119th (2025–2027)
H.R. 9972
The American Patients First Act of 2026 modifies Medicare payment rules for skin substitute products, which are cellular or tissue-based materials used to treat wounds. Beginning January 1, 2027, Medicare will cover these products under a new unified billing code and pay $457 per square centimeter for them through December 31, 2030. The legislation requires that skin substitute products meet strict domestic sourcing requirements, meaning all materials must come from U.S. citizens or permanent residents, and all harvesting, processing, and manufacturing must occur in the United States, though the Secretary can grant temporary waivers during supply shortages. To prevent fraud and misuse, the bill establishes multiple oversight measures including prepayment claim reviews starting January 2027, prior authorization requirements beginning January 2028, and identification of top-spending providers for investigation. The law also restricts payment to only the reasonable portion of products used (at minimum 350 square centimeters or 120 percent of the wound size), limits reimbursement to three applications per wound unless there is improvement, and requires providers to hold certain wound care certifications. The bill allocates $2.5 million annually from 2028 through 2031 for program oversight. Additionally, the Secretary must submit a report by January 1, 2030, analyzing production costs and patient access to these products.