible 
professional during a year (beginning 
with 2028), subject to subclauses (II) 
and (III), for purposes of determining 
the amount paid under this part with 
respect to such covered professional 
services and DPPS eligible professional 
for such year, the update to the 
nonqualifying APM conversion factor 
established under subsection (d) 
applicable to such services and such 
professional for such year shall be 
multiplied by the adjustment factor 
specified under subparagraph (A)(ii) 
with respect to such professional and 
such year.
``(II) Nonapplication to certain 
updates.--Subclause (I) shall not apply 
with respect to covered professional 
services furnished during a year in the 
case that the update to the conversion 
factor described in such subclause for 
such year is less than 0 percent.
``(III) Nonapplication of certain 
adjustment factors for lack of timely 
feedback reports.--
``(aa) In general.--
Subclause (I) shall not apply 
with respect to covered 
professional services furnished 
by a DPPS eligible professional 
during a year if the DPPS 
eligible professional does not 
receive timely feedback in 
accordance with item (bb) with 
respect to each quarter of the 
performance period for such 
year and would, without 
application of this item, 
otherwise be subject to the 
DPPS adjustment factor 
described in subparagraph 
(A)(ii)(III) for such year.
``(bb) Timely feedback 
described.--For purposes of 
item (aa), a DPPS eligible 
professional receives timely 
feedback in accordance with 
this item with respect to a 
quarter of a performance period 
if, not later than the date 
that is 60 days after the last 
day of such quarter, such 
professional receives the 
confidential feedback required 
under paragraph (12) on the 
performance of such 
professional during such 
quarter with respect to 
administrative claims-based 
measures included in the 
performance categories 
described in subparagraph 
(A)(i)(II) of such paragraph, 
including--

``(AA) a 
description of the 
patients and episodes 
attributed with respect 
to such measures for 
purposes of assessing 
the performance of such 
professional during 
such quarter;

``(BB) an 
identification of the 
items and services 
furnished by such 
professional or another 
individual that will 
contribute to the 
assessment of the 
performance of such 
professional during 
such quarter with 
respect to such 
measures; and

``(CC) an 
identification of 
whether each item or 
service identified 
under subitem (BB) for 
the quarter was 
furnished by such 
professional or another 
individual (and, in the 
case that the 
performance of such 
professional for such 
quarter with respect to 
such measures is 
assessed based on 
participation in a 
group practice or other 
group, whether each 
such item or service 
was furnished by such 
professional, another 
individual in such 
group, or another 
individual outside of 
such group).

``(IV) Hold harmless.--In computing 
the amount of any coinsurance under 
section 1833(a)(1) and the expenses 
incurred for applying the deductible 
under section 1833(b) with respect to 
covered professional services furnished 
by a DPPS eligible professional for a 
year, such coinsurance and incurred 
expenses shall be computed as if the 
update to the conversion factor 
applicable to such services and 
professional for such year were not 
subject to the adjustment factor under 
subclause (I).''.
(2) Conforming amendment.--Section 1848(d)(20) of the 
Social Security Act (42 U.S.C. 1395w-4(d)(20)) is amended by 
inserting ``, subject to subsection (q)(6)(E)(ii),'' before 
``the update to the nonqualifying APM conversion factor''.
(c) Reforming Performance Thresholds.--Section 1848(q)(6)(D) of the 
Social Security Act (42 U.S.C. 1395w-4(q)(6)(D)) is amended--
(1) in clause (i), by striking ``clauses (iii) and (iv)'' 
and inserting ``clauses (iii) through (vi)''; and
(2) by adding at the end the following new clauses:
``(v) Temporary extension of special 
rules.--
``(I) In general.--With respect to 
each of 2028 through 2033 (or such 
later year as determined by the 
Secretary pursuant to subclause (II)), 
the Secretary shall establish a 
performance threshold for purposes of 
determining DPPS adjustment factors 
under subparagraph (A) for such year in 
accordance with the requirements 
described in clause (iii), except that 
such performance threshold may not be 
greater than 75 points.
