October 23, 2026

The third quarter of 2026 was a productive one. Despite the political environment in Washington, many of our priorities began to move through the legislative process with bipartisan support. Prior authorization reform advanced through two key House committees. A House subcommittee held a hearing on physician payment reform legislation. MGMA also placed your priorities on the record in our comments on the CY 2027 Medicare Physician Fee Schedule proposed rule.

In September, members joined us in San Antonio for MGMA's centennial Annual Conference. At the Government Affairs town hall, members identified three top priorities: Medicare reimbursement, Medicare Advantage and prior authorization. Attendees described Medicare payment as unsustainable. They reported that an approved prior authorization does not guarantee payment and that payer denials continue to add administrative burden for staff. This feedback will guide our agenda for the remainder of the year.

What follows is a summary of where these issues stand and what lies ahead.

Legislative update:

Prior authorization reform is advancing. The Improving Seniors' Timely Access to Care Act (H.R. 3514) passed the Ways and Means and Energy and Commerce Committees unanimously this summer and has over 300 House cosponsors. It would statutorily require electronic prior authorization in Medicare Advantage. We urge Congress to enact it.

Prior authorization approvals should be honored. MGMA endorsed the Protecting Approved Care Act (H.R. 10394) from Reps. Bob Onder, M.D. (R-MO) and Greg Landsman (D-OH). It would prohibit Medicare Advantage organizations from downcoding or reversing payment for services approved through prior authorization.

Physician payment reform received its first hearing. MGMA worked closely with the Doctors Caucuses on the Patients First Act (H.R. 9693), introduced by Reps. John Joyce, M.D. (R-PA), Greg Murphy, M.D. (R-NC) and Kim Schrier, M.D. (D-WA). The bill would provide a permanent annual inflationary update and modernize budget neutrality. MGMA submitted a statement for the record for the September Energy and Commerce Health Subcommittee hearing urging passage. In the near term, Congress must still prevent the 2027 payment reduction.

Regulatory update:

CY 2027 PFS comments. On September 14, MGMA submitted comments on the CY 2027 Medicare Physician Fee Schedule proposed rule. CMS proposed conversion factor reductions of 1.19% for qualifying APM participants and 1.68% for all other clinicians. MGMA urged CMS to:

• Withdraw the 50% payment reduction for E/M services billed with modifier -25 on the same day as a global procedure. MGMA also pressed this with White House and CMS staff.
• Rescind the remote patient monitoring changes, including the practice employee requirement.
• Delay the mandatory Ambulatory Specialty Model.

Medicare enrollment. MGMA urged CMS to withdraw broad enrollment, revalidation and revocation changes in the CY 2027 Home Health proposed rule, which would add undue compliance burden for practices.
Workforce. MGMA asked DHS to exempt healthcare workers from a proposed $103,265 H-1B petition fee.
Artificial intelligence. MGMA has urged HHS to ensure that AI supports clinical judgment rather than replacing it. Payers should disclose their use of AI in utilization management and claims processing. MGMA is also closely monitoring the CMS WISeR Model, which uses AI-assisted prior authorization in traditional Medicare.

Fourth quarter outlook:
The fourth quarter will be decisive. Key dates include:

• By November 1: CMS is expected to release the CY 2027 PFS final rule. MGMA will provide an analysis and a member webinar.
• November 3: Midterm elections. Congress will return for an abbreviated lame-duck session.
• December 11: Government funding expires under the continuing resolution enacted in September. A year-end spending measure is the most likely vehicle for a healthcare package.
• December 31: The temporary 2.5% Medicare physician payment increase, the Advanced APM incentive payment and the GPCI work floor are all scheduled to expire.
• January 1, 2027: The mandatory Ambulatory Specialty Model begins for selected physicians treating heart failure and low back pain. Electronic prior authorization regulatory requirements take effect for Medicare Advantage and Medicaid plans. Lab reimbursement cuts under the Protecting Access to Medicare Act (PAMA) take effect.

MGMA's priorities for the lame-duck session are clear: prevent the 2027 payment reduction, extend the Advanced APM incentive payment, extend the GPCI work floor and continue building toward permanent Medicare payment reform.

Your engagement strengthens this advocacy. I encourage you to contact your members of Congress about these priorities and to join an MGMA advocacy workgroup or the Policy Advisory Network.

This work reflects the core value of MGMA membership. Advocacy is one of the most tangible ways MGMA serves your practice, translating member priorities into policy outcomes that affect both your financial stability and your ability to care for patients.

Thank you for your continued engagement and trust. MGMA will continue to advocate for federal policies that support medical groups and the patients they serve.

Sincerely,
Anders Gilberg
Senior Vice President, Government Affairs