Provider Reimbursement Stability Act of 2026
Official title: A bill to amend title XVIII of the Social Security Act to ensure stability for provider payments under the Medicare program.
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Read twice and referred to the Committee on Finance.
Provider Reimbursement Stability Act of 2026
This bill allows for larger annual adjustments to the Medicare physician fee schedule. It also requires the Centers for Medicare & Medicaid Services (CMS) to make 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.
Current law prohibits annual adjustments to the Medicare physician fee schedule that would result in a more than $20 million difference between the adjusted amount and the non-adjusted amount of total expenditures. The bill increases this threshold to $57.64 million beginning in 2028, with adjustments for inflation every five years beginning in 2033.
Additionally, for certain services, the bill requires the CMS to determine the difference between expenditures based on estimated utilization of the service and expenditures based on actual utilization. If this difference exceeds a certain percentage of total expenditures under the fee schedule, the CMS must reconcile this difference by adjusting payments for the following year. This requirement applies to services for which payment was bundled with another service and there was a separate or add-on payment during the previous year.
Finally, the CMS must update the prices and rates of each category of direct costs that affect payments (e.g., prices of equipment) at least every five years, with updates made to each category in the same year. The bill also prohibits the CMS from varying a certain adjustment factor by more than 2.5% each year.
- Introduced in Senate Formatted Text PDF Formatted XML
- THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION, INC. (AOTA)
- MASON CONSULTING, LLC
- AMERICAN SOCIETY FOR DERMATOLOGIC SURGERY ASSOCIATION
- CONGRESS OF NEUROLOGICAL SURGEONS
- AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS
- CALIFORNIA MEDICAL ASSOCIATION INC.
Bodies those filers lobbied
- SENATE
- HOUSE OF REPRESENTATIVES
- Centers For Medicare and Medicaid Services (CMS)
- Health & Human Services, Dept of (HHS)
- Office of Management & Budget (OMB)
- Centers For Disease Control & Prevention (CDC)
- Natl Institutes of Health (NIH)
- Veterans Affairs, Dept of (VA)
Cite this page
U.S. Congress. (2026). S. 5180: Provider Reimbursement Stability Act of 2026. 119th Congress. Open America. https://openamerica.io/bill/119-S-5180/
"S. 5180: Provider Reimbursement Stability Act of 2026." 119th Congress, 2026, Open America, https://openamerica.io/bill/119-S-5180/.
S. 5180, 119th Cong. (2026), https://openamerica.io/bill/119-S-5180/.
[S. 5180: Provider Reimbursement Stability Act of 2026](https://openamerica.io/bill/119-S-5180/)