I 

118TH CONGRESS 

1ST SESSION H. R. 5380 

To amend title XVIII of the Social Security Act to increase data transparency 

for supplemental benefits under Medicare Advantage. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 8, 2023 

Mr. SARBANES introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy 

and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to increase 

data transparency for supplemental benefits 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. INCREASING DATA TRANSPARENCY FOR SUP4 PLEMENTAL BENEFITS UNDER MEDICARE 

5 ADVANTAGE. 

6 (a) IN GENERAL.—Section 1857(e) of the Social Se7 curity Act (42 U.S.C. 1395w–27(e)) is amended by adding 

8 at the end the following new paragraph: 


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•HR 5380 IH

1 ‘‘(6) REPORTING OF ENROLLEE-LEVEL DATA

2 ON SUPPLEMENTAL BENEFITS.— 

3 ‘‘(A) IN GENERAL.—Beginning with plan 

4 years beginning on or after January 1, 2027, a 

5 contract under this section with an MA organi6 zation shall require the organization to submit 

7 to the Secretary, for each MA plan offered by 

8 the organization, enrollee-level data on supple9 mental benefits (by item or service, or category 

10 of item or service, as determined appropriate by 

11 the Secretary, and national provider identifier), 

12 including eligibility for such benefits, the types 

13 of benefit categories offered, data on utilization 

14 of and payments for such benefits (including 

15 the total amount spent by the plan for each en16 rollee who utilized such benefits and the total 

17 out-of-pocket cost per utilization for each en18 rollee). 

19 ‘‘(B) DATA ACCESS.— 

20 ‘‘(i) IN GENERAL.—On the first Mon21 day in October of each year (beginning 

22 with 2028), the Secretary shall make data 

23 submitted under subparagraph (A) avail24 able to individuals and entities for the pur25 pose of conducting— 


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•HR 5380 IH

1 ‘‘(I) evaluations and other anal2 ysis to support the program under 

3 this title; and 

4 ‘‘(II) other health care related re5 search. 

6 ‘‘(ii) PUBLIC USE DATA FILE.—Not 

7 later than October 1 of each year (begin8 ning with 2028), the Secretary shall make 

9 a public use data file containing the data 

10 submitted under subparagraph (A) avail11 able on the internet website of the Centers 

12 for Medicare & Medicaid Services. 

13 ‘‘(iii) CONFIDENTIALITY.—In making 

14 data available under this subparagraph, 

15 the Secretary shall have in place proce16 dures to safeguard the privacy of any indi17 vidually identifiable enrollee information.’’. 

18 (b) RULE OF CONSTRUCTION.—Nothing in the 

19 amendments made by this section shall affect the collec20 tion of information as proposed pursuant to the notice en21 titled ‘‘Agency Information Collection Activities: Proposed 

22 Collection; Comment Request’’, published in the Federal 

23 Register on March 14, 2023 (88 Fed. Reg. 15726). 

Æ 


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