HR-9002-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Melanie Stansbury (D-NM)
What it does
This bill would reauthorize federal funding through fiscal year 2031 for the Centers for Medicare & Medicaid Services (CMS) to contract with quality improvement organizations and similar entities. Those contractors would provide technical assistance to health professionals in practices of 15 or fewer clinicians, helping them navigate the Merit-based Incentive Payment System (MIPS) and alternative payment models under Medicare. MIPS is an existing Medicare program that adjusts provider payments up or down based on performance measures such as quality, cost, and use of health information technology.
Who benefits
Health professionals in small practices (15 or fewer clinicians), particularly those in rural and underserved areas, who would receive free or subsidized guidance on meeting complex Medicare reporting requirements. Patients in those communities who may retain access to local providers that might otherwise struggle to comply with MIPS requirements. Quality improvement organizations and similar contractors that would receive federal contracts to deliver the assistance. Rural hospitals and federally qualified health centers that work alongside small practices.
Who is hurt
Taxpayers who fund the reauthorized program. Larger or better-resourced practices that do not qualify for the assistance and must bear their own MIPS compliance costs, potentially creating an uneven competitive landscape. Organizations competing for CMS contracts who are not among the specified eligible entities. If the program is seen as propping up practices that would otherwise consolidate, it could indirectly slow efficiency gains that some health economists associate with larger group practices.
Supporters argue
Supporters argue that MIPS compliance imposes a disproportionate administrative burden on small and rural practices, which lack the dedicated billing and compliance staff that larger health systems employ. They contend that without targeted assistance, small practices may exit Medicare participation or consolidate into larger systems, reducing patient access in already underserved communities — a documented trend in rural healthcare over the past decade. Extending this program through 2031 preserves a proven infrastructure for keeping independent small practices viable.
Opponents argue
Opponents argue that repeatedly reauthorizing technical assistance for MIPS compliance treats the symptom rather than the disease — the underlying complexity of MIPS itself — and that resources would be better spent simplifying the payment system. They contend that subsidizing small practices' compliance costs indefinitely may delay necessary consolidation or modernization, and that the program's effectiveness in measurably improving care quality or provider retention in underserved areas has not been rigorously demonstrated.
Constitutional context
Congress has broad authority to set conditions on Medicare payments under the Taxing and Spending Clause (Art. I, §8, cl. 1), and this bill operates squarely within that framework by reauthorizing an existing spending program. No significant constitutional tension is present.
Checks and balances
Congress holds the appropriations authority and sets the reauthorization timeline; CMS (executive branch) administers contracts and selects qualifying entities; the Government Accountability Office and congressional oversight committees provide accountability over program spending and outcomes.
Historical precedent
The original SURS program and similar CMS technical assistance initiatives were established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which created MIPS and directed CMS to support small and rural practices in meeting its requirements.