H.R. 9693

Patients First Act of 2026

Sponsor: John Joyce

69 cosponsors
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Official summary

Written by the Congressional Research Service.

Patients First Act of 2026

This bill modifies payments and incentive programs under the Medicare physician fee schedule.

The bill establishes a temporary program to provide hybrid payments for certain primary care services. Under the program, payments for services relating to care management, behavioral health integration, office-based evaluation and management (including telehealth), and communications (e.g., phone calls) are made on a monthly basis to providers for each individual that is attributed to the provider's practice. The monthly amount is based on the national average amount for such services. Providers may opt into the model; in order to qualify, providers must be owned or controlled by health care practitioners and must have had the majority of their prior year's payments consist of payments for the covered services.

The bill also renames the Merit-based Incentive Payment System (MIPS) and modifies the program to include performance measures relating to care efficiency (e.g., reducing avoidable hospitalizations). (MIPS is an incentive program under Medicare that allows health professionals to receive payment adjustments based on certain performance measures.) The bill generally reduces the program's performance-based payment adjustments, including positive adjustments for providers that are not owned or controlled by health care practitioners.

Finally, the bill allows for larger annual adjustments to the Medicare physician fee schedule and bases these adjustments on inflation. It also requires certain corrections to compensate for expenditures under the fee schedule that exceed a certain amount in a given year, and it limits how much certain adjustment factors may vary each year.

Text of the bill

Expand all

I Strengthening reimbursement and patient access

II POINTS

III APM improvement

Sec. 301. Qualifying APM participant threshold freeze

(a) In general. Section 1833(z)(2) of the Social Security Act (42 U.S.C. 1395l(z)(2)) is amended—

(1) in subparagraph (B)—

(A) in the header, by striking 2026 and 2028 and inserting 2029; and

(B) in the matter preceding clause (i), by striking 2026 and 2028 and inserting 2029; and

(2) in subparagraph (C)—

(A) in the header, by striking 2027 and 2029 and inserting 2030; and

(B) in the matter preceding clause (i), by striking 2027 and 2029 and inserting 2030.

(b) Conforming amendments. Section 1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)) is amended—

(1) in subclause (II), in the matter preceding item (aa), by striking 2026 and 2028 and inserting 2029; and

(2) in subclause (III), the matter preceding item (aa), by striking 2027 and 2029 and inserting 2030.

(c) Authority To modify thresholds. Section 1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)) is amended—

(1) in subclause (II)—

(A) in item (aa), by inserting (or such lower percentage as may be specified by the Secretary) after 40 percent; and

(B) in item (bb), by inserting (or such lower percentages as may be specified by the Secretary) after respectively; and

(2) in subclause (III)—

(A) in item (aa), by inserting (or such lower percentage as may be specified by the Secretary) after 50 percent; and

(B) in item (bb), by inserting (or such lower percentages as may be specified by the Secretary) after respectively.

IV Physician payment improvements