Puerto Rico Integrity in Medicare Advantage Act

Bill: 115-hr-6809
Sponsor: full_name: Resident Commissioner González-Colón, Jenniffer [R-PR-At Large]
Introduced: 2018-09-13
Policy area: Health
Subjects: Administrative remedies

Disaster relief and insurance

Health care costs and insurance

Health personnel

Insurance industry and regulation

Medicare

Puerto Rico

U.S. territories and protectorates
Latest action: action_date: 2018-09-13
text: 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.

Summaries:
action_date: 2018-09-13
action_desc: Introduced in House
text: <p><b>Puerto Rico Integrity in Medicare Advantage Act</b></p> <p>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 in Puerto Rico.</p>

tv_txt: I 115th CONGRESS 2d Session H. R. 6809 IN THE HOUSE OF REPRESENTATIVES September 13, 2018 Miss González-Colón of Puerto Rico (for herself, Mr. Serrano , Mr. Bacon , Mr. Soto , and Mrs. Murphy of Florida ) 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 provide for temporary stabilization of Medicare Advantage payments following Hurricane Maria.

1. Short title This Act may be cited as the Puerto Rico Integrity in Medicare Advantage Act . 2. Temporary stabilization of Medicare Advantage payments following Hurricane Maria (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 (7), ; (2) in paragraph (4), by striking In and inserting Subject to paragraph (7), in ; and (3) by adding at the end the following new paragraph: (7) Average geographic adjustment floor For each of 2019, 2020, and 2021, when calculating the adjusted average capital amount under section 1876(a)(4) for the purposes of establishing the base payment amount, the average geographic adjustment shall not be less than 0.70 for any area. . (b) Ensuring payments flow to Puerto Rico providers and patients Section 1854(a)(6) of the Social Security Act ( 42 U.S.C. 1395w–24(a)(6) ) is amended— (1) in subparagraph (B)(iv)— (A) by striking Exception. —In the case of and inserting Exceptions.— (I) In the case of ; and (B) by adding at the end the following new subclause: (II) In the case of an area to which section 1853(n)(7) applies with respect to a year, clause (iii) shall be waived for bids submitted for such area and year and subparagraph (C) shall apply. ; and (2) by adding at the end the following new subparagraph: (C) Strengthening support to health care providers in Puerto Rico When reviewing bids submitted by plans serving areas in Puerto Rico, the Secretary shall ensure that, of the increase in blended benchmark amount attributable to section 1853(n)(7) (above the amount that would otherwise be determined under section 1853(n)), no less than 50 percent is directed toward provider compensation. .