``(II) Flexibility to extend 
special rule.--In the case that 
extraordinary circumstances, including 
a natural disaster, a public health 
emergency, or cybersecurity incident, 
affect reporting, data collection, or 
the assessment of performance under 
this subsection for 2034, the Secretary 
may extend the application of subclause 
(I) until the first year for which such 
extraordinary circumstances do not 
affect reporting, data collection, or 
assessment of performance under this 
subsection (as determined by the 
Secretary).
``(III) Optional transition 
period.--With respect to the year 
immediately following the last year 
with respect to which subclause (I) 
applies (after application of subclause 
(II), if applicable), the Secretary 
may, pursuant to notice and comment 
rulemaking, establish a performance 
threshold for purposes of determining 
DPPS adjustment factors under 
subparagraph (A) for such year and such 
subsequent consecutive years as 
specified by the Secretary in a manner 
that provides for a gradual and 
incremental transition from the 
performance threshold established under 
subclause (I) to the performance 
threshold established under clause 
(vi).
``(vi) Replacement performance threshold.--
``(I) In general.--With respect to 
the year immediately following the last 
year with respect to which clause (v) 
applies and each subsequent year, the 
performance threshold established under 
this subparagraph for purposes of 
determining DPPS adjustment factors 
under subparagraph (A) shall be 
computed in accordance with the 
replacement performance threshold 
methodology established by the 
Secretary under in subclause (II).
``(II) Replacement performance 
threshold methodology.--For purposes of 
subclause (I), the Secretary shall, 
pursuant to notice and comment 
rulemaking and based on the 
recommendations submitted under 
subclause (III), establish a 
methodology (referred to in this clause 
as the `replacement performance 
threshold methodology') to be used 
instead of the mean or median described 
in clause (i) for computing the 
performance threshold applied under 
this subparagraph.
``(III) Recommendations for 
replacement performance threshold 
methodology.--Not later than December 
31, 2029, the Comptroller General of 
the United States shall, in accordance 
with subclause (IV), submit to Congress 
and the Secretary a report including 
detailed recommendations on a 
methodology to be used instead of the 
mean or median described in clause (i) 
for computing the performance threshold 
described in subclause (I) and that is 
based on data that are accurate and 
reliable.
``(IV) Recommendation 
requirements.--In making the 
recommendations required under 
subclause (III), the Comptroller 
General of the United States shall--
``(aa) seek to prevent 
unintended consequences that 
may result from weighing 
quality and cost performance 
categories;
``(bb) consider the impact 
of such recommendations on 
different types of DPPS 
eligible professionals, 
including such professionals in 
a small group practice and such 
professionals that serve rural 
or underserved communities; and
``(cc) consult with 
stakeholders, including 
organizations representing 
physicians.''.
(d) Maintaining Budget Neutrality.--Section 1848(q)(6)(F) of the 
Social Security Act (42 U.S.C. 1395w-4(q)(6)(F)) is amended--
(1) in clause (i)--
(A) in the clause heading, by inserting ``for years 
before 2028'' after ``factor''; and
(B) in subclause (I)--
(i) by striking ``With respect'' and 
inserting ``For years before 2028, with 
respect''; and
(ii) by striking ``subparagraph 
(A)(ii)(I)'' and inserting ``subparagraph 
(A)(i)(II)(aa)'';
(2) in clause (ii)--
(A) in the clause heading, by inserting ``for years 
before 2028'' after ``requirement''; and
(B) in subclause (I), by striking ``Subject to'' 
and inserting ``For years before 2028, subject to'';
(3) in clause (iii)--
(A) in subclause (I), by inserting ``before 2028'' 
before ``that are below''; and
(B) in subclause (II), by inserting ``before 2028'' 
after ``with respect to a year''; and
(4) by adding at the end the following new clause:
``(v) Budget neutrality for 2028 and 
subsequent years.--For 2028 and each subsequent 
year, the Secretary shall decrease DPPS 
adjustment factors under subparagraph 
(A)(ii)(I) for DPPS eligible professionals 
whose composite performance score for such year 
is above the performance threshold established 
under subparagraph (D) for such year in order 
to ensure that the estimated increase in the 
aggregate allowed charges resulting from the 
application of such adjustment factors (after 
application of this clause) to such 
professionals for such year is not more than 
the estimated decrease in such charges 
resulting from the application for such year of 
DPPS adjustment factors under subclauses (III) 
and (IV) of subparagraph (A)(ii) to DPPS 
eligible professionals whose composite 
performance score for such year is below such 
performance threshold.''.
