Scott Peters

Patients First Act of 2026

This bill modifies payments and incentive programs under the Medicare physician fee schedule.

The bill establishes a temporary program to provide hybrid payments for certain primary care services. Under the program, payments for services relating to care management, behavioral health integration, office-based evaluation and management (including telehealth), and communications (e.g., phone calls) are made on a monthly basis to providers for each individual that is attributed to the provider's practice. The monthly amount is based on the national average amount for such services. Providers may opt into the model; in order to qualify, providers must be owned or controlled by health care practitioners and must have had the majority of their prior year's payments consist of payments for the covered services.

The bill also renames the Merit-based Incentive Payment System (MIPS) and modifies the program to include performance measures relating to care efficiency (e.g., reducing avoidable hospitalizations). (MIPS is an incentive program under Medicare that allows health professionals to receive payment adjustments based on certain performance measures.) The bill generally reduces the program's performance-based payment adjustments, including positive adjustments for providers that are not owned or controlled by health care practitioners.

Finally, the bill allows for larger annual adjustments to the Medicare physician fee schedule and bases these adjustments on inflation. It also requires certain corrections to compensate for expenditures under the fee schedule that exceed a certain amount in a given year, and it limits how much certain adjustment factors may vary each year.

This resolution condemns Iran's state-sponsored persecution of the Baha'i religious minority and Iran's continued violation of international human rights treaties. The resolution calls on Iran to (1) immediately release Baha'is and others imprisoned or detained solely on account of religion, (2) end its state-sponsored campaign of hate propaganda against the Baha'is, and (3) reverse certain policies that discriminate against Baha'is and other religious minorities. The resolution also urges the President and the Department of State to impose sanctions on Iranian officials and others who are responsible for serious human rights abuses, including abuses against Iran's Baha'i community.

No War Appropriations through Reconciliation Act or the No WAR Act

This bill establishes a budget point of order that prohibits considering reconciliation legislation that provides funding for unauthorized military force against Iran.

(Reconciliation is an expedited method by which Congress may adopt changes in spending and revenue laws to achieve the budgetary goals reflected in a congressional budget resolution. Reconciliation bills are considered by Congress using expedited legislative procedures that prevent a filibuster and restrict amendments in the Senate.)

Specifically, the point of order may be raised to prohibit the consideration of reconciliation legislation that provides budget authority for hostilities, including hostilities conducted by a proxy force, against Iran unless Congress has authorized such hostilities through a declaration of war or a specific authorization for use of military force.

Under the bill, hostilities includes any offensive military operation, strike, covert action, or sustained engagement involving armed conflict against Iranian military forces, territory, or government institutions.

The point of order may be waived by a vote of at least three-fifths of all Senators duly chosen and sworn (60 votes if there are no vacancies).

Ensuring Patient Access to Critical Breakthrough Products Act

This bill provides for Medicare coverage of medical devices that are approved under the Food and Drug Administration (FDA) Breakthrough Devices Program. (Under the program, manufacturers work with the FDA to expedite the review and approval of certain medical devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating human diseases or conditions.)

The bill allows designated medical breakthrough devices to be temporarily covered under Medicare during a four-year transitional period. Manufacturers must apply to the Centers for Medicare & Medicaid Services (CMS) to receive this designation. Qualifying devices must (1) have received priority review from the FDA, (2) received premarket approval (if applicable) based on clinical data that includes data from Medicare beneficiaries, (3) already generally qualify for Medicare coverage, and (4) not present an undue risk of harm that outweighs potential clinical benefits for Medicare beneficiaries.

The CMS must approve or deny applications within six months of receipt and must provide an explanation in the case of a denial. In addition, the CMS must make permanent coverage decisions before the end of the transitional period upon a timely request to do so, as specified.

The bill provides funds through FY2030 for the CMS to implement the bill.

Accelerating Access to Critical Therapies for ALS Reauthorization Act of 2026

This act reauthorizes through FY2031 and revises programs that support research and development of drugs and other therapies to address amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig's disease) and other neurodegenerative diseases.

The act reauthorizes

• grants from the National Institutes of Health (NIH) for scientific research on investigational drugs to prevent or treat ALS for individuals not otherwise eligible for clinical trials,

• grants from the Food and Drug Administration (FDA) for research and development of therapies to prevent and treat ALS and other neurodegenerative diseases, and

• a Public-Private Partnership including the FDA and NIH that supports development and regulatory review of treatments for neurodegenerative diseases.

Also, the NIH, in considering renewal of its grants, must assess available information on the safety and efficacy of the investigational drugs. It must also require grantees to promptly report serious and unexpected adverse events associated with their investigational drugs.

Additionally, the FDA must publish a plan describing actions it will take over a five-year period to foster development of safe and effective drugs, and facilitate access to investigational drugs, that treat ALS and other rare neurodegenerative diseases. The FDA must also publish a report describing the actions it has taken under the plan.

Combating Illicit Xylazine Act

This bill regulates xylazine under the Controlled Substances Act (CSA).

Xylazine, also known as tranq, is a nonopioid sedative and pain reliever that is approved for use in animals. Recently, the Drug Enforcement Administration (DEA) has reported an increase in trafficking of fentanyl mixed with xylazine.

This bill adds xylazine, including its salts, isomers, and salts of isomers, to schedule III of the CSA. Schedule III controlled substances, including anabolic steroids, buprenorphine, and ketamine, have less potential for abuse than a schedule I or II substance, have a currently accepted medical use, and have low or moderate risk of dependence if abused.

Under the bill, manufacturing, distributing, or dispensing xylazine, or possessing with intent to manufacture, distribute, or dispense xylazine for illicit use is subject to criminal penalties under the CSA. The bill also requires xylazine transactions to be tracked in the drug reporting system maintained by the DEA.

The bill exempts from registration under the CSA persons and entities that possess xylazine (1) lawfully dispensed by a veterinarian or pharmacy and (2) for an animal or for use in certain animal-control or wildlife programs.

The bill also exempts xylazine manufacturers from the CSA's physical security requirements.

Finally, the bill requires the DEA, in coordination with the Food and Drug Administration, to report on (1) the prevalence and impact of illicit xylazine use in the United States, and (2) updated information on the prevalence and proliferation of xylazine trafficking and misuse in the United States.