Patients First Act of 2026

Section 102: This section establishes a hybrid payment model for primary care services that provides monthly payments to qualifying suppliers for each attributed patient without applying any cost-sharing requirements. This could benefit Medicare beneficiaries by removing out-of-pocket costs for essential primary care services like care management and behavioral health integration.

Section 103: This provision implements a work geographic index floor adjustment during high inflationary years through 2032. This helps ensure that physicians practicing in areas impacted by high inflation receive fair adjustments, which supports continuous patient access to care in those regions.

Section 203: This section creates a Quality Reform Task Force with a majority of members comprised of designated health care practitioners and specialized representation. This ensures that the people we vote for hold officials accountable by requiring the Secretary of Health and Human Services to formally respond to expert recommendations on medical quality measures, promoting transparency and clinically sound standards.

Section 204: This provision ensures that Medicare professionals do not face negative payment adjustments if the government fails to provide required administrative claims-based feedback on time. This protects healthcare providers from being penalized due to administrative delays by the government.

Section 206: This section expands access to claims data for qualified clinical data registries and clinician-led registries to conduct research and quality improvements. This allows providers to better analyze patient outcomes and improve the safety and quality of care delivered to the public.

Section 207: This provision exempts small practices with 15 or fewer ordering professionals, rural health professional shortage areas, and specific preventive imaging services from certain appropriate use criteria penalties. This protects small, community-based providers and patients from unnecessary burdens when seeking routine screenings like mammographies or lung cancer screenings.

Section 101: This section outlines updates to nonqualifying and qualifying Alternative Payment Model conversion factors based on the Medicare Economic Index less 1 percentage point, bounded by a floor and ceiling. Depending on economic conditions, holding updates below the full estimated percentage increase could create financial pressures for certain physician practices that may indirectly affect patient care options.

Section 204: This provision requires the Secretary to reduce positive Merit-based Incentive Payment System adjustment factors by 50 percent for professionals who are part of an excluded practice starting in 2032. This reduction could impose financial penalties or lower incentives for certain medical practices defined as excluded practices.