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HR 9693

Patients First Act of 2026

119th Congress Introduced by Brian Babin and 32 co-sponsors

The bill replaces physician payment rules with a Hybrid Primary Care Payment Model and a new POINTS-based quality system to emphasize primary care, data-driven measures, and budget

Introduced in House
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Bill Summary · HR 9693

Overview

  • Bill: HR 9693
  • Session: 119th Congress, 2nd Session
  • Title: Patients First Act of 2026
  • Primary aim: Modify Medicare physician payments and related payment reform mechanisms to change how value and efficiency are incentivized, with a strong emphasis on primary care, data infrastructure, and a transition to a new payment framework (the “Patient Outcome Improvement National Tabulation System” or “POINTS”).
  • Introduced: July 15, 2026
  • Principal sponsors: Rep. Joyce (PA) and numerous co-sponsors
  • Committees: House Energy and Commerce; Ways and Means

Purpose and intent

  • Replace or reform certain aspects of the physician payment system under Medicare, with a focus on:
    • Recalibrating the conversion factor updates for physician payments.
    • Implementing a hybrid payment model for primary care.
    • Overhauling the measurement and reporting framework for value-based payment (renaming MIPS to POINTS and expanding governance around quality, resource use, and care efficiency measures).
    • Expanding data access to support research and quality improvement.
    • Introducing budgetary and implementation guardrails to manage volatility and ensure budget neutrality.

Key provisions and changes

1) Modifications to physician payment updates (Section 101)

  • Amends Section 1848(d) to introduce a new update formula for 2027 and later years.
  • Updates are tied to the MEI (Medicare Economic Index) minus 1 percentage point, with a 0.5 percentage point increase for the nonqualifying APM conversion factor.
  • Adds floor/ceiling rules:
    • If the update is less than 25% of the MEI increase, it is set to 25% of the MEI increase.
    • If the update is more than 75% of the MEI increase, it is limited to 75% of the MEI increase.
  • Requires annual reports to Congress on these updates, including impacts on beneficiary access and practice consolidation.

2) Hybrid payment model for primary care (Section 102)

  • Creates a new Sec. 1866H establishing a Hybrid Payment Model for Primary Care (2027–2031).
  • Structure:
    • Monthly per qualifying supplier payment for each attributed patient, replacing designated primary care service payments under 1848 for that year.
    • Payment amount equals 1/12 of the national average payment for designated primary care services (as if no cost-sharing) adjusted by a geographic index and risk adjustment.
    • No cost sharing on monthly payments.
  • Attribution and enrollment:
    • Patients enrolled in Part B and not in MA can designate a qualifying supplier as their primary care provider; otherwise attribution may be based on prior claims history.
  • Definitions include: designated health care practitioner (e.g., certain non-physician providers), designated primary care services (care management, behavioral health integration, office-based E&M, and patient-provider communications), and “excluded practices” with ownership/control limitations (with a 15-practitioner exception).
  • Funding: Payments funded from the Medicare Part B Trust Fund.

3) Transition to a new quality/measurement system (Section 201)

  • Establishes the Patient Outcome Improvement National Tabulation System (POI-NTS) effective Jan 1, 2032, replacing MIPS/MBI terminology with POINTS.
  • Transition plan to rename and transition terminology, with a requirement that references to POINTS/MIPS be reconciled during the transition.

4) Payment reform and measurement reforms (Section 202)

  • Amends 1848(q) to realign performance period terminology and update measures to reflect care efficiency and other modernized metrics.
  • Introduces a new CARE EFFICIENCY category and expands the measures portfolio (quality, resource use, and care efficiency) with updates for performance periods beginning in 2032.
  • Adds explicit consideration for specialty-specific measures, data registries, and the inclusion/exclusion process for measures.

5) Quality Reform and data governance (Section 203)

  • Establishes a Quality Reform Task Force to advise on measures, ensure alignment with clinical guidelines, and oversee implementation.
  • Task Force composition prioritizes designated health care practitioners and specialty representation; cap on total members at 25.
  • Requires Secretary responses to Task Force recommendations within 120 days and annual reporting on Task Force activities and outcomes.

