Set the national fee schedule

Months 3–15; annual updates thereafter · Payment Rates Board; UHADiscuss this step

Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.

What	Today	Change	Trade-off
Medicare Physician Fee Schedule (RBRVS) & the AMA RUC amendedYear 0–2 Provider payment & regulation	Medicare fees anchor all payers; relative values largely developed by the AMA's RUC committee.	Becomes the UHP national fee schedule, rebalanced toward primary care; independent review of relative values.	Primary care gains, procedural specialists lose.
Hospital and insurer price transparency rules amendedYear 4 Provider payment & regulation	Hospitals and insurers must publish negotiated rates.	Largely moot: one public price list; retained for cash/opt-out providers.	Transparency is automatic.
FQHC and Rural Health Clinic prospective payment (encounter rates) amendedYear 1 Provider payment & regulation	Health centers get a per-visit rate from Medicare and Medicaid, plus Section 330 grants for uninsured care.	UHP keeps an all-inclusive encounter rate for health centers at no less than today's Medicaid PPS rate; Section 330 grants shift from uninsured care to capacity and enabling services (translation, transport).	Health centers keep stable funding but lose their unique role as the uninsured safety net, since every provider now accepts everyone.
Certified Community Behavioral Health Clinics amendedYear 2 Provider payment & regulation	Clinics paid a cost-based daily or monthly rate under Medicaid demonstrations.	Become a UHP provider type with a prospective all-inclusive rate.	Stable funding for behavioral health; cost-based rates weaken efficiency incentives.
Site-of-service payment differences (hospital outpatient vs. physician office) replacedYear 2 Provider payment & regulation	The same service pays more when billed by a hospital outpatient department, which encourages hospitals to buy practices.	One price per service regardless of setting (site-neutral), except where added costs are documented.	Removes the incentive to acquire practices; hospital outpatient revenue falls.
Office of Primary Care (new) newYear 1 Federal programs	No federal entity is responsible for primary-care capacity.	A UHA office that sets primary-care spending targets, runs the primary-care capitation option, and monitors primary-care access.	Protects the most under-invested part of the system; shifting money to primary care takes it from specialists and hospitals.