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. 204. Modification of MIPS payment adjustments

(a) In general. Section 1848(q)(6)(B) of the Social Security Act (42 U.S.C. 1395w–4(q)(6)(B)) is amended—

(1) in clause (iii), by striking and at the end;

(2) in clause (iv), by amending such clause to read as follows:

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(iv) for 2022 and subsequent years (through 2026), 9 percent;

; and

(3) by adding at the end the following new clauses:

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(v) for 2027 through 2031, 2 percent;

(vi) for 2032, 3 percent;

(vii) for 2033, 4 percent; and

(viii) for 2034, 5 percent.

(b) No reduction in case of failure To provide feedback

(1) In general. 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:

Text this section adds to the law

(G) No reduction in payments in case of failure to provide feedback. Notwithstanding the preceding provisions of this paragraph, in the case that the Secretary fails to provide a MIPS eligible professional feedback required under paragraph (12) with respect to the performance of such professional for a performance period with respect to a year for administrative claims-based measures included in the performance categories described in subparagraph (A)(i)(II) of such paragraph, if application of subparagraph (E) would result in a negative adjustment to payment for covered professional services furnished by such professional during such year, the product otherwise determined under such subparagraph for such professional and year shall be deemed to be zero.

(2) Modification of feedback requirements. Section 1848(q)(12) of the Social Security Act (42 U.S.C. 1395w–4(q)(12)) is amended—

(A) in subparagraph (A)(i)(II), by inserting (and, beginning with 2032, shall, on a quarterly basis and with respect to administrative claims-based measures in accordance with clause (vi)) after may; and

(B) by adding at the end the following new clause:

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(vi) Feedback on administrative-claims based measures. With respect to quarters beginning on or after January 1, 2032, the Secretary shall, not later than 60 days after each such quarter, provide to each MIPS eligible professional, with respect to administrative claims-based measures included in the performance categories described in subparagraph (A)(i)(II), feedback on such professional’s performance, including—

(I) 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;

(II) 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

(III) 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).

(c) Extension of additional incentive payments for certain professionals. Section 1848(q)(6) of the Social Security Act (42 U.S.C. 1395w–4(q)(6)) is amended—

(1) in subparagraph (C)—

(A) by inserting and for 2032 and each subsequent year after 2024,; and

(B) by inserting (other than, with respect to 2032 and each subsequent year, such a professional that is part of an excluded practice (as defined in section 1866H(f))) after MIPS eligible professional; and

(2) in subparagraph (F)(iv)(I), by inserting and for 2032 and each subsequent year before the period.

(d) Reduction in positive adjustments for certain professionals. Section 1848(q)(6) of the Social Security Act (42 U.S.C. 1395w–4(q)(6)), as amended by paragraph (1), is further amended by adding at the end the following new subparagraph:

Text this section adds to the law

(H) Reduction in positive adjustments for certain professionals. The Secretary shall reduce each positive MIPS adjustment factor otherwise determined under this paragraph for a year (beginning with 2032) for a MIPS eligible professional who is part of an excluded practice (as defined in section 1866H(f)) by 50 percent. The preceding sentence shall be applied in a budget neutral manner.

III APM improvement

IV Physician payment improvements