Pay PCPs Act of 2026

Pay PCPs Act of 2026 (S. 5269) would let the Secretary of Health and Human Services create an optional "hybrid" payment model within Medicare's physician fee schedule for primary care providers. Instead of being paid only per visit, participating providers could receive a monthly per-patient payment (40–70% of expected fee-schedule revenue) covering care management, patient communications, behavioral health integration, and office visits, combined with continued fee-for-service payments for other services like screenings, vaccinations, and wellness visits. The bill also allows quality-based bonus payments, directs HHS to set up beneficiary-attribution procedures, exempts participating providers from MIPS reporting, and creates a technical advisory committee to help recalibrate how Medicare values physician services generally. It appropriates $10 billion for fiscal years 2027–2031 to fund the payments.

The bill affects Medicare beneficiaries and the primary care providers (physicians, nurse practitioners, physician assistants, and similar practitioners) who choose to participate — participation is voluntary for providers. Beneficiaries who designate a primary care provider under this model could also see their cost-sharing for related primary care services cut by 50%, with HHS required to report to Congress on the effects of that reduction, including on utilization and potential fraud.

The bill was introduced in the Senate on August 5, 2026, by Sen. Sheldon Whitehouse (D-RI) with Sen. Bill Cassidy (R-LA), and referred to the Senate Committee on Finance. It would need to be approved by the committee, pass the full Senate and House, and be signed into law before taking effect.

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