H.R. 8840 — Fair Care Act of 2026

This section replaces the existing health savings account rules to allow deductions for contributions by individuals covered under any qualified plan, including employer plans, individual plans, short-term plans, Medicare, Medicaid, VA health care, TRICARE, and association health plans. It sets annual contribution limits at $5,000 for plans with actuarial value below 40 percent, $4,300 for plans with 40 to 75 percent actuarial value, and $3,600 for plans with higher actuarial value, while denying deductions to dependents and imposing a 10 percent penalty plus income inclusion for failure to maintain coverage during the 12-month testing period after mid-year eligibility.

This section allows taxpayers to elect that excess premium tax credits under section 36B be deposited directly into a health savings account. Such deposits are treated as credits allowed under section 36B for purposes of the refund appropriation in 31 U.S.C. 1324 and are includible in the taxpayer’s gross income. The changes apply to taxable years beginning after the date of enactment.

This section gives the force and effect of law to the June 20, 2019, rule issued by the Internal Revenue Service, the Employee Benefits Security Administration, and the Department of Health and Human Services on Health Reimbursement Arrangements and Other Account-Based Group Health Plans. It subjects those arrangements to all sections in this title.

This section establishes an alternative State innovation waiver under section 1332 of the Affordable Care Act beginning in plan year 2026. It permits States to waive cost-sharing reduction requirements under section 1402 if they instead distribute equivalent pass-through funding to health savings accounts of qualifying individuals (those enrolled in an HSA and silver, bronze, or copper coverage with household income at or below 250 percent of the federal poverty line). The funding calculation adjusts actuarial values to 84, 77, and 63 percent for bronze coverage and 74, 67, and 53 percent for copper coverage (from 94, 87, and 73 percent). It appropriates necessary sums for cost-sharing payments for plan years 2026 through 2030.

This section allows a taxpayer to elect one taxable year beginning during the 3-year period starting 1 year after enactment, during which contributions to a health savings account are treated as qualified retirement savings contributions for purposes of the saver's credit under section 25B of the Internal Revenue Code.

This section establishes a grant program administered by the Administrator of the Centers for Medicare & Medicaid Services to distribute up to $5 million annually among eligible entities. The grants support distribution of impartial information on health savings accounts, public awareness activities, enrollment facilitation, and referrals for complaints or grievances.

This section prohibits corporations incorporated after December 31, 2026, from receiving tax benefits for offering health insurance to employees. It preserves tax benefits for health savings account contributions offered by such corporations.

This section expands the requirement to obtain coverage through an Exchange to the President, Vice President, Members of Congress, and Federal employees (previously limited to Members of Congress and congressional staff). It defines Federal employee to include any individual covered by 5 U.S.C. 2105(c) or (f). It converts all plans under the Federal Employees Health Benefits Program into health savings accounts funded at the level of the second-least expensive silver plan available through the Exchange where the individual resides.

This section requires health insurance issuers to accept every employer and individual applying for coverage in the individual or group market. It restricts enrollment to open or special enrollment periods tied to qualifying events, permits service-area and capacity-based limits on network plans with a 180-day suspension on new offers after denial, and allows denial of coverage for insufficient financial reserves with the same 180-day suspension. It caps premium rate variations at 5-to-1 for age and 1.5-to-1 for tobacco use and directs states to establish rating areas subject to Secretarial review.

This section expands the definition of employer under ERISA (29 U.S.C. 1002(5)) to treat a group or association of employers as an employer for sponsoring group health plans if it meets specified requirements. These include a substantial business purpose unrelated to health coverage, a formal organizational structure with governing body, control by employer members, commonality of interest (same trade or single-state or metropolitan region), nondiscrimination on health factors, and limits on eligibility to current or former employees of member employers and their beneficiaries.

This section defines short-term limited duration insurance as health insurance coverage under a contract with an expiration date less than 12 months after the original effective date. It extends guaranteed renewability rules to issuers of such coverage in the individual market, permits issuers to offer renewability at application with the contract specifying the choice, and applies these changes to contracts effective on or after January 1, 2026.

This section establishes the Invisible Guaranteed Coverage Pool Reinsurance Program within 2 years of enactment. It directs the Secretary of Health and Human Services to award grants to states, or operate a federal default pool, to allow insurers to cede risk for individuals expected to incur more than $10,000 in annual costs, with the ceding issuer paying 90 percent of the premium to the pool, retaining risk only for the first $10,000 of benefits, and applying Medicare reimbursement rates thereafter. It appropriates $200 billion for the first 10 years after establishment and allocates funds based on state population and health status. It also imposes a tax of $4 per policy month on health insurance plans sold through Affordable Care Act exchanges, paid by the plan sponsor.

