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119-hr-7520119th CongressWALLET
Efficiency Adjustment Delay Act
Sponsored By: Representative Estes, Ron [R-KS-4]
Introduced
Summary
Delays a planned efficiency adjustment to physicians' work relative value units (RVUs) until January 1, 2030. The bill would also change short-term Medicare payment update rates for clinicians in alternative payment models and require a CMS report on a possible one-time RVU change for services not recently reviewed.
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- Clinicians and specialty groups would avoid the immediate efficiency-related changes to work RVUs and updates to intraservice time inputs for non-time-based services until January 1, 2030. This postpones the policy from the November 5, 2025 final rule.
- The Secretary must submit a report to Congress within two years assessing whether a one-time, across-the-board RVU adjustment is needed for services not revalued or reviewed in the prior 10 years. If the report supports it, CMS may implement that single adjustment after 2030 under set consultation and methodology limits.
- For 2026 the bill raises the update to the qualifying APM conversion factor to 1.24% and the nonqualifying update to 0.74%. For 2027 and later the updates are set at 0.75% for qualifying APMs and 0.25% for nonqualifying APMs.
- The bill clarifies that delaying the efficiency adjustment does not block revaluing misvalued codes or assigning values to new or revised codes.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Higher Medicare payment updates 2026
This bill would change the percent updates used to set two Medicare APM conversion factors for 2026. For 2026, the qualifying update would be 1.24% and the nonqualifying update would be 0.74%. For 2027 and each later year, the qualifying update would be 0.75% and the nonqualifying update would be 0.25%. These updates would change the conversion factor used to calculate doctors' Medicare payments.
Delay of Medicare RVU Adjustment
This bill would stop HHS from applying the November 5, 2025 final rule that makes a one-time efficiency adjustment to doctors' work RVUs before January 1, 2030. The Secretary would have two years after enactment to report to the House Energy and Commerce and Ways and Means Committees and the Senate Finance Committee on whether an across-the-board adjustment is needed, with supporting evidence. If the report supports an adjustment, the Secretary would be allowed to apply one such adjustment on or after January 1, 2030 only after consulting affected physician specialties, excluding services revalued or reviewed in the prior 10 years, and following the bill's methodology limits. The Secretary would not be allowed to apply that efficiency adjustment more than once. The delay would not prevent revaluing misvalued codes or assigning values to new or revised codes.
Sponsors & CoSponsors
Sponsor
Estes, Ron [R-KS-4]
KS • R
Cosponsors
Rep. Suozzi, Thomas R. [D-NY-3]
NY • D
Sponsored 2/12/2026
Rep. Mann, Tracey [R-KS-1]
KS • R
Sponsored 5/12/2026
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 5/12/2026
Rep. Schmidt, Derek [R-KS-2]
KS • R
Sponsored 5/12/2026
Rep. Foushee, Valerie P. [D-NC-4]
NC • D
Sponsored 5/12/2026
Rep. Murphy, Gregory F. [R-NC-3]
NC • R
Sponsored 5/13/2026
Rep. Correa, J. Luis [D-CA-46]
CA • D
Sponsored 5/13/2026
Rep. Bean, Aaron [R-FL-4]
FL • R
Sponsored 5/13/2026
Rep. Davis, Donald G. [D-NC-1]
NC • D
Sponsored 5/13/2026
Rep. Salazar, Maria Elvira [R-FL-27]
FL • R
Sponsored 6/25/2026
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 6/25/2026
Rep. Rouzer, David [R-NC-7]
NC • R
Sponsored 6/30/2026
Rep. Edwards, Chuck [R-NC-11]
NC • R
Sponsored 9/1/2026
Rep. Thanedar, Shri [D-MI-13]
MI • D
Sponsored 9/1/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov