Title: Addressing Social Determinants in Medicare Advantage Act of 2021
Policy area: Health

Summary:
Addressing Social Determinants in Medicare Advantage Act of 2021
This bill allows Medicare Advantage plans to offer certain supplemental benefits that are currently only available to chronically ill enrollees to enrollees with low-income or who meet other criteria, such as socioeconomic risk factors.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4074 Introduced in House (IH)]

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117th CONGRESS
  1st Session
                                H. R. 4074

     To amend title XVIII of the Social Security Act to expand the 
  availability of supplemental benefits to certain Medicare Advantage 
                               enrollees.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 23, 2021

Mr. Bilirakis 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 expand the 
  availability of supplemental benefits to certain Medicare Advantage 
                               enrollees.

    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 ``Addressing Social Determinants in 
Medicare Advantage Act of 2021''.

SEC. 2. EXPANDING THE AVAILABILITY OF SUPPLEMENTAL BENEFITS TO CERTAIN 
              MEDICARE ADVANTAGE ENROLLEES.

    (a) In General.--Section 1852(a)(3)(D) of the Social Security Act 
(42 U.S.C. 1395w-22(a)(3)(D)) is amended--
            (1) in the header, by striking ``chronically ill'' and 
        inserting ``certain'';
            (2) in clauses (i) and (ii), by striking ``chronically 
        ill'' each place such term appears and inserting ``specified'' 
        in each such place; and
            (3) in clause (iii), by amending such clause to read as 
        follows:
                            ``(iii) Specified enrollee defined.--In 
                        this subparagraph, the term `specified 
                        enrollee' means an enrollee in an MA plan 
                        that--
                                    ``(I) the Secretary determines--
                                            ``(aa) has one or more 
                                        comorbid and medically complex 
                                        chronic conditions that is life 
                                        threatening or significantly 
                                        limits the overall health or 
                                        function of the enrollee;
                                            ``(bb) has a high risk of 
                                        hospitalization or other 
                                        adverse health outcomes; and
                                            ``(cc) requires intensive 
                                        care coordination;
                                    ``(II) is a low-income enrollee (as 
                                specified by the Secretary); or
                                    ``(III) meets any other criterion 
                                determined appropriate by the 
                                Secretary, such as criteria relating to 
                                social and socioeconomic risk.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to plan years beginning on or after January 1, 2023.
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