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 c…
This bill amends Medicare Advantage encounter-data rules to require, for plan years starting January 1, 2027, inclusion of: the allowed payment amount, patient cost-sharing amounts (deductible, copayment, coinsurance), and indicators showing whether the beneficiary previously received an at‑home health risk assessment. The indicators must distinguish assessments provided by an assessment entity that is owned or controlled by the MA organization (a "specified assessment entity") from assessments provided by other assessment entities.
Left emphasizes transparency and anti‑conflict oversight benefits
Relative to its intended legislative type, this bill establishes a clear, narrowly targeted statutory requirement to add specific data elements to Medicare Advantage encounter data and provides basic definitions and an effective date, but it leaves significant operational, technical, fiscal, and accountability details to be specified by the Secretary without statutory guidance.
This bill amends Medicare Advantage encounter-data rules to require, for plan years starting January 1, 2027, inclusion of: the allowed payment amount, patient cost-sharing amounts (deductible, copayment, coinsurance), and indicators showing whether the beneficiary previously received an at‑home health risk assessment.
The indicators must distinguish assessments provided by an assessment entity that is owned or controlled by the MA organization (a "specified assessment entity") from assessments provided by other assessment entities.
The Secretary of HHS will define "assessment entity."
Narrow, low-cost transparency measure with plausible bipartisan support, yet potential industry resistance and procedural barriers lower odds.
Relative to its intended legislative type, this bill establishes a clear, narrowly targeted statutory requirement to add specific data elements to Medicare Advantage encounter data and provides basic definitions and an effective date, but it leaves significant operational, technical, fiscal, and accountability details to be specified by the Secretary without statutory guidance.
Left emphasizes transparency and anti‑conflict oversight benefits
These are examples from the analysis, not a ranked list of the most-affected groups.
Left emphasizes transparency and anti‑conflict oversight benefits
Likely views the bill favorably as a transparency and anti-conflict measure that can expose related‑party arrangements and beneficiary cost burdens.
Sees potential to support oversight, beneficiary protection, and data for evaluating in‑home assessment programs.
Some uncertainty about implementation resources and data privacy, but overall supportive.
Generally supportive of transparency but cautious about implementation costs and unintended consequences.
Wants clearer definitions, a reasonable phase‑in, and funding for IT changes.
Views the bill as a pragmatic oversight improvement if administrative burdens are constrained.
Skeptical of additional federal reporting mandates and potential regulatory expansion into MA plan operations.
Concerned this creates unnecessary compliance costs that could be passed to beneficiaries or reduce plan flexibility.
May accept limited transparency but not at high cost.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Narrow, low-cost transparency measure with plausible bipartisan support, yet potential industry resistance and procedural barriers lower odds.
The bill has not accumulated any surfaced votes yet.
Left emphasizes transparency and anti‑conflict oversight benefits
Narrow, low-cost transparency measure with plausible bipartisan support, yet potential industry resistance and procedural barriers lower od…
Relative to its intended legislative type, this bill establishes a clear, narrowly targeted statutory requirement to add specific data elements to Medicare Advantage encounter data and provides basic definitions and an…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.