Read twice and referred to the Committee on Finance.
The bill amends Medicare Advantage risk adjustment rules in the Social Security Act.
Key changes: require CMS to use two years of diagnostic data starting in 2026; exclude diagnoses obtained from chart reviews and health risk assessments from risk-adjustment calculations; require CMS procedures to identify and verify such diagnoses; and direct CMS to evaluate and publicly report coding-pattern differences and apply coding adjustments, potentially at plan/contract level.
Narrow technical reform with fiscal impact that attracts strong industry and provider interest; could pass if folded into larger health or budget package.
Relative to its intended legislative type, this bill delivers direct, well-targeted statutory amendments to Medicare Advantage risk-adjustment rules and assigns clear responsibilities and timelines, but it provides limited fiscal detail, incomplete definitions, and only high-level implementation and verification guidance.
Liberals worry exclusion may undercount vulnerable patients' needs
Liberals worry exclusion may undercount vulnerable patients' needs
Likely cautiously supportive of measures reducing payment gaming and protecting Medicare solvency, while wary of unintended harm.
Concern centers on whether excluding chart-review and HRA diagnoses will undercount true health needs of vulnerable beneficiaries.
Pragmatic view: the bill targets plausible overpayments and seeks better measurement.
Support hinges on CMS rule clarity, administrative feasibility, and ensuring risk scores remain accurate and equitable.
Generally favorable: the bill combats coding-driven payment inflation and protects taxpayers.
Some reservations about expanding CMS procedural requirements, but net positive if it reduces excessive MA payments.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Narrow technical reform with fiscal impact that attracts strong industry and provider interest; could pass if folded into larger health or budget package.
The bill has not accumulated any surfaced votes yet.
Liberals worry exclusion may undercount vulnerable patients' needs
Narrow technical reform with fiscal impact that attracts strong industry and provider interest; could pass if folded into larger health or…
Relative to its intended legislative type, this bill delivers direct, well-targeted statutory amendments to Medicare Advantage risk-adjustment rules and assigns clear responsibilities and timelines, but it provides limi…
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