S. 5180 — Provider Reimbursement Stability Act of 2026

This section raises the budget neutrality threshold for annual adjustments to the Medicare physician fee schedule to $57,640,000 for 2028 (from $20,000,000) and maintains that amount through 2032, with indexing to the Medicare Economic Index every five years beginning in 2033.

This section requires the Secretary to reconcile differences between estimated and actual utilization for specified services—newly unbundled services with expected expenditures exceeding 0.1 percent of total physician fee schedule spending—when applying budget neutrality adjustments under the Medicare physician fee schedule for years beginning in 2029. It directs the Secretary to adjust the conversion factor in the second year after each such year if the difference exceeds the 0.1 percent threshold and exempts those adjustments from further budget neutrality requirements.

This section requires the Secretary of Health and Human Services to update prices and rates for all categories of direct cost inputs used to calculate practice expense relative value units for physicians’ services at least once every 5 years, beginning no later than 5 years after enactment. Updates must occur simultaneously across clinical staff wage rates, medical supply prices, equipment prices, and any other specified inputs, after consultation with physician specialty societies and other stakeholders.

This section limits year-to-year changes to the Medicare physician fee schedule conversion factor. Beginning in 2028, it prohibits the Secretary from applying a budget neutrality adjustment that would cause the factor to vary by more than 2.5 percent from the factor established for the preceding year.