6) Modifications to MIPS adjustments and reporting (Section 204)

  • Restructures MIPS final score components and adjusts the incremental adjustments for years 2027–2031 (and beyond).
  • Adds protections for clinicians in cases where feedback is delayed or incomplete (no negative adjustments if feedback is missing).
  • Extends incentive programs for certain professionals through 2032 with adjustments to participation rules for excluded practices.
  • Introduces a new incentive structure for reporting on new or substantively changed measures, with protections for new measures and temporary benchmarks.

7) Access to and use of data (Section 206)

  • Creates expanded access to claims data for qualified clinical data registries and clinician-led registries starting 2027.
  • Enables linking claims data with outcomes data, supporting quality improvement and research, with de-identified or aggregated data permissible.
  • Data access subject to reasonable fees and transparency; registries retain intellectual property rights.

8) Imaging and appropriate use criteria data (Section 207)

  • Expands requirements around data collection for applicable imaging services, including a Qualified Clinical Decision Support Mechanism.
  • Establishes reporting requirements, exemptions for certain imaging types and settings, and provisions for small/rural practices.
  • Requires furnishing professionals to include the ordering professional’s NPI on imaging claims after 2027.
  • Adds a governance provision for low-compliance ordering professionals and related data reporting.

9) APM participation thresholds (Section 301)

  • Freezes qualifying APM participant thresholds for 2029 and 2030, with adjustments to prompt future realignment to budget constraints.
  • Allows Secretary to adjust threshold percentages downward as needed.

10) Other budget and implementation provisions (Title III–IV)

  • Various budget neutrality adjustments, corrections related to utilization estimates, and annual reporting requirements.
  • Requires timely updates to direct costs used to calculate RVUs (every ~5 years) and implementation safeguards to ensure consistency and transparency.
  • Likely effects on Medicare budget neutrality calculations, supplemental payments, and potential shifts in practice patterns.

Who and what would be affected

  • Medicare physicians and other designated health care practitioners (e.g., PAs, NPs, CNSs) who bill for Part B services.
  • Primary care practices and clinicians attributed to a patient roster under the Hybrid Payment Model.
  • Specialty clinicians, hospitals, and practice groups impacted by quality measures, data reporting, and potential participation requirements.
  • Qualified clinical data registries and clinician-led registries that develop and maintain measures used in the new system.
  • Medicare beneficiaries, through potential changes in payment updates, access to services, and the geographic and risk-adjusted payment model effects.

Procedural and timeline notes

  • Effective start of major changes: 2027 for many reforms (hybrid model, new payment adjustments, data access provisions).
  • 2031–2032: Transition to the new Patient Outcome Improvement National Tabulation System (renaming MIPS to POINTS) takes full effect for performance periods starting in 2032.
  • Ongoing reporting: Annual reports to Congress on updates to conversion factors; annual Task Force reporting; and quarterly updates on imaging/decision-support compliance data under the new rules.
  • Special studies: Comptroller General to study barriers to participation in value-based models by 2029 and report recommendations.

Potential impacts (high-level)

  • Incentivizes broader adoption of primary care-led, value-based payments via a guaranteed monthly payment model in addition to or in lieu of traditional FFS payments for designated primary care services.
  • Introduces more explicit cost-control and data-driven quality measurement with a governance structure intended to align measures with clinical guidelines and specialty realities.
  • Expands data-sharing capabilities to fuel research and quality improvement, but preserves registries’ ownership of their measures.
  • Adds budgetary guardrails to limit year-to-year fluctuations in the conversion factor.
  • Requires modernization of terminology and reporting frameworks in Medicare payment policy (MIPS → POINTS).

Note: This summary presents the bill’s provisions as written and does not reflect any amendments or legislative changes that may occur during committee consideration or floor action.

Compiled from official sources — confirm details with the bill’s official record.

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