This section repeals the employer mandate requiring applicable large employers to offer minimum essential health coverage to full-time employees or pay penalties. It also eliminates the related reporting requirements and the study and report on the mandate's effects under the Patient Protection and Affordable Care Act. The changes apply to months and periods beginning after December 31, 2026, except the study repeal which takes effect upon enactment.

This section expands eligibility for the premium tax credit under section 36B to individuals offered employer-sponsored minimum essential coverage. The change applies to taxable years beginning after the date of enactment.

This section limits the exclusion from gross income for employer-provided health coverage to $10,200 for self-only coverage and $27,500 for all other coverage. Amounts above those thresholds become taxable income for taxable years beginning after December 31, 2026, with the dollar limits indexed annually for cost-of-living adjustments using a modified C-CPI-U measure.

This section increases the maximum permissible age variation in premium rates charged by health insurance issuers in the individual and small group markets to 5 to 1 for adults (from 3 to 1), for plan years beginning on or after January 1, 2026, as the Secretary may implement through interim final regulation.

This section expands eligibility for premium tax credits under section 36B to taxpayers with household income up to 600 percent of the poverty line (from 400 percent). It replaces the single applicable percentage table with age-based tables that set initial and final percentages on a sliding scale for five age groups (up to 29, 30–39, 40–49, 50–59, and over 59), using the older spouse’s age on joint returns. The changes apply to taxable years beginning after December 31, 2026.

This section requires the Secretary of the Treasury to calculate the premium tax credit under section 36B of the Internal Revenue Code based on the taxpayer’s prior year tax return. It also directs the Secretary of Health and Human Services to set open enrollment periods for health insurance marketplaces that end on April 15.

This section establishes a copper level of coverage for health plans offered on Exchanges. It requires such plans to provide benefits actuarially equivalent to 50 percent of the full actuarial value of benefits under the plan, with out-of-pocket limits 30 percent higher than bronze plans, and deems them compliant with cost-sharing requirements. The changes apply to plan years beginning on or after January 1, 2026.

This section modifies state innovation waivers under section 1332 of the Affordable Care Act. It permits a gubernatorial certification in lieu of enacted state law, requires the Secretary to approve or deny applications within 45 days (with concurrent public comment) for urgent situations or substantially similar prior waivers, limits provisional approvals to 3 years (extendable to 6 years total), sets standard waiver terms at 6 years with unlimited renewals, prohibits early termination except for material noncompliance, and replaces the “at least as affordable” standard with a requirement of comparable affordability for low-income individuals, those with serious health needs, and other vulnerable populations.

This section permits American Health Benefit Exchanges to allow enrollments outside initial, open, and special enrollment periods beginning with plan year 2026. It also authorizes group health plans and issuers of group or individual coverage to permit such enrollments starting in plan year 2026 and to charge a one-time enrollment fee.

This section authorizes state-operated American Health Benefit Exchanges to set open enrollment periods every 12, 24, or 36 months, as determined by the State, beginning with plan years one year after the date of enactment.

This section appropriates $10,000,000 to the Center for Medicare & Medicaid Innovation for new research and pilot programs on enrolling individuals in health insurance plans that operate across state lines, with funds required to be made available no later than one year after enactment.

This section authorizes $160 million to the Federal Trade Commission to investigate anti-competitive mergers and practices among inpatient and outpatient health care providers. It requires hospitals in counties above median population density with a Herfindahl-Hirschman Index above 4,000 to bill at the average Medicare Advantage reimbursement rate beginning in 2028, phased in at 178 percent of that rate in 2028, 150 percent in 2029, 130 percent in 2030, and 110 percent in 2031, with exceptions for hospitals holding less than 15 percent market share in their hospital referral region or located in rural areas. It authorizes $1 billion annually for fiscal years 2026 through 2035 for grants to states that lack certificate of need laws, restrictive scope-of-practice limits, any-willing-provider mandates, certificate of public advantage laws, or network adequacy rules. It increases critical access hospital reimbursement rates under Medicare Part A and Part B to 102 percent in 2026, rising by one percentage point each year through 2033 and to 110 percent thereafter (from 101 percent).

This section expands the definition of corporation under the Federal Trade Commission Act to include any organization described in section 501(c)(3) of the Internal Revenue Code of 1986 that is exempt from taxation under section 501(a) of such Code.

This section exempts one or more private health insurance issuers or their designated agents from the antitrust laws when jointly negotiating prices for particular hospital services with a hospital provider. It takes effect on the date of enactment but does not apply to conduct occurring before that date.

