Efficiency Adjustment Delay Act
Sponsored By: Representative Estes
Introduced
Summary
Pauses Medicare's planned efficiency cut to physician work relative value units. This bill would delay a CMS rule that changes work RVUs and set strict conditions and a review before any one-time, across-the-board RVU change could occur.
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- Physicians and specialty groups would avoid the efficiency-based work-RVU reductions until January 1, 2030. Any later one-time change could be applied only once and must exclude services revalued or reviewed within the prior 10 years.
- The Department of Health and Human Services would have 2 years to report to congressional committees on whether a one-time, across-the-board adjustment is necessary and to provide supporting evidence. If the report supports the change, CMS must consult affected physician specialties before implementing it.
- The bill changes annual update rates. For 2026 the qualifying alternative payment model conversion factor update becomes 1.24% and the nonqualifying update becomes 0.74%. For 2027 and later years those updates are 0.75% and 0.25% respectively.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Delay to Medicare doctor work values
This bill would stop HHS from applying the efficiency cut to physician work values and related in‑service time updates before January 1, 2030. Within two years of enactment, HHS would have to send Congress a report on whether a one‑time, across‑the‑board adjustment is needed for services not revalued or reviewed in the prior 10 years. If the report supports an adjustment, HHS could apply one one‑time change on or after January 1, 2030 only if it consults affected physician specialties and excludes services revalued or reviewed in the prior 10 years. HHS would also have to use a method that generally avoids relying on a productivity‑vs‑inflation factor unless the nonqualifying APM conversion factor update for that year is at least equal to the prior year’s CPI‑U increase. Revaluing misvalued codes and setting values for new or revised codes would still be allowed.
Higher Medicare payment updates for doctors
This bill would change the annual updates used to set Medicare physician payments. For 2026 the qualifying APM conversion factor update would be 1.24 percent and the nonqualifying update would be 0.74 percent. For 2027 and each later year, the qualifying update would be 0.75 percent and the nonqualifying update would be 0.25 percent. These updates would affect payment rates under the Medicare physician fee schedule.
Sponsors & CoSponsors
Sponsor
Estes
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
Schmidt
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
Bean (FL)
FL • R
Sponsored 5/13/2026
Davis (NC)
NC • D
Sponsored 5/13/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov