“A bill to provide for the establishment of hybrid primary care payments under the Medicare program, and for other purposes.”
No CRS summary available for this bill.
This section makes findings on the importance of primary care transformation for Medicare beneficiaries with chronic conditions or in rural areas, the fact that fee-for-service payment fails to recognize 25 percent or more of primary care activities, the lower share of total health spending devoted to primary care in the United States than in other wealthy nations, and distortions in Medicare physician fee schedule payments arising from more than 8,000 billing codes and inaccurate time estimates.
This section authorizes the Secretary of Health and Human Services to establish hybrid payments under the Medicare physician fee schedule available only to primary care providers, consisting of prospective per-member-per-month payments representing 40 to 70 percent of expected annual total allowed charges plus fee-for-service payments. It requires risk-adjusted prospective payments to support care management, behavioral health integration, and office-based evaluation and management visits; excludes participating providers from the Merit-based Incentive Payment System; and directs the Secretary to attribute beneficiaries using historical claims data and beneficiary affirmation while identifying quality measures for performance bonuses.
This section authorizes the Secretary of Health and Human Services to reduce by 50 percent any beneficiary cost sharing under Medicare Part B for primary care services reimbursed through hybrid payments, provided the beneficiary designates a primary care provider as their usual source of care. It requires the Secretary to report to Congress within 180 days of implementation and annually thereafter on impacts to utilization and any observed fraud or abuse.
This section establishes a 13-member technical advisory committee within the Centers for Medicare & Medicaid Services to advise the Secretary on determining relative value units under the Medicare physician fee schedule. The committee, chaired by a CMS representative and staffed by CMS personnel, reviews valuation methodologies, research, HCPCS code changes, bundling opportunities, operational burdens, and effects on beneficiary access, quality, and health disparities. It receives up to $5 million per year for operations and $10 million per year for research and development from the Supplementary Medical Insurance Trust Fund for fiscal years 2027 through 2031 and terminates after five years.