This section prohibits group health plans and health insurance issuers from entering contracts with providers that restrict steering enrollees to other providers, offering incentives for specific providers, requiring contracts with affiliates, or limiting other plans’ ability to pay lower rates. It adds an attestation requirement for self-insured plans, exceptions for certain HMOs and value-based networks, an annual compliance attestation, and a directive for the Secretary to issue implementing regulations within one year of enactment. The section applies to new contracts 18 months after enactment and to existing contracts upon renewal or three years after enactment, whichever is earlier.

This section limits eligibility to participate as accountable care organizations (ACOs) in the Medicare Shared Savings Program to ACO professionals in group practice arrangements and networks of individual practices of ACO professionals, effective January 1, 2026. It removes eligibility for partnerships or joint ventures between hospitals and ACO professionals, hospitals employing ACO professionals, and other groups determined appropriate by the Secretary.

This section repeals sections 6001 and 10601 of the Patient Protection and Affordable Care Act and section 1106 of the Health Care and Education Reconciliation Act of 2010. It restores the prior Medicare exception to the prohibition on physician self-referrals for hospitals as if those provisions had never been enacted.

This section authorizes group health plans and issuers of group or individual health insurance coverage to elect to pay enrollees a fixed amount for shoppable procedures instead of providing coverage for those services, if the enrollee agrees. Shoppable procedures include primary and preventive services, prenatal care and childbirth, and common scheduled surgeries. The fixed payment must equal or exceed the median negotiated rate in the geographic area, remain constant for the plan year, apply regardless of provider, and allow the enrollee to retain any excess over the provider’s charge. Providers must publicly post prices charged under this model, and the Secretary may waive essential health benefits requirements to permit such payments.

This section requires hospitals to publish standard charges for all items and services in machine-readable format via open APIs, including chargemaster rates, negotiated rates with third-party payers, and discounted cash prices, along with any additional information the Secretary requires to promote public awareness of pricing. It imposes a civil monetary penalty of up to $300 per day on hospitals that fail to comply after a corrective action plan. It also requires health plans to disclose specific negotiated rates with providers and aggregate out-of-network payments, and to make all required transparency information available free of charge in machine-readable format via websites and open APIs.

This section directs the Secretary of Health and Human Services to convene, by January 1, 2026, an advisory group to recommend ways to reduce the burden of federal administrative requirements on hospitals. By January 1, 2027, the group must submit recommendations for executive action to the Secretary and for legislative proposals to Congress; it consists of three representatives of large multistate employers, three representatives of health insurance issuers meeting specified enrollment and geographic criteria, and seven public policy experts in hospital consolidation.

This section requires 340B hospital covered entities under subparagraphs (L) and (M) of subsection (a)(4) to report annually, beginning 14 months after enactment, the number and percentage of individuals dispensed or administered covered drugs by insurance type (including Medicare, Medicaid, private coverage, and uninsured), total and charity care costs at each child site, aggregate gross reimbursements and acquisition costs for such drugs, eligibility contracts, and third-party vendors. It directs the Secretary to issue interim final regulations within 6 months and publish the data publicly in searchable form, and requires OIG and GAO reports to Congress within 1–2 years on charity care levels and contract compliance.

This section requires disproportionate share hospitals participating in the 340B drug discount program to submit and regularly update information on their low-income outpatient utilization rates for outpatient hospital services, including at child sites. It also directs the Health Resources and Services Administration to submit annual reports to Congress on the submitted information beginning one year after enactment.

This section requires group health plans and health insurance issuers offering group coverage with at least 100 enrollees to notify each enrollee, beginning one year after enactment, of the amount the plan sponsor or employer expended or contributed for that individual's coverage in the current plan year and each prior plan year. It authorizes the Secretary of Health and Human Services to impose civil monetary penalties of up to $100 per enrollee per day for noncompliance.

This section requires the Comptroller General to conduct a study within one year of enactment describing profit- and revenue-sharing relationships in commercial health care markets that involve physician groups, laboratory, radiology, pharmacy, surgical, hospital, group purchasing, or rehabilitation services, whether through joint ventures, management agreements, or other gain-sharing contracts. The study must also describe federal oversight by the Department of Health and Human Services and the Federal Trade Commission, identify limitations in that oversight, and make recommendations as appropriate. It further requires submission of a report on the study to the Senate Committee on Health, Education, Labor, and Pensions and the House Committees on Education and Workforce and Energy and Commerce.

This section establishes a program for expedited development and priority review of generic complex drug products under section 505(j) of the Federal Food, Drug, and Cosmetic Act. It requires the Secretary to designate qualifying products within 60 days of a sponsor request after review by experienced FDA staff and senior managers, bars withdrawal of designations based on later approvals of other products, and directs issuance of implementation guidance within one year after public comment.

