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S5269119th CongressWALLET

Pay PCPs Act of 2026

Sponsored By: Senator Whitehouse, Sheldon [D-RI]

Introduced

Summary

Creates a hybrid payment framework for primary care that pairs a monthly per-member-per-month payment with continued fee-for-service billing to support team-based care, care coordination, and better access for patients with complex needs or in rural or low-income communities. This approach is aimed at helping practices transform how they deliver primary care.

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  • Families and beneficiaries: The bill would cut beneficiary Part B cost-sharing by 50% for primary care services paid through the hybrid model when a primary care provider is designated as the usual source of care and notified to CMS. It also requires a report to Congress within 180 days of implementation and yearly after that on utilization and possible fraud or abuse.
  • Primary care providers and clinics: It would let primary care providers receive a PMPM payment equal to 40% to 70% of expected annual allowed charges for included services while still billing fee-for-service for other services. The bill also appropriates $10.0 billion for fiscal years 2027 through 2031 to fund hybrid payments and does not force providers to participate.
  • CMS operations, quality, and oversight: The Secretary could set quality measures and bonuses and exempt participating providers from some Merit-based Incentive Payment System reporting. The bill creates a technical advisory committee and allows transfers from the Supplementary Medical Insurance Trust Fund up to $5.0 million and $10.0 million per year for implementation and research and development through 2031.

*Would authorize $10.0 billion in appropriations for 2027–2031 and permit additional trust fund transfers for committee work, increasing federal outlays relative to current law.*

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Lower Medicare primary care costs

If enacted, the bill would let HHS create a voluntary hybrid Medicare payment for primary care. Participating primary care providers would get a monthly per-member payment plus fee-for-service for services not covered by the monthly payment. The monthly payment would equal 40% to 70% of expected annual allowed charges for included primary care services. You would pay 50% less Part B cost-sharing for primary care services when you designate and confirm a provider as your usual source of care. Screenings, preventive services, annual wellness visits, vaccines, and initial preventive physical exams would still be paid separately and at least at current Medicare payment levels. The bill would appropriate $10 billion for these hybrid payments for fiscal years 2027–2031, and joining the program would be voluntary. Providers in the program would be exempt from the named MIPS reporting requirement.

New CMS RVU advisory committee

If enacted, the bill would create a 13-member technical advisory committee inside CMS to advise on relative value unit valuation under the physician fee schedule. The committee would include Medicare-billing providers, primary care clinicians, and technical experts and would be chaired and staffed by CMS personnel. It would advise on valuation methods, code bundling or collapse, research needs, fraud and abuse risks, and effects on access and quality. The committee would terminate no later than five years after it starts. The Secretary would be authorized to transfer up to $5 million per year for operations and up to $10 million per year for research from the Federal Supplementary Medical Insurance Trust Fund for fiscal years 2027–2031, and transferred amounts would remain available until expended.

Sponsors & CoSponsors

Sponsor

Whitehouse, Sheldon [D-RI]

RI • D

Cosponsors

  • Sen. Cassidy, Bill [R-LA]

    LA • R

    Sponsored 8/5/2026

Roll Call Votes

No roll call votes available for this bill.

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