Bill > S5180

This bill, titled the "Provider Reimbursement Stability Act of 2026," aims to ensure more predictable payments for healthcare providers under Medicare, which is the federal health insurance program for people aged 65 and older and certain younger people with disabilities. Specifically, it modifies how Medicare calculates payments for physician services by adjusting the "budget neutrality threshold," which is a mechanism to ensure that changes in payment rules don't increase overall Medicare spending. The bill increases this threshold amount over several years, starting with $20 million and rising to $57.64 million by 2028, with future increases tied to inflation. It also introduces "budget neutrality corrections" for certain services where estimated patient usage differs significantly from actual usage, allowing for adjustments to payment rates to account for these discrepancies. Furthermore, the bill mandates that the Secretary of Health and Human Services must update the direct costs used to calculate practice expense relative value units (RVUs), which are components of physician payment, at least every five years, and requires consultation with stakeholders like physician groups. Finally, it caps the year-to-year change in the "conversion factor," a key element in determining physician payments, to a maximum of 2.5% to prevent drastic fluctuations, while still maintaining the overall budget neutrality requirement.