This section revises the 180-day exclusivity period for first generic drug applicants under section 505(j)(5)(B)(iv) of the Federal Food, Drug, and Cosmetic Act. The period now begins on the earlier of the first commercial marketing of the drug by any first applicant or the date when a non-first applicant receives tentative approval, 33 months have passed since submission of the first application, and approval is not precluded under clause (iii), if no first applicant has been approved by that date. It also requires the Secretary of Health and Human Services to publish information within 60 days of enactment sufficient for applicants to assess whether these conditions have been or will be met.

This section revises the citizen petition process for challenging applications under section 505(b)(2) or (j) of the Federal Food, Drug, and Cosmetic Act. It requires petitions and supplements to be filed before any related civil action and no later than 60 days after the petitioner knew or should have known the basis for the request. It directs the Secretary to consider specified factors when determining whether a petition’s primary purpose is to delay approval, to refer such petitions to the Federal Trade Commission, and to dismiss untimely or noncompliant civil actions. It also updates related timing and response rules for petitions.

This section preempts any state or local law that prohibits a pharmacy or pharmacist from dispensing an FDA-designated interchangeable biosimilar in place of a biological reference product.

This section expands eligibility for fast track designation of drugs under section 506(b) of the Federal Food, Drug, and Cosmetic Act by deeming a drug to address an unmet medical need for a disease or condition if fewer than three drugs are available to treat it.

This section establishes a conditional approval pathway at the Food and Drug Administration for human drugs intended to treat rapidly progressive terminal diseases with substantial unmet medical need or rare diseases that result in substantially shortened lifespan or other serious adverse health effects. It requires phase 1 safety evidence plus phase 2 effectiveness evidence (or animal-model data for certain pediatric rare diseases), authorizes priority review and rolling submissions, permits real-world evidence, extends rare-disease designation benefits including tax credits, and allows withdrawal of conditional approval if safety data no longer support it.

This section limits orphan drug exclusivity under 21 U.S.C. 360cc to a single 7-year period for the first designation of a drug for a rare disease or condition and a single 3-year period for any subsequent designation of the same drug for a different rare disease or condition. It bars any additional exclusivity after two periods, regardless of further designations.

This section shortens the exclusivity period for brand-name biological products to 5 years (from 12 years) before biosimilar applications may be approved under section 351(k). It makes conforming reductions to related pediatric exclusivity extensions in section 351(m). The changes apply only to biological products licensed on or after the date of enactment.

This section authorizes the Secretary of Health and Human Services to establish a mechanism to regulate drug manufacturers’ financial contributions to patient out-of-pocket costs, such as drug co-pays.

This section provides an antitrust exemption allowing one or more private health insurance issuers or their agents to jointly negotiate wholesale acquisition prices of prescription drugs with manufacturers, provided the issuers do not jointly determine any single price. The exemption applies only to conduct occurring on or after the date of enactment.

This section exempts biological products subject to regulation under section 351 of the Public Health Service Act from any requirements or references in the Federal Food, Drug, and Cosmetic Act regarding official compendia.

This section deems all biological products licensed under section 351(k) of the Public Health Service Act interchangeable with their reference products. It eliminates the prior 12-month exclusivity period for the first interchangeable biosimilar for applications approved on or after enactment, requires the Secretary to brief the chairs and ranking members of the Senate HELP Committee and House Energy and Commerce Committee before requiring any switching study, and applies pediatric assessment rules to biosimilars as if they contain a new active ingredient except when the indication, dosage form, strength, or route matches the reference product.

This section permits approval of applications under subsections (b)(2) or (j) of section 505 even when the labeling omits safety information, including contraindications, warnings, precautions, dosing, or administration, that is protected by exclusivity under clauses (iii) or (iv) of subsection (j)(5)(F), clauses (iii) or (iv) of subsection (c)(3)(E), section 527(a), or extensions under sections 505A or 505E. It requires the Secretary to mandate any appropriate safety statements in such labeling to ensure safe use.

This section establishes a separate congressional review process for Food and Drug Administration rules that applies in lieu of chapter 8 of title 5, United States Code. It requires the FDA to submit detailed reports on proposed rules, mandates joint resolutions of approval for major rules to take effect within 70 session or legislative days, provides disapproval procedures for nonmajor rules, imposes a regulatory cut-go requirement, and directs review of rules currently in effect.

This section directs the Comptroller General to study the total number of rules and major rules in effect as of the date of enactment, as well as the aggregate estimated economic cost of all such rules. The Comptroller General must submit a report containing the findings to Congress within one year.

