I 
119TH CONGRESS 
1ST SESSION H. R. 5454 
To amend title XVIII of the Social Security Act to apply improved prompt 
payment requirements to Medicare Advantage organizations. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 18, 2025 
Mr. ARRINGTON (for himself and Ms. SA´NCHEZ) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 apply 
improved prompt payment requirements to Medicare Ad-
vantage organizations. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Advantage 
Prompt Pay Act’’. 
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SEC. 2. APPLICATION OF IMPROVED PROMPT PAYMENT RE-
QUIREMENTS TO MEDICARE ADVANTAGE OR-
GANIZATIONS. 
(a) REQUIREMENTS.— 
(1) IN GENERAL.—Section 1857 of the Social 
Security Act (42 U.S.C. 1395w–27) is amended— 
(A) in subsection (f), by striking para-
graph (1) and inserting the following: 
‘‘(1) REQUIREMENTS.— 
‘‘(A) ITEMS AND SERVICES FURNISHED BY 
IN-NETWORK
AND
OUT-OF-NETWORK
PRO-
VIDERS OF SERVICES AND SUPPLIERS.— 
‘‘(i) IN GENERAL.—A contract under 
this part between the Secretary and a 
Medicare Advantage organization offering 
a Medicare Advantage plan shall require 
the organization to provide prompt pay-
ment for not less than 95 percent of clean 
claims submitted to the organization, with 
respect to covered items or services fur-
nished to enrollees by a provider of services 
or supplier, within the applicable number 
of calendar days after the date of initial 
receipt of such clean claim, regardless of 
whether such items or services are fur-
nished under a contract between the orga-
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nization and the provider of services or 
supplier. 
‘‘(ii) APPLICABLE
NUMBER
OF
CAL-
ENDAR DAYS.—In clause (i), the term ‘ap-
plicable number of calendar days’ means— 
‘‘(I) in the case of a claim sub-
mitted electronically, by a provider of 
services or supplier for items or serv-
ices furnished under a contract be-
tween the organization and the pro-
vider of services or supplier, 14 days; 
and 
‘‘(II) in the case of a claim not 
described in subclause (I), 30 days. 
‘‘(B) CLEAN
CLAIM
DEFINED.—In this 
paragraph, the term ‘clean claim’ means a 
claim that— 
‘‘(i) has a complete data set, with re-
spect to the UB–04 or CMS 1500 form, as 
applicable (or successor to such applicable 
form), for all entries identified as manda-
tory entries by the National Uniform Bill-
ing Committee; and 
‘‘(ii) in the case of a claim submitted 
electronically, is completed in accordance 
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with the applicable standards and data ele-
ments adopted under section 1173(a). 
‘‘(C) REBUTTABLE PRESUMPTION FOR RE-
CEIPT OF CLAIM.— 
‘‘(i) IN
GENERAL.—For purposes of 
this paragraph, there shall be a rebuttable 
presumption that a claim has been received 
by an MA organization— 
‘‘(I) in the case of a claim sub-
mitted electronically, on the date 
verified in the health care claim status 
request and response transaction that 
is for such claim and meets applicable 
standards and data elements adopted 
under section 1173(a) for such elec-
tronic requests and responses; and 
‘‘(II) in the case of a claim sub-
mitted otherwise, on the fifth business 
day after the postmark date of the 
claim or the date specified in the time 
stamp of the transmission. 
‘‘(ii) BUSINESS
DAY
DEFINED.—In 
clause (i)(II), the term ‘business day’ 
means any day other than Saturday, Sun-
day, or a legal public holiday described in 
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section 6103 of title 5, United States 
Code. 
‘‘(D) INTEREST
APPLIED
FOR
CLEAN 
CLAIMS NOT PROMPTLY PAID.—If payment for 
such covered items or services is not issued, 
mailed, or otherwise transmitted to the provider 
of services or supplier for such claims that are 
clean claims, in accordance with subparagraph 
(A), by not later than the deadline for such 
payment under such subparagraph, the MA or-
ganization shall pay the provider of services or 
supplier interest at the rate used for purposes 
of section 3902(a) of title 31, United States 
Code (relating to interest penalties for failure to 
make prompt payments) for the period begin-
ning on the day after such required payment 
date and ending on the date on which payment 
is made.’’; and 
(B) in subsection (g)— 
(i) by redesignating paragraph (4) as 
paragraph (5); 
(ii) by inserting after paragraph (3) 
the following new paragraph: 
‘‘(4) APPLICATION OF CIVIL MONEY PENALTIES 
TO PROMPT PAY VIOLATIONS.—If the Secretary de-
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termines that an MA organization with a contract 
under this section is not in compliance with sub-
section (f)(1), the Secretary shall provide, in addi-
tion to any other remedies authorized by law, for 
civil money penalties of not more than $25,000 for 
each such determination. In making a determination 
under the previous sentence, the Secretary may take 
into account information collected pursuant to sec-
tion 1851(d)(4)(D)(v).’’; and 
(iii) in paragraph (5), as redesignated 
by clause (i), by striking ‘‘or (3)’’ and in-
serting ‘‘, (3), or (4)’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to items 
and services furnished on or after January 1, 2027, 
and contract years beginning on or after such date. 
(b) PROVISION OF INFORMATION REGARDING COM-
PLIANCE WITH PROMPT PAYMENT REQUIREMENTS.— 
Section 1851(d)(4)(D) of the Social Security Act (42 
U.S.C. 1395w–21(d)(4)(D)) is amended— 
(1) in clause (iii), by striking ‘‘and’’ at the end; 
(2) in clause (iv), by striking the period and in-
serting ‘‘, and’’; and 
(3) by adding at the end the following new 
clause: 
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‘‘(v) information regarding compliance 
of the plan with the prompt payment re-
quirements under section 1857(f)(1), in-
cluding, with respect to the most recent 
12-month period for which data are avail-
able— 
‘‘(I) the number and percent of 
submitted claims for which payment 
was made by the plan; 
‘‘(II) the number and percent of 
submitted claims— 
‘‘(aa) that were for items or 
services furnished by a provider 
of services or supplier under a 
contract between the organization 
offering the plan and the pro-
vider of services or supplier; and 
‘‘(bb) that were for items or 
services not furnished under such 
a contract; 
‘‘(III) the number and percent of 
submitted claims described in each of 
items (aa) and (bb) of subclause (II) 
for which payment was made by the 
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plan by the deadline required pursu-
ant to section 1857(f)(1)(A); 
‘‘(IV) the number and percent of 
submitted claims described in each of 
items (aa) and (bb) of subclause (II) 
for which interest was paid by the 
plan 
pursuant 
to 
section 
1857(f)(1)(D); and 
‘‘(V) the total amount of interest 
paid by the plan pursuant to such sec-
tion.’’. 
Æ 
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