To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification.

Bill: 118-hr-8561
Sponsor: full_name: Rep. Tenney, Claudia [R-NY-24]
Introduced: 2024-05-23
Policy area: Health
Latest action: action_date: 2024-12-17
text: Referred to the Subcommittee on Health.

Summaries:

tv_txt: I 118th CONGRESS 2d Session H. R. 8561 IN THE HOUSE OF REPRESENTATIVES May 23, 2024 Ms. Tenney (for herself, Mr. Tonko , Ms. Stefanik , Mr. Williams of New York , Mr. Morelle , Mr. Langworthy , and Mr. Molinaro ) 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 significant under projection of MA local area growth due to wage index reclassification.

1. Addressing significant under projection of MA local area growth due to wage index reclassification (a) Local adjustment method and applicability Section 1853(c)(6) of the Social Security Act ( 42 U.S.C. 1395w–23(c)(6) ) is amended at the end by adding the following new subparagraph: (D) Further adjustment for significant under projection of local area growth Beginning with rates calculated for 2025 when computing rates for purposes of calculating benchmark amounts for an applicable plan, the Secretary shall adjust the growth percentage under subparagraph (A) to reflect the rate of growth in the MA local area, including making adjustments to growth estimates for previous years back no further than 2024. For purposes of this subparagraph, an applicable plan is an MA local plan in a service area where the area wage index under section 1886(d)(3)(E) increased by more than 20 percent in a prior year on average across the service area of the plan. Upon request from an applicable plan, the Secretary shall issue the adjustment for that year for the MA local plan as soon as practicable. . (b) Adjusting the benchmark cap Section 1853(k)(1) of the Social Security Act ( 42 U.S.C. 1395w–23(k)(1) ) is amended— (1) in subparagraph (B)(i), by striking adjustment under subparagraph (C) of such subsection for a year before 2004 and inserting adjustments under subparagraphs (C) or (D) of such subsection for a year before 2004 or 2024, respectively ; and (2) in subparagraph (B)(ii) add the following new subparagraph: (III) for an applicable plan under subsection (c)(6)(D), the amount specified in subsection (c)(1)(D) adjusted by the growth percentage determined under subsection (c)(6)(D) . (c) Adjusting the base payment amount Section 1853(n)(2)(E) of the Social Security Act ( 42 U.S.C. 1395w–23(n)(2)(E) ) is amended— (1) in clause (i)(I), by striking adjustment under subparagraph (C) of such subsection for a year before 2004 and inserting adjustments under subparagraphs (C) or (D) of such subsection for a year before 2004 or 2024, respectively ; and (2) in clause (i)(II), by inserting , or, for an applicable plan under subsection (c)(6)(D), the amount specified in subsection (c)(1)(D) adjusted by the growth percentage determined under subsection (c)(6)(D) before the period at the end. (d) Immediate implementation To address current under projection of local area growth Notwithstanding section 1853(b) of the Social Security Act and any other provision of law that would otherwise require prior notice, the Secretary shall take immediate action to adopt or amend calendar year 2025 Medicare Advantage Capitation Rates in accordance with the provisions of this section and to make any other methodological changes or take other actions necessary and appropriate to assure appropriate rate adjustments for MA local plans affected by significant under projection of local area growth as described in section 1853(c)(6)(D) of the Social Security Act made effective herewith, provided that if otherwise required notice of such actions shall be published in the federal register as soon as possible and in any case within 30 days of such actions.