This section establishes a provisional approval pathway for new human drugs treating serious or life-threatening diseases with reasonable likelihood of premature death absent early intervention, or diseases posing epidemic or pandemic threats. It requires FDA priority review of applications within 90 days (or 3 weeks on a rolling basis during epidemics or pandemics), permits use of real-world evidence and scientifically substantiated surrogates, grants access to benefits from other designations such as orphan-drug status, and mandates sponsor-funded patient registries to track all users until full approval or rescission.

This section requires holders of approved biologics licenses to submit to the Secretary lists of patents that could reasonably be asserted against unlicensed manufacturers, within 30 days of approval or by March 23, 2026, for products approved before enactment. It directs the Secretary to publish and update every 30 days a single public searchable list containing each product's name, patents, licensure date, marketing status, exclusivity periods, and biosimilarity determinations. It incorporates the list into the biosimilar patent dispute process and bars infringement actions on patents not timely disclosed.

This section prohibits a group health plan or health insurance issuer offering group or individual coverage, and any contracted pharmacy benefit manager, from receiving price reductions or other remuneration from drug manufacturers for covered prescription drugs, unless the reduction is reflected at the point of sale to the enrollee and any other payments are transparent flat service fees meeting conditions set by the Secretary. The prohibition takes effect January 1, 2026.

This section prohibits Medicare PDP sponsors and MA-PD organizations from retroactively reducing payments on clean pharmacy claims after receipt, except during routine audits finding the claim not clean, while permitting retroactive increases under written agreement. It bars PBMs managing Medicare drug plans from transmitting enrollee data to PBM-owned pharmacies without voluntary consent and from requiring or incentivizing use of such pharmacies. It requires PDP sponsors and MA organizations using drug cost-based reimbursement standards to update those standards at least every 7 days starting January 1 each year, disclose sources and prices immediately, establish a 7-day appeal process for pricing disputes, and provide data in XML or comparable format. These rules apply to contracts and plan years beginning on or after January 1, 2026.

This section prohibits group health plans, health insurance issuers offering group coverage, and entities providing pharmacy benefit management services from entering contracts with drug manufacturers, distributors, or related parties that prevent disclosure of information to plan sponsors. It requires semiannual reports to plan sponsors in machine-readable format, beginning with the first plan year after enactment of the Fair Care Act of 2026, that detail copayment assistance amounts, per-drug data including National Drug Codes, wholesale acquisition costs, enrollee out-of-pocket spending, gross and net plan spending after rebates, and formulary placement rationales for high-cost drugs.

This section requires the Comptroller General of the United States to conduct a study, in consultation with stakeholders, on the role of pharmacy benefit managers in the pharmaceutical supply chain, including market competition, rebates and fees, formulary design, prior authorization times, and step therapy. It directs submission of a report with findings and policy recommendations to the Secretary of Health and Human Services and the Senate HELP and House Energy and Commerce Committees within 3 years of enactment.

This section authorizes the Secretary of Health and Human Services to base Medicare Part B drug payments on an international pricing index. The Secretary must weight countries with market-based drug policies more heavily than those with price controls.

This section authorizes the Secretary of Health and Human Services to test a model integrating drug benefits under Medicare parts A, B, and D, notwithstanding any provision of section 1115A.

This section defines terms used in the Act, including alternative dispute resolution system, claimant, collateral source benefits, contingent fee, economic damages, future damages, health care lawsuit, health care liability action, health care liability claim, health care provider, health care services, medical product, and noneconomic damages.

This section establishes a 3-year statute of limitations for health care lawsuits, running from the date of the breach or tort or completion of treatment, or 1 year after discovery of the injury, whichever occurs first. It extends the period for minors under age 6 to the later of 3 years from the breach or treatment, 1 year after discovery, or the minor’s 8th birthday, tolls the limit during periods of fraud or collusion by a parent or guardian, and preserves any state law setting a shorter period, a different trigger, or a statute of repose.

This section limits damages and liability in health care lawsuits by (1) allowing unlimited recovery of economic damages, (2) capping noneconomic damages at $250,000 regardless of the number of parties or claims, (3) prohibiting discounting of future noneconomic damages to present value, (4) imposing several liability only in direct proportion to each party’s percentage of responsibility, and (5) preserving any state law that sets a different monetary limit on damages.

This section requires courts to supervise damage payments in health care lawsuits to prevent conflicts of interest that reduce amounts paid to claimants. It caps contingent attorney fees at 40 percent of the first $50,000 recovered, 33 and one-third percent of the next $50,000, 25 percent of the next $500,000, and 15 percent of any amount above $600,000, whether recovery occurs by judgment, settlement, or alternative dispute resolution, and preserves state laws imposing lower limits.

This section requires courts in health care lawsuits to order periodic payments, without reduction to present value, for future damages of $50,000 or more upon request by any party, provided the defendant has sufficient insurance or assets, in accordance with the Uniform Periodic Payment of Judgments Act. It applies to actions not first set for trial before the effective date and preserves state laws with different thresholds or mandatory periodic payment rules.

