Patients First Act of 2026
Sponsored By: Senator Marshall, Roger [R-KS]
Introduced
Summary
Revamps Medicare physician payments and quality measurement to push more care into primary care, change how annual payment updates are set, and replace MIPS with a new POINTS system. It would test a national monthly payment for primary care and tighten measurement and registry rules.
Personalized for You
How does this bill affect your finances?
Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
6 provisions identified: 2 benefits, 0 costs, 4 mixed.
No cost-sharing primary care payments
If enacted, the bill would create a five-year Medicare primary-care payment model from 2027 through 2031. The model would pay qualifying suppliers a monthly per-patient amount equal to 1/12 of the Secretary’s estimated national average for designated primary-care services, with geographic and risk adjustments. If you are a Part B enrollee not in Medicare Advantage and are attributed to a participating supplier, you would not owe cost sharing for that monthly payment. Payments would come from the Federal Supplementary Medical Insurance Trust Fund, and the Secretary could assign a supplier if an enrollee does not choose one.
Changes to Medicare doctor payments
If enacted, the bill would change how Medicare sets the physician fee-schedule conversion factor beginning in 2027. For clinicians not in qualifying APMs, the annual update would generally equal the Medicare Economic Index increase minus 1.0 percentage point, with qualifying APMs getting an extra 0.5 point; computed updates would be floored at 25% and capped at 75% of the MEI increase. The Secretary could not apply budget-neutral adjustments that change the conversion factor by more than 2.5% year-to-year. Beginning in 2029, the Secretary would reconcile estimated versus actual utilization differences above 0.1% of total estimated Part B expenditures. The bill also sets specified budget-neutrality dollar amounts ($20 million before 2028 and $57.64 million for 2028) and updates practice-expense inputs at least every five years.
Changes to MIPS payment and feedback
If enacted, the bill would change how MIPS (and later POINTS) scores affect payments and feedback. For performance years starting January 1, 2027, a clinician who elects to report a qualifying new or substantially changed quality measure would be given the highest possible score for that measure. Beginning in 2032, clinicians who are part of defined "excluded practices" would be barred from certain extra incentive payments and would have any positive MIPS adjustment reduced by 50 percent (applied budget-neutrally). The bill would also protect clinicians from negative adjustments when required administrative claims–based feedback is missing, and require CMS to send detailed quarterly claims-based feedback within 60 days for quarters starting on or after January 1, 2032.
Medicare imaging exemptions and reporting
If enacted, the bill would change Medicare’s imaging appropriate-use rules starting January 1, 2027. It would exempt imaging ordered for clinical trials, orders by professionals in practices with 15 or fewer ordering professionals, orders in rural health professional shortage areas, mammography, CT lung screening, CT colonography, emergency care, and other screening services the Secretary names. Qualified clinical decision support tools would have to supply specified information, and furnishing providers would have to include the ordering clinician’s NPI on claims when different. The Secretary would identify low-compliant ordering professionals (excluding exempt orders) and could use interventions, and must report to Congress by January 1, 2031 and every five years thereafter.
New POINTS provider scoring rules
If enacted, the bill would replace the current MIPS program with a new system called POINTS for performance periods beginning January 1, 2032. POINTS would add a care-efficiency performance category and require annual final lists of quality, resource-use, and care-efficiency measures. A Quality Reform Task Force would recommend measures, and the Secretary would have to respond within 120 days and generally include recommended measures unless a written clinical or program-integrity justification is published. Measures with strong Task Force support would get special protections before being excluded.
New rules for clinical registries
If enacted, the bill would set new qualification standards for clinical registries and let qualified registries request Medicare claims data by January 1, 2027. Registries would need clinician-led governance, strong data-quality checks, timely feedback to users, and transparency about measure methods. Designations would last three years and could be renewed. The Secretary could also provide Medicaid and CHIP claims data when appropriate, and registries could be charged a reasonable fee equal to CMS's cost to provide the data.
Sponsors & CoSponsors
Sponsor
Marshall, Roger [R-KS]
KS • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov