Why It Matters

Congress faces a complex landscape of Medicare payment deadlines and statutory requirements that govern how the federal government reimburses hospitals, physicians and other health care providers. A recent Congressional Research Service report provides a guide to the schedules and resources governing Medicare fee-for-service payment rules, which routinely draw congressional attention from provider and beneficiary groups.

Medicare payment systems operate on different rulemaking schedules depending on the type of provider or service. Members of Congress and committees are frequently contacted by provider and beneficiary groups about Medicare fee-for-service payment rules, and Medicare rulemaking must comply with both general Administrative Procedure Act procedures and Medicare-specific statutory requirements.

Legislation enacted in July 2025 provided a one-time 2.5% increase to Medicare physician payment rates from Jan. 1 through Dec. 31. The increase applies to physician payments for the year but does not retroactively compensate physicians for the payment reduction that took effect in 2025. The American Medical Association has warned that the July 2025 law includes significant funding cuts and policy changes to Medicaid and the Health Insurance Marketplaces, Medicare physician payment and medical student loans that will worsen patient access.

The Big Picture

Medicare rulemaking generally operates on two calendars. The first, used for hospital inpatient services, inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, inpatient psychiatric facilities and hospice, generally follows a spring-to-summer schedule. Proposed rules typically appear in April or May, with final rules issued during the summer ahead of the federal fiscal year beginning Oct. 1.

The second calendar covers physician services, outpatient hospital services, ambulatory surgical centers, home health services and end-stage renal disease dialysis. Proposed rules generally appear in the summer, with final rules issued later in the year ahead of the calendar year beginning Jan. 1. For the Medicare Physician Fee Schedule, CRS identifies July or August as the typical proposed-rule period and November as the typical final-rule period.

These schedules are not merely administrative convention. Federal law requires the secretary of Health and Human Services to establish the physician fee schedule by regulation before Nov. 1 of the preceding year. CRS notes that the statute does not broadly address public comment for the Physician Fee Schedule, although it does establish comment requirements for specific components of the physician payment system.

CMS has continued issuing rules governing payments for the upcoming fiscal year. The agency issued its fiscal 2027 Skilled Nursing Facility and Inpatient Psychiatric Facility final rules July 29. The SNF rule provides a 2.4% payment update, which CMS estimates will increase aggregate payments by about $883 million.

CMS also proposed fiscal 2027 rules for inpatient rehabilitation facilities and hospice in April. The proposed IRF rule would increase payment rates by 2.4%, while the proposed hospice rule would also provide a 2.4% payment update.

The Bottom Line

The CRS report serves as a reference tool for lawmakers and congressional staff navigating Medicare fee-for-service payment rules, identifying the schedules, statutory requirements and federal resources governing payment updates across different provider types.

The different rulemaking calendars mean Congress, health care providers and beneficiary groups must track Medicare payment policy throughout the year rather than around a single annual deadline. Members and committees may also face pressure to intervene legislatively when providers object to payment changes or when statutory provisions alter how CMS calculates reimbursement.

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