American Patients First Act of 2026

Key Points

• This bill changes how Medicare pays for skin substitutes, which are biological or synthetic materials used to heal serious wounds. Starting in 2027, Medicare would pay a fixed rate of $457 for every square centimeter of these products used on a patient. This set price aims to make costs more predictable for the government and healthcare providers.
• To qualify for Medicare payment, these products must be made entirely in the United States. This means the human tissue used must come from U.S. donors, and all harvesting and manufacturing must happen in American facilities. The government can only skip this rule for up to 180 days if there is a major shortage of supplies.
• The bill adds new rules to prevent fraud and waste in wound care. Doctors would only be paid for the amount of material actually needed for the wound, and there is a limit on how many times they can apply it if the wound is not getting better. Also, only specially certified wound care experts would be allowed to bill Medicare for these treatments.
• Medicare will keep a close eye on doctors who bill the most for these products. The top 3 percent of billers will face extra reviews before they get paid. If a doctor has too many claims denied, they could be kicked out of the Medicare program or investigated for fraud by the government.

Impact Analysis

Govbase has not yet run an impact analysis on this legislation.