This bill proposes significant amendments to Medicare, focusing on enhancing program integrity, patient access, and drug affordability. It mandates that, starting in 2026, the risk adjustment methodology for Medicare Advantage plans must utilize two years of diagnostic data when available, aiming for more accurate and equitable payments. This provision seeks to improve the accuracy of payments to Medicare Advantage plans based on the health status of their enrollees. The legislation also expands site-neutral payment policies by eliminating certain exceptions for off-campus provider-based departments and applying physician office rates to specific on-campus outpatient department services, effective January 1, 2026. This change seeks to standardize payments for similar services across different settings, though it includes important exemptions for critical access, sole community, Medicare-dependent, and other rural hospitals. Furthermore, to address drug costs, the bill requires 340B covered entities to provide covered outpatient drugs to patients at a price not exceeding the entity's acquisition cost, less any additional discounts or rebates, and mandates public reporting of drug pricing data. Finally, it expands the rural provider exception under the Stark Law, allowing physician-owned hospitals in rural areas to furnish designated health services if they primarily serve local residents, and increases penalties for Skilled Nursing Facilities failing to report quality data.