Provider Reimbursement Stability Act of 2026

Key Points

• The bill raises the dollar threshold that triggers automatic budget neutrality adjustments to Medicare physician payments. Before 2027 the threshold was $20 million; it jumps to $54.3 million in 2027, meaning smaller changes to the fee schedule will no longer force offsetting cuts to other services.
• Starting in 2032 and every five years after, the threshold will be increased based on cumulative growth in the Medicare Economic Index, keeping it in line with rising costs of running a medical practice.
• When the government uses estimated utilization to set payment rates for newly unbundled services, the bill requires a correction two years later to reconcile the difference between what was predicted and what actually happened. If the error exceeds 0.1% of total estimated Part B spending, the conversion factor must be adjusted.
• Medicare must update the prices of clinical staff wages, medical supplies, equipment, and other direct cost inputs at least every five years, and all categories must be updated at the same time. The Secretary must also consult with physician specialty societies when making these updates.
• Beginning in 2027, the bill caps the year-over-year change in the Medicare physician fee schedule conversion factor at 2.5%, preventing large sudden swings in how much doctors are paid for their services.