II 

118TH CONGRESS 

1ST SESSION S. 3307 

To amend title XVIII of the Social Security Act to require the inclusion 

of certain information in encounter data under Medicare Advantage. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 15, 2023 

Ms. CORTEZ MASTO (for herself, Mr. CASSIDY, Ms. WARREN, and Mrs. 

BLACKBURN) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to require 

the inclusion of certain information in encounter data 

under Medicare Advantage. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Encounter Data En5 hancement Act’’. 

2 

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1 SEC. 2. INCLUSION OF CERTAIN INFORMATION IN ENCOUN2 TER DATA UNDER MEDICARE ADVANTAGE. 

3 Section 1859 of the Social Security Act (42 U.S.C. 

4 1395w–28) is amended by adding at the end the following 

5 new subsection: 

6 ‘‘(j) INCLUSION OF CERTAIN INFORMATION IN EN7 COUNTER DATA.— 

8 ‘‘(1) IN GENERAL.—In the case of any encoun9 ter data submitted by a Medicare Advantage plan 

10 with respect to an item or service furnished to an in11 dividual under such plan during a plan year begin12 ning on or after January 1, 2026, the Secretary 

13 shall require that such data include— 

14 ‘‘(A) the type of payment from the plan to 

15 the provider, such as, but not limited to capita16 tion, value-based, or fee-for-service; 

17 ‘‘(B) the allowed amount for such item or 

18 service; 

19 ‘‘(C) the amount of cost sharing (including 

20 deductibles, copayments, and coinsurance) im21 posed for such item or service; 

22 ‘‘(D) an indicator identifying encounter 

23 records including the provision of an at-home 

24 health risk assessment by a specified assess25 ment entity; 

3 

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1 ‘‘(E) an indicator identifying encounter 

2 records including the provision of an at-home 

3 health risk assessment by an assessment entity 

4 not described in subparagraph (D); 

5 ‘‘(F) an indicator identifying encounter 

6 records including the provision of an at-home 

7 health risk assessment by an entity not de8 scribed in subparagraph (D) or (E); 

9 ‘‘(G) an indicator identifying encounter 

10 records including the provision of a health risk 

11 assessment outside of the home by any entity; 

12 ‘‘(H) an indicator of whether the item or 

13 service was provided in-network for the plan; 

14 and 

15 ‘‘(I) the standard unique health identifier 

16 (described in section 1173(b)) of the ordering 

17 provider, in the case of data submitted with re18 spect to— 

19 ‘‘(i) durable medical equipment, pros20 thetics, orthotics, and supplies; 

21 ‘‘(ii) laboratory tests; 

22 ‘‘(iii) imaging services; 

23 ‘‘(iv) home health services; and 

24 ‘‘(v) other items or services as deter25 mined by the Secretary. 

4 

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1 ‘‘(2) DEFINITIONS.—For purposes of this sub2 section: 

3 ‘‘(A) ASSESSMENT ENTITY.—The term ‘as4 sessment entity’ means an entity with a focus 

5 on furnishing in-home health risk assessments, 

6 as specified by the Secretary. 

7 ‘‘(B) SPECIFIED ASSESSMENT ENTITY.— 

8 The term ‘specified assessment entity’ means, 

9 with respect to an MA organization and a plan 

10 year, an assessment entity with respect to 

11 which such organization (or any person with an 

12 ownership or control interest (as defined in sec13 tion 1124(a)(3)) in such organization) is a per14 son with an ownership or control interest (as so 

15 defined).’’. 

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