Pay PCPs Act of 2026

The "Pay PCPs Act of 2026" authorizes the Secretary of Health and Human Services to establish a hybrid payment model for primary care providers under Medicare, combining prospective, per-member-per-month (PMPM) payments with traditional fee-for-service. This model aims to transform how primary care is paid for by addressing the limitations of the existing fee-for-service system, which often fails to adequately compensate for team-based care and care coordination. The PMPM component, covering 40 to 70 percent of expected annual charges, is designed to compensate for essential primary care activities often unrecognized by current fee schedules, such as care management, patient communications, and behavioral health integration. By offering predictable and flexible revenue through PMPM payments, the bill intends to foster practice transformation and improve health outcomes for Medicare beneficiaries. It ensures that other services like screenings and vaccinations remain separately payable via fee-for-service, and primary care providers receiving these hybrid payments would also be excluded from the Merit-based Incentive Payment System (MIPS). Furthermore, the bill allows for a 50 percent reduction in beneficiary cost-sharing for primary care services covered by the hybrid payments, provided the beneficiary designates a primary care provider. To ensure quality, the Secretary may identify quality measures and offer bonus payments for high performance. An appropriation of $10 billion is allocated for fiscal years 2027 through 2031 to fund these hybrid payments, with a waiver for budget neutrality. Finally, the bill mandates the establishment of a Technical Advisory Committee within the Centers for Medicare & Medicaid Services. This committee will advise the Secretary on reforming the determination of relative value units under the physician fee schedule, including designing new valuation methodologies to improve payment accuracy and fairness.