Provider Reimbursement Stability Act of 2026

This bill, known as the Provider Reimbursement Stability Act of 2026, seeks to enhance the stability of payments to healthcare providers under the Medicare program. A key provision involves updating the budget neutrality threshold for physician payments, significantly increasing it from $20,000,000 to $57,640,000 for 2028, with subsequent annual indexing and further adjustments every five years based on the Medicare Economic Index (MEI).

The legislation also introduces a mechanism to correct payment rates when initial budget neutrality adjustments are based on inaccurate utilization estimates. Beginning in 2029, if the difference between estimated and actual utilization for specified services exceeds a 0.1 percent threshold, the Secretary must adjust the conversion factor in a future "assumption correction period" to reconcile this difference. These reconciliation adjustments are explicitly excluded from further budget neutrality calculations, preventing cascading effects.

Furthermore, the bill mandates that the Secretary must update the prices and rates for direct cost inputs, such as clinical staff wages, medical supplies, and equipment, used in calculating practice expense relative value units (RVUs) at least once every five years. These updates must be simultaneous across all categories and involve consultation with relevant stakeholders. Finally, starting in 2028, the bill limits the year-to-year budget neutrality adjustment to the Medicare physician fee schedule conversion factor to a maximum variance of 2.5 percent, providing greater predictability for providers while maintaining the overall budget neutrality requirement.