This section shields a health care provider from being named as a party in a product liability lawsuit or held liable in a class action against the manufacturer, distributor, or seller when the provider prescribes or dispenses an FDA-approved, licensed, or cleared medical product.

This section preserves the application of title XXI of the Public Health Service Act to civil actions for vaccine-related injuries or deaths, and maintains all defenses available to defendants under other Federal law in health care lawsuits.

This section limits expert witness testimony in health care liability cases by requiring that witnesses be licensed in the State or a contiguous bordering State and have practiced there during the year preceding the alleged injury. It applies the same requirements to rebuttal witnesses and authorizes courts to waive them if appropriate witnesses are unavailable.

This section establishes minimum qualifications for expert witnesses testifying on the standard of care in health care lawsuits. An expert must be licensed in at least one state, match the defendant’s specialty (including board certification) or general practice, and have devoted a majority of professional time in the preceding year to active clinical practice or teaching in that field. It bars contingent-fee experts, applies the same rules to lawsuits against employing entities, preserves courts’ authority to disqualify witnesses on other grounds, and does not preempt stricter state requirements.

This section renders inadmissible in any health care liability action all statements, gestures, or conduct by a health care provider expressing apology, fault, sympathy, condolence, compassion, or benevolence that relate to a patient's discomfort, pain, suffering, injury, or death from an unanticipated outcome of medical care. It leaves in effect any state laws that make additional communications inadmissible as evidence of liability.

This section requires plaintiffs, or their attorneys, in health care lawsuits alleging negligence to file an affidavit of merit simultaneously with the complaint. The affidavit must be signed by a qualified health professional, certify review of supplied medical records, and state the applicable standard of care, the opinion that it was breached, the actions that should have been taken to comply, how the breach proximately caused the alleged injury, and the records reviewed. The court may grant a 28-day extension for good cause, and the provision leaves state laws with additional pre-litigation filing requirements in effect.

This section requires 90 days of written notice to a health care provider before a person may commence a health care lawsuit, except when the action is filed within 6 months of the statute of limitations expiring or within 1 year of the statute of repose expiring as to any claimant. It leaves in place any state law that sets a different notice period.

This section limits the liability of physicians and attending medical personnel for harm caused by acts or omissions while furnishing qualified charity care, provided the conduct is not grossly negligent. It preempts inconsistent state laws unless those laws provide greater protection from liability, and applies to claims arising from acts or omissions after the date of enactment.

This section establishes rules of construction for health care lawsuits under the subtitle. It preempts state laws that prevent application of the subtitle’s provisions and supersedes chapter 171 of title 28, United States Code, to the extent that chapter allows greater damages or contingent fees, longer filing periods, reduced periodic payments, or bars evidence of collateral source benefits. It preserves state and federal law on all other issues and all defenses available under other provisions.

This section applies the subtitle's provisions governing health care lawsuits to any such action initiated on or after the date of enactment in federal or state court or an alternative dispute resolution system. It preserves the statute of limitations in effect at the time of accrual for any injury occurring before enactment.

This section establishes an optional reformed Medicaid payment system for states electing to participate on or after the implementation date. Under the system, federal payments equal an adjusted aggregate beneficiary-based amount plus any chronic care quality bonus, in lieu of standard matching payments. States must contribute a non-federal share calculated using a federal percentage of at least 75 percent, with federal funds limited to services for individuals at or below 100 percent of the poverty line under modified adjusted gross income rules without the 5 percent disregard.

This section modifies the income eligibility threshold for the premium tax credit under section 36B. It permits a state that elects under section 1903A of the Social Security Act to substitute its Medicaid income eligibility percentage as of January 1, 2009, for the 100 percent of federal poverty line floor when determining eligibility for taxpayers enrolled through the state's Exchange. The change applies to taxable years beginning after the date of enactment.

This section permits states to contract with other state or local agencies or private contractors to determine Medicaid eligibility, provided the contracts create no incentives to delay or deny eligibility. Beginning October 1, 2026, it allows states to redetermine eligibility every 6 months (or fewer) for individuals whose eligibility is based on modified adjusted gross income under the ACA expansion or certain other categories.

This section lowers the safe harbor threshold for state taxes on health care providers under Medicaid. It reduces the threshold (1) to 4 percent (from 6 percent) for fiscal years beginning on or after January 1, 2027, and before January 1, 2036; (2) to 3 percent for fiscal years beginning on or after January 1, 2036, and before January 1, 2041; (3) to 2 percent for fiscal years beginning on or after January 1, 2041, and before January 1, 2046; (4) to 1 percent for fiscal years beginning on or after January 1, 2046, and before January 1, 2051; and (5) to 0 percent for fiscal years beginning on or after January 1, 2051.

