H.R. 8622: Medicare Physician Data-driven Performance Payment System Act of 2026
This bill is known as the Medicare Physician Data-driven Performance Payment System Act of 2026. It aims to revise the current payment system used by Medicare for physicians, transitioning from the Merit-based Incentive Payment System (MIPS) to a new system called the Data-driven Performance Payment System (DPPS), effective January 1, 2027.
Key Changes Proposed
- Transition to DPPS: The bill establishes the DPPS, which will replace MIPS as the performance payment system under Medicare. References to MIPS in existing laws will be updated to reflect this change.
- Adjustment Factors: The bill modifies how payment adjustment factors are calculated for physicians based on their performance. For 2028 and beyond, different performance thresholds will influence payment rates, with higher scores leading to larger payment adjustments.
- Performance Thresholds: The Secretary of Health and Human Services is tasked with setting performance thresholds, which will determine the payments physicians receive based on their performance in quality and cost metrics. The maximum threshold for 2028 through 2033 will not exceed 75 points, and adjustments can be extended if extraordinary circumstances affect performance assessments.
- Budget Neutrality: The bill ensures that the effects of the new payment adjustments will be budget neutral, meaning the total costs will not exceed certain budget limits. Adjustments will be made based on performance scores to maintain this neutrality.
- Support for Small Practices: The bill includes provisions to assist smaller medical practices, particularly those in underserved areas, by offering additional incentives for participating in the DPPS. These practices, with a size of 15 or fewer professionals, may receive lump-sum payments to improve care management and technology adoption.
Performance Evaluation Structure
Under the DPPS, the performance of physicians will be evaluated based on composite scores derived from the data collected on various measures of care quality and cost efficiency. The criteria for achieving a higher score will include positive contributions and a demonstrated ability to manage patient care effectively.
Incentive Payments for Value-based Care
To encourage the adoption of value-based care practices, the bill provides for additional lump-sum incentive payments to eligible professionals who meet specific criteria during DPPS savings years. These incentives are aimed at improving care management and implementing advanced healthcare technologies.
Feedback and Reporting Requirements
The Secretary will ensure that timely feedback is provided to DPPS eligible professionals regarding their performance metrics, which is crucial for maintaining transparency and enabling physicians to make informed adjustments to their practice.
Relevant Companies
- UNH - UnitedHealth Group may be impacted due to its role as a major private health insurance provider that collaborates with Medicare.
- ANTM - Anthem, Inc. might be affected as it also operates in the Medicare space.
This is an AI-generated summary of the bill text. There may be mistakes.
Sponsors
2 bill sponsors
Actions
2 actions
| Date | Action |
|---|---|
| Apr. 30, 2026 | Introduced in House |
| Apr. 30, 2026 | Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. |
Corporate Lobbying
0 companies lobbying
None found.
* Note that there can be significant delays in lobbying disclosures, and our data may be incomplete.
