[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 5180 Introduced in Senate (IS)]
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119th CONGRESS
2d Session
S. 5180
To amend title XVIII of the Social Security Act to ensure stability for
provider payments under the Medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 30, 2026
Mr. Boozman (for himself, Mr. Welch, Mr. Marshall, Mr. King, Mr.
Tillis, and Mrs. Shaheen) introduced the following bill; which was read
twice and referred to the Committee on Finance
_______________________________________________________________________
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 2028,
$20,000,000;
``(BB) for 2028,
$57,640,000; and
``(CC) for 2029 and
each subsequent year,
the amount specified in
this item for the
preceding year.
``(cc) Indexing limitation
on annual adjustments.--For
2033 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 2029) 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 section 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
later than 5 years after the date of
the enactment of this clause, and not
less often than every 5 years
thereafter, 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
2028, 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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