[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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