Provider Reimbursement Stability Act of 2026
Latest action (30 Jul 2026): Introduced
What this bill does
This bill would amend Medicare's physician fee schedule rules under the Social Security Act to change how "budget neutrality" adjustments are calculated. It raises the dollar threshold that triggers a budget-neutrality adjustment from $20 million to about $57.6 million starting in 2028, with that figure held steady afterward except for periodic adjustments tied to a Medicare economic index every five years starting in 2033. It also creates a process, beginning in 2029, for Medicare to compare estimated versus actual utilization for certain newly unbundled services and correct the conversion factor if the difference exceeds a set threshold, without those corrections themselves being subject to budget-neutrality rules. The bill further requires the Secretary of Health and Human Services to update, at least every five years, the cost inputs (such as clinical staff wages, medical supplies, and equipment prices) used to calculate practice expense payment values, in consultation with stakeholders including physician specialty societies. Finally, it caps how much the annual physician fee schedule conversion factor can change year-to-year due to budget-neutrality adjustments, limiting variance to 2.5 percent starting in 2028.
The bill primarily affects physicians and other providers paid under Medicare's Physician Fee Schedule, as well as the Centers for Medicare & Medicaid Services, which administers these calculations. By raising thresholds and capping year-to-year swings, the bill is intended to make Medicare physician payment changes more predictable and gradual.
The bill was introduced in the Senate on July 30, 2026, by Senator John Boozman along with several cosponsors, and referred to the Senate Committee on Finance. It has not yet received a committee vote, floor vote, or further congressional action.
Plain-English summary generated by Bill100 AI from the official record. Always verify against the source below.
Official summary
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.
Common questions
- What does S. 5180 do?
- This bill would amend Medicare's physician fee schedule rules under the Social Security Act to change how "budget neutrality" adjustments are calculated. It raises the dollar threshold that triggers a budget-neutrality adjustment from $20 million to about $57.6 million starting in 2028, with that figure held steady afterward except for periodic adjustments tied to a Medicare economic index every five years starting in 2033. It also creates a process, beginning in 2029, for Medicare to compare estimated versus actual utilization for certain newly unbundled services and correct the conversion factor if the difference exceeds a set threshold, without those corrections themselves being subject to budget-neutrality rules. The bill further requires the Secretary of Health and Human Services to update, at least every five years, the cost inputs (such as clinical staff wages, medical supplies, and equipment prices) used to calculate practice expense payment values, in consultation with stakeholders including physician specialty societies. Finally, it caps how much the annual physician fee schedule conversion factor can change year-to-year due to budget-neutrality adjustments, limiting variance to 2.5 percent starting in 2028. The bill primarily affects physicians and other providers paid under Medicare's Physician Fee Schedule, as well as the Centers for Medicare & Medicaid Services, which administers these calculations. By raising thresholds and capping year-to-year swings, the bill is intended to make Medicare physician payment changes more predictable and gradual. The bill was introduced in the Senate on July 30, 2026, by Senator John Boozman along with several cosponsors, and referred to the Senate Committee on Finance. It has not yet received a committee vote, floor vote, or further congressional action.
- Has S. 5180 become law?
- Not yet. As of 30 Jul 2026, S. 5180 is introduced.
- Who sponsored S. 5180?
- S. 5180 was sponsored by Sen. John Boozman [R-AR] (Republican-AR), with 7 cosponsors.
- What's the latest action on S. 5180?
- Introduced (30 Jul 2026).
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