This section authorizes states to approve or renew Medicaid demonstration projects that permit enrollees to elect participation in a direct primary care service arrangement for a year. It deems references to the Secretary in subsection (a) to mean the state for such projects and exempts them from the requirements of subsection (e).

This section establishes a new tax deduction under section 199B of the Internal Revenue Code for qualified charity care. Direct primary care physicians may deduct the published fee for such services plus half the lowest monthly subscription fee per patient visit, while other providers may deduct the unreimbursed Medicare physician fee schedule amount; qualified charity care consists of unreimbursed physicians’ services furnished to Medicaid or CHIP enrollees, subject to a cap equal to the taxpayer’s gross receipts from physicians’ services.

This section sets Medicare payment for items and services furnished in an off-campus provider-based department at the rate determined under the physician fee schedule under section 1848 as if furnished in a physician office setting. The change applies to items and services furnished on or after January 1, 2026.

This section prohibits individuals entitled to Medicare Part A benefits under sections 226 or 226A of the Social Security Act (42 U.S.C. 426, 426–1), or otherwise eligible to enroll under sections 1818 or 1818A (42 U.S.C. 1395i–2, 1395i–2a), who first become annuitants after the date of enactment from continuing enrollment in any Federal Employees Health Benefits Program plan.

This section prohibits enrollment in Medicare Part B or Part D for individuals who attain age 65 on or after January 1, 2032, and have earned $10,000,000 or more in lifetime wages. It also bars the sale or issuance of Medigap policies to such individuals on or after January 1, 2032.

This section permits deductions for costs taken into account in determining special subsidy payments received under Medicare Part D (section 1860D–22 of the Social Security Act), notwithstanding the exclusion of those payments from gross income under section 139A. It applies to taxable years beginning after December 31, 2026.

This section repeals the net investment income tax for taxable years beginning after December 31, 2026.

This section extends Medicare bad debt reimbursement reductions through FY2026 for hospitals, skilled nursing facilities, and other providers. It applies the prior year's percentage, increased by 10 points, for cost reporting periods beginning in FY2027 through FY2029.

This section establishes, beginning with plan year 2026, an online Medicare enrollment process that requires individuals to compare costs among traditional fee-for-service coverage, provider-led accountable care organizations, and Medicare Advantage plans. It requires each Medicare Advantage plan to maintain an actuarial value equal to traditional parts A and B coverage, calculates market-area benchmarks from the prior-year weighted average of all bids and fee-for-service per-person costs (less the statutory part B premium), requires beneficiaries to pay any excess or retain 100 percent of savings below the benchmark, limits annual premium increases to $20 per month for existing fee-for-service enrollees for the first five years, and authorizes Medicare Advantage plans to offer multiyear contracts with guaranteed premiums.

This section establishes processes allowing individuals to opt out of Medicare Part A entitlement without losing Title II benefits and to revoke such waivers, with revocation triggering a late enrollment penalty under Part B. It creates a special open enrollment period without late enrollment penalties for individuals enrolled in only Part A or only Part B as of the general effective date. It requires auto-enrollment of dual eligible individuals into certain MA-PD plans, with the right to decline or switch plans. It also deems enrollment of Medicare beneficiaries into low-premium Part D plans unless they opt out during a coordinated period, applying late enrollment penalties only after such an opt-out.

This section establishes an annual out-of-pocket limit for Medicare enrollees beginning in 2026, set at the dollar amount in effect under section 223(c)(2)(A)(ii) of the Internal Revenue Code for self-only coverage. Once the limit is reached, enrollees incur no further cost-sharing for deductibles and coinsurance under Parts A and B or standard Part D coverage, and the Secretary pays or reimburses the excess from the Part A and Part B trust funds. It applies the same limit to MA-PD plans (which may substitute a lower amount), exempts certain alternative Part D coverage from the Part D deductible, and requires PDP sponsors to report enrollees’ out-of-pocket cost-sharing amounts.

This section exempts months during which an individual has any other health coverage from the Medicare Part B late enrollment penalty under section 1839(b) of the Social Security Act. The change applies to months of coverage beginning after the date of enactment.

This section requires all Medigap policies to provide guaranteed coverage to every eligible individual without regard to preexisting conditions, effective on the date of enactment.

This section revises rules for Accountable Care Organizations under Medicare by basing enrollment on the method established under part E, requiring such networks to bear full financial risk if payments do not cover liabilities, and allowing ACOs to direct payments to a centralized entity rather than individual providers. It also directs the Secretary of Health and Human Services to establish a bidding process for ACO networks similar to that used for Medicare Advantage plans.

