Promoting Fairness for Medicare Providers Act of 2026
Sponsored By: Representative Bilirakis
Introduced
Summary
Align Medicare payment for high-supply-cost surgical procedures in office-based facilities. This bill would base facility payments for those procedures on ambulatory surgical center rates beginning in 2027, and it would set definitions, enrollment rules, and limits on patient coinsurance.
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- Patients and Medicare enrollees: Coinsurance for facility services would not exceed the inpatient hospital deductible. If normal coinsurance would be higher the bill requires higher payments so a patient’s out-of-pocket for facility services stays at or below that deductible.
- Office-based facilities and clinicians: Physician offices could enroll as office-based facilities if they meet federal standards and accept Medicare payment as full. Facility payments for the defined high-supply-cost procedures would follow a new formula tied to ASC rates with a 90% benchmark and an 80% facility-payment application for office-based settings.
- States, ASCs, and outpatient departments: State agencies would determine compliance with conditions of participation for office-based facilities. The bill also applies the new payment rules to off-campus outpatient departments and adjusts ASC treatment for these procedures.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 0 costs, 1 mixed.
New Medicare rules for office surgeries
If enacted, the bill would create an "office-based facility" enrollment for some doctor offices starting in 2027. To enroll, an office would need to meet Secretary-specified health and safety standards and accept assignment and the new facility payment as full payment for the listed procedures. The bill would define "specified high supply cost surgical procedures" using a 2023 baseline that requires a supply price-input over $500 and would require yearly review and MEI-based indexing beginning in 2028. For those procedures in enrolled offices, Medicare would use ASC-style payment rules but set facility amounts below full ASC rates (including 90% and 80% rules and a 90% non-device adjustment for device-intensive cases). The bill would cap a beneficiary's yearly coinsurance for these facility services so it would not exceed that year's inpatient hospital deductible, and the Secretary would increase the office payment to cover any shortfall. The Secretary could use state surveyors or certification agencies to check compliance.
Sponsors & CoSponsors
Sponsor
Bilirakis
FL • R
Cosponsors
Rep. Ruiz, Raul [D-CA-25]
CA • D
Sponsored 3/9/2026
Rep. Murphy, Gregory F. [R-NC-3]
NC • R
Sponsored 3/9/2026
Davis (IL)
IL • D
Sponsored 3/9/2026
Joyce (PA)
PA • R
Sponsored 3/17/2026
Roll Call Votes
No roll call votes available for this bill.
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