(e) Investing in Under-resourced Practices to Assist in Value-based 
Care and Quality Improvement.--Section 1848(q)(6) of the Social 
Security Act (42 U.S.C. 1395w-4(q)(6)) is amended by adding at the end 
the following new subparagraph:
``(G) Investing in under-resourced practices to 
assist in value-based care and quality improvement.--
``(i) In general.--In the case of a DPPS 
eligible professional who furnishes covered 
professional services during a year that is a 
DPPS savings year (as defined in clause (v)) 
and for which the professional meets the 
criteria specified in clause (ii), in addition 
to the amount of payment that would otherwise 
be made for such services under this part for 
such year, there also shall be paid to such 
professional, from the amount specified in 
clause (iv)(I) for such DPPS savings year, a 
lump-sum incentive payment (in such amount as 
specified by the Secretary) which shall be used 
by such professional to improve care 
management, address health-related social 
needs, implement and further the use of 
certified EHR technology (as defined in 
subsection (o)(4)), improve performance with 
respect to the performance categories described 
in paragraph (2)(A), or implement and 
participate in value-based care models.
``(ii) Criteria.--
``(I) Attestation.--A DPPS eligible 
professional meets the criteria 
specified in this clause for a year if, 
with respect to such year and 
professional, data was submitted under 
this subsection and, for purposes of 
this subparagraph, it is demonstrated 
through an attestation that the 
professional is in a small practice 
described in subclause (II).
``(II) Small practices.--Subject to 
clause (iii), a small practice 
described in this subclause is a 
practice of 15 or fewer professionals.
``(iii) Secretarial authority to give 
priority to certain small practices.--The 
Secretary may, with respect to a DPPS savings 
year and based on the amount specified in 
clause (iv)(I) with respect to such year, for 
purposes of this subparagraph give priority to 
DPPS eligible professionals in certain small 
practices by applying clause (ii)(II) for such 
year as if instead of describing a practice of 
15 or fewer professionals, such clause 
described any one or more of the following:
``(I) A practice of 15 or fewer 
professionals located in a rural area.
``(II) A practice of 15 or fewer 
professionals located in a health 
professional shortage area (as 
designated under in section 
332(a)(1)(A) of such Act).
``(III) A practice of 15 or fewer 
professionals located in a medically 
underserved area.
``(IV) A practice of 15 or fewer 
professionals with a low composite 
score.
``(iv) Funding for incentive payments.--
``(I) Amount available.--The amount 
specified in this subclause, with 
respect to a DPPS savings year, is the 
amount by which the amount described in 
subclause (II) for such year exceeds 
the amount described in subclause (III) 
for such year.
``(II) Aggregate decrease.--The 
amount described in this subclause is 
the estimated decrease in the aggregate 
allowed charges resulting from the 
application of DPPS adjustment factors 
under subclauses (III) and (IV) of 
subparagraph (A)(ii) to DPPS eligible 
professionals whose composite 
performance score for a year is below 
the performance threshold under 
subparagraph (D) for such year.
``(III) Aggregate increase.--The 
amount described in this subclause is 
the estimated increase in the aggregate 
allowed charges resulting from the 
application of DPPS adjustment factors 
under subparagraph (A)(ii)(I) (after 
application of subparagraph (F)(v)) to 
DPPS eligible professionals whose 
composite performance score for a year 
is above the performance threshold 
under subparagraph (D) for such year.
``(IV) Funding limitation.--In no 
case may the amounts used to carry out 
this subparagraph with respect to a 
year exceed the amount specified for 
such year under subclause (I).
``(v) DPPS savings year.--For purposes of 
this subparagraph, the term `DPPS savings year' 
means a year (beginning with 2028) for which 
the amount described in clause (iv)(II) exceeds 
the amount described in clause (iv)(III).
``(vi) Coordination with other incentive 
payments.--The amount of any additional payment 
under this subparagraph and any other provision 
under this section or section 1833, including 
section 1833(m) shall be determined without 
regard to any additional payment under such 
other provision and this subparagraph, 
respectively.''.
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