This section establishes a mechanism allowing individuals enrolled in Medicare Part B to select a primary care physician, with patient liability limited to $5 per visit. It directs the Secretary to pay each selected physician a monthly fee covering evaluation and monitoring services, including telephone and email communications, office visits, preventive care, and vaccinations, in lieu of other Part B payments.

This section establishes definitions for purposes of the new part, including Medicare enrollee (an individual entitled to benefits under part A and enrolled under part B, or as otherwise specified), Medicare fee-for-service (the original program under parts A and B as modified by this part, excluding parts C and D), and Medicare fee-for-service enrollee. It supersedes inconsistent provisions of the Social Security Act and applies to items and services furnished on or after January 1, 2026, and to plan years beginning on or after that date.

This section expands Medicare telehealth coverage to include respiratory services, audiology services, and outpatient therapy services (physical therapy, occupational therapy, and speech-language pathology). It permits certified diabetes educators and licensed respiratory therapists, audiologists, occupational therapists, physical therapists, and speech-language pathologists to furnish such services. It also covers remote patient monitoring services for individuals with covered chronic conditions (including congestive heart failure and chronic obstructive pulmonary disease) for periods of up to 90 days, renewable by the treating physician.

This section authorizes the Secretary of Health and Human Services to waive Medicare telehealth payment restrictions on originating sites, geographic limits, technology, providers, and services beginning January 1, 2026, if the waiver is expected to reduce spending without reducing quality of care, improve quality without increasing spending, or applies to high-need health professional shortage areas. It requires the Secretary to establish a public comment process, reassess each waiver at least every three years, and post biennial data on affected beneficiaries, expenditures, and utilization starting two years after the first waiver takes effect.

This section waives geographic requirements for Medicare telehealth coverage of mental health services furnished on or after January 1, 2026, at originating sites listed in section 1834(m)(4)(C)(ii) other than a site described in subclause (IX). It also permits the patient's home to serve as an originating site for such services and directs the Secretary of Health and Human Services to consider adding further services to those authorized for telehealth payment under section 1834(m)(1).

This section waives geographic requirements under Medicare for telehealth services for emergency medical care, as determined by the Secretary, furnished on or after January 1, 2026, to an eligible individual at an originating site that is a rural health clinic, a critical access hospital, or a federally qualified health center. The Secretary must also consider adding services to those authorized for telehealth payment.

This section requires the Secretary to review the Medicare process for adding telehealth services and, based on the review, revise the criteria to prioritize improved access to care through telehealth and clarify the contents of requests to add such services.

This section expands Medicare telehealth coverage by adding rural health clinics and Federally qualified health centers as originating sites, regardless of whether the patient is located in a rural area, and as distant sites eligible for payment. The changes apply to services furnished on or after January 1, 2026, subject to applicable state law.

This section exempts facilities of the Indian Health Service, Indian tribes, tribal organizations, and Native Hawaiian health care systems from Medicare telehealth originating site requirements under section 1834(m) of the Social Security Act. It also bars facility fees for any such site that meets only the new exemption and not the standard originating site criteria. The changes apply to services furnished on or after January 1, 2026.

This section authorizes the Secretary to temporarily waive or modify Medicare requirements for payment for telehealth services under section 1834(m) in any emergency area during an emergency period.

This section permits the face-to-face encounter required for Medicare hospice recertification at 180 days and subsequent periods to occur via telehealth, without regard to the geographic and originating-site restrictions in section 1834(m)(4)(C). It also requires the Comptroller General to report to Congress within three years on the number and percentage of beneficiaries recertified through telehealth and the appropriateness of those recertifications.

This section permits a provider or supplier to furnish technologies, as defined by the Secretary, directly to a Medicare beneficiary for telehealth, remote patient monitoring, or other technology-based services on or after the date of enactment. The technologies must not be offered as part of any advertisement or solicitation and must meet any additional requirements established by regulation.

This section directs the Medicare Payment Advisory Commission to study increasing access to telehealth services in the home under Medicare, including how other payers allow the home as an originating site and which services or beneficiary subgroups would be suitable. The Commission must report results and recommendations to Congress within 24 months of enactment.

This section requires the Center for Medicare and Medicaid Innovation to analyze telehealth waivers issued under section 1115A(d)(1) and their effects on quality and spending under Medicare and Medicaid in its required reports.

This section expands the payment and service delivery models that the Center for Medicare and Medicaid Innovation may test to include allowing health professionals who are not otherwise eligible under section 1834(m) to furnish telehealth services.

This section directs the Secretary to consider testing Center for Medicare and Medicaid Innovation models that examine the use of telehealth under Medicare.