Medicare Advantage Integrity Act

Bill: 117-hr-1969
Sponsor: full_name: Resident Commissioner González-Colón, Jenniffer [R-PR-At Large]
Introduced: 2021-03-17
Policy area: Health
Subjects: Administrative remedies

Health care costs and insurance

Health personnel

Insurance industry and regulation

Medicare
Latest action: action_date: 2021-03-18
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2021-03-17
action_desc: Introduced in House
text: <p><b>Medicare Advantage Integrity 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.</p>

tv_txt: I 117th CONGRESS 1st Session H. R. 1969 IN THE HOUSE OF REPRESENTATIVES March 17, 2021 Miss González-Colón 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.

1. Short title This Act may be cited as the Medicare Advantage Integrity Act . 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. .