CHC REBASE Act of 2026
- Sponsor
- Rep. Rulli, Michael A. [R-OH-6]
- Committees
- Ways and Means Committee (primary)
- Last action
- Sep 15, 2026
Bottom line
The CHC REBASE Act seeks to bolster the financial stability of community health centers by ensuring more equitable Medicare reimbursement for in-person and telehealth services, and by clarifying payments for Medicare Advantage patients.
What it actually does
This bill aims to reform Medicare payment systems for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). It mandates the Secretary of Health and Human Services to adjust FQHC payment rates to cover 100% of reasonable costs by 2028, establishes a working group to recommend further modifications, and permanently integrates telehealth services into FQHC and RHC payment systems starting in 2027. Additionally, it requires guidance to clarify "wraparound payments" for FQHCs serving Medicare Advantage enrollees and mandates a GAO report on FQHC inclusion in MA networks.
Proponents argue
Proponents argue that FQHCs and RHCs are critical access points for primary care, especially in underserved and rural areas, and that current Medicare payment rates often do not cover the actual cost of care, jeopardizing their sustainability. This bill would ensure these centers are adequately reimbursed, allowing them to expand services, invest in staff, and continue serving vulnerable populations. Making telehealth payments permanent is also seen as crucial for maintaining access to care.
Opponents contend
Opponents might raise concerns about the potential increase in Medicare spending due to higher FQHC reimbursement rates, especially if the "reasonable costs" calculation is perceived as too generous or if it leads to unintended cost escalations. Some might also argue that the bill could create an uneven playing field for other healthcare providers if FQHCs receive preferential payment treatment. Concerns could also be raised about the administrative burden of new reporting requirements and working group activities.
The bill is relatively short and its core provisions are clearly stated, making it accessible for a reader to understand its main impacts within a reasonable timeframe.
Section 2, amending Section 1834(o)(6)(A)(i) of the Social Security Act
Mandated Adjustment of FQHC Payment Rates
This provision requires the Secretary of HHS to adjust Medicare payment rates for Federally Qualified Health Centers (FQHCs) starting in 2028. The adjustment aims to ensure that the total payments FQHCs receive for services cover 100% of their estimated reasonable costs, removing previous limitations like per-visit payment caps or productivity screens. This is intended to better reflect the actual expenses FQHCs incur in providing care.
Supporters argue
Supporters argue that this adjustment is vital for the survival and growth of FQHCs, which often serve low-income and rural populations. By covering 100% of reasonable costs, FQHCs can avoid operating at a loss on Medicare patients, allowing them to invest in staff, technology, and expanded services, ultimately improving access and quality of care for seniors.
Critics contend
Critics might contend that mandating 100% of "reasonable costs" without strict definitions or oversight could lead to inflated costs and increased Medicare expenditures. They might argue that existing payment systems, while imperfect, provide necessary cost controls, and removing them could create an unsustainable financial burden on the Medicare program.
Tradeoffs
The provision balances the need to ensure financial viability for essential community health providers against concerns about potential cost increases for the Medicare program and the need for robust oversight of "reasonable costs."
Section 2, amending Section 1834(o)(6)(C) of the Social Security Act
FQHC Payment System Working Group
This provision mandates the Secretary of HHS to convene a working group within 180 days of the bill's enactment. This group, composed of various stakeholders including FQHC representatives, patients, and CMS officials, will examine and make recommendations on further modifications to the FQHC prospective payment system. Its duties include evaluating payment rates, identifying services that should be covered, and exploring new payment and delivery system innovations.
Section 3, amending Section 1834(m)(8) of the Social Security Act
Permanent Medicare Coverage and Payment for Telehealth Services at FQHCs/RHCs
This section permanently integrates telehealth services into the Medicare payment systems for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), effective January 1, 2027. This means that telehealth services furnished by these centers will be paid under their respective prospective payment systems, and the costs associated with providing these services will be considered allowable costs. This makes permanent the flexibilities that were largely temporary during the COVID-19 public health emergency.
Section 4(a)
Clarification of Medicare Advantage Wraparound Payments for FQHCs
This provision directs the Secretary of HHS to issue guidance by December 31, 2026, clarifying how Federally Qualified Health Centers (FQHCs) calculate and claim "wraparound payments" for services provided to Medicare Advantage (MA) enrollees. These payments cover the difference between what an MA plan pays an FQHC and what Medicare would pay under the FQHC's prospective payment system. The guidance will also standardize payment processes for Medicare administrative contractors and establish a review mechanism for FQHCs to dispute payment determinations.
Prohibits Medicare administrative contractors (MACs) from requiring FQHCs to submit their Medicare Advantage plan contracts as a prerequisite for receiving "wraparound payments."
Section 4(a)(2)(B)
Why it matters:This is standard legislative practice for addressing specific operational or administrative issues within broader policy directives. It's a technical fix to a known problem.
Case for: Proponents argue this removes an unnecessary administrative burden and barrier for FQHCs seeking their rightful "wraparound payments," streamlining the process and ensuring timely compensation.
Case against: No specific opposition is typically raised against removing unnecessary administrative hurdles for providers, as it generally improves efficiency.
Estimated impact: Reduces administrative burden and potential payment delays for FQHCs serving Medicare Advantage enrollees, potentially affecting thousands of claims annually.