Title: Medicare Advantage Integrity Act
Policy area: Health

Summary:
Medicare Advantage Integrity Act
This bill temporarily establishes geographic adjustments for certain Medicare Advantage payment formulations, and specifies that a certain percentage of corresponding payment increases must be directed toward compensating providers.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1969 Introduced in House (IH)]

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117th CONGRESS
  1st Session
                                H. R. 1969

To amend title XVIII of the Social Security Act to address disparity in 
 Medicare Advantage benchmark rates for regions with low Medicare fee-
                        for-service penetration.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 17, 2021

 Miss Gonzalez-Colon 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 address disparity in 
 Medicare Advantage benchmark rates for regions with low Medicare fee-
                        for-service penetration.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Advantage Integrity Act''.

SEC. 2. ADDRESSING DISPARITIES IN MEDICARE ADVANTAGE BENCHMARK LEVELS 
              BASED ON PENETRATION.

    (a) In General.--Section 1853(n) of the Social Security Act (42 
U.S.C. 1395w-23(n)) is amended--
            (1) in paragraph (1)(B), by striking ``subsequent year'' 
        and inserting ``subsequent year, subject to paragraph (6),''; 
        and
            (2) by adding at the end the following new paragraph:
            ``(6) Average geographic adjustment floor.--For 2022 and 
        each subsequent year, when calculating the adjusted average per 
        capita cost under section 1876(a)(4) for the purposes of 
        establishing the base payment amount specified in paragraph 
        (2)(E), the average geographic adjustment shall not be less 
        than 0.70 for any area. For purposes of the previous sentence, 
        the Secretary may define the term `average geographic 
        adjustment' by program instruction or otherwise.''.
    (b) Ensuring Plan Payments Flow to Providers.--Section 1857(e) of 
the Social Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at 
the end the following new paragraph:
            ``(6) Strengthening support to health care providers.--A 
        contract under this section with an MA organization shall 
        require that, with respect to any increase in blended benchmark 
        amount attributable to section 1853(n)(6), the plan shall 
        provide that no less than 50 percent of such increase is 
        directed toward provider compensation.''.
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