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

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I Strengthening reimbursement and patient access

II POINTS

Sec. 203. Quality reform task force

Section 1848(q)(2) of the Social Security Act (42 U.S.C. 1395w–4(q)(2)) is amended by adding at the end the following new subparagraph:

Text this section adds to the law

(E) Quality Reform Task Force

(i) In general. Not later than 6 months after the date of the enactment of this subparagraph, the Secretary shall establish a Quality Reform Task Force (in this subparagraph referred to as the Task Force) for purposes of issuing recommendations with respect to the use of quality, resource use, and care efficiency measures under this subsection.

(ii) Membership

(I) In general. Members of the Task Force shall be appointed by the Secretary and shall include—

(aa) representatives of the Department of Health and Human Services;

(bb) representatives of eligible professional organizations (as defined in subparagraph (D)(ii)(II)); and

(cc) other experts determined appropriate by the Secretary.

(II) Appropriate representation. In making appointments under subclause (I), the Secretary shall ensure that—

(aa) each medical specialty or subspecialty as determined appropriate by the Secretary in which a MIPS eligible professional may practice is adequately represented on the Task Force through a relevant organization described in subclause (I)(bb) if a measure relating to such specialty or subspecialty is under consideration;

(bb) a majority of the Task Force is comprised of designated health care practitioners (as defined in section 1866H(f)) or representatives of designated health care professional-led professional organizations described in subclause (I)(bb);

(cc) not more than 3 members of the Task Force are representatives of group health plans, health insurance issuers, or Medicare Advantage organizations; and

(dd) at least 1 designated health care practitioner who is not part of an excluded practice (as defined in section 1866H(f)) who practices in a medical specialty or subspecialty is included on the Task Force when the Task Force is considering measures relating to such specialty or subspecialty.

(III) Maximum number of members. The number of members of the Task Force may not exceed 25.

(iii) Duties

(I) In general. The Task Force shall, with respect to each performance period beginning on or after January 1, 2032—

(aa) issue recommendations on quality, resource use, and care efficiency measures for use under this subsection; and

(bb) update any recommendations previously issued by the Task Force as determined appropriate by the Task Force.

(II) Requirements. The Task Force—

(aa) shall ensure that any measure recommended under subclause (I) conforms with applicable clinical guidelines developed by a professional organization representing the medical specialty or subspecialty to be subject to such measure and is designed to promote quality of care, improve resource use, or reduce costs;

(bb) may only recommend a quality measure to the extent that data for such measure can be submitted through certified EHR technology, administrative or billing claims, or a qualified clinical data registry;

(cc) shall take into account the circumstances of practitioners in specialty types that furnish services that do not typically involve face-to-face interaction with patients (or that typically involve such interaction only at the direction of another practitioner ordering such services);

(dd) shall, in reviewing measures and making recommendations, take into account—

(AA) how the measure relates to an episode of care or a continuum of health care, as applicable, involved;

(BB) the context of the respective performance category of such measure and how the measure may serve to complement or align with measures applicable in other performance categories under this subsection;

(CC) measures developed by qualified clinical data registries; and

(DD) consult with such registries as necessary in the development and evaluation of measures; and

(ee) ensure that the role of qualified clinical data registries in the development, maintenance, and refinement of measures is preserved or strengthened.

(iv) Secretarial response to recommendations

(I) In general. Not later than 120 days after the Task Force issues recommendations with respect to measures for a performance period, the Secretary shall transmit to the Task Force and to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a formal written response that, with respect to each such recommendation, affirmatively states one of the following:

(aa) The Secretary will implement the recommendation as issued.

(bb) The Secretary will implement the recommendation with specified modifications, accompanied by a written explanation of the modifications and the clinical, administrative, or program integrity basis for each such modification.

(cc) The Secretary will implement the recommendation in part, accompanied by a written explanation of which elements will be implemented and the basis for declining the remainder.

(dd) The Secretary declines to implement the recommendation, accompanied by a detailed written explanation of the clinical, administrative, or program integrity basis for the decision.

(II) Inclusion of measures

(aa) In general. The Secretary shall include a measure receiving a recommendation from the Task Force for a performance period in the final measures list published under subparagraph (D)(i) for such performance period unless the Secretary, not later than 90 days after receiving the recommendation, publishes in the Federal Register a written determination explaining the specific clinical, administrative, or program integrity basis for excluding the measure.

(bb) Further requirements for certain recommendations. Notwithstanding item (aa), with respect to any measure recommended by the Task Force for a performance period with the support of not fewer than 75 percent of the members of the Task Force, the Secretary may not exclude such measure from the final measures list published under subparagraph (D)(i) for such performance period unless the Secretary—

(AA) consults with the task force regarding such proposed exclusion; and

(BB) includes in the written determination under subclause (I) a response to the Task Force's position and a specific finding that the basis for exclusion outweighs the clinical judgment of the Task Force.

(III) Annual report. Not later than March 1 of each year beginning with the first calendar year after the Task Force issues its initial recommendations, the Secretary shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate, and shall make publicly available on the website of the Centers for Medicare & Medicaid Services, a report that includes, for each recommendation issued by the Task Force during the preceding calendar year—

(aa) the text of the recommendation and the vote of the Task Force;

(bb) the Secretary’s response under subclause (I);

(cc) the outcome with respect to the final measures list published under subparagraph (D)(i), including whether the recommended measure was included, included with modifications, or excluded; and

(dd) if the measure was excluded or modified, the written justification provided under subclause (I).

III APM improvement

IV Physician payment improvements