Medicare Advantage Integrity Act

I 117TH CONGRESS 1ST SESSION H. R. 1969 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. IN THE HOUSE OF REPRESENTATIVES MARCH 17, 2021 Miss GONZA´LEZ-COLO´N 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 with- in 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. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare Advantage 4 Integrity Act’’. 5 VerDate Sep 11 2014 05:08 May 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 1969 IH SEC. 2. ADDRESSING DISPARITIES IN MEDICARE ADVAN- 1 TAGE BENCHMARK LEVELS BASED ON PENE- 2 TRATION. 3 (a) IN GENERAL.—Section 1853(n) of the Social Se- 4 curity Act (42 U.S.C. 1395w–23(n)) is amended— 5 (1) in paragraph (1)(B), by striking ‘‘subse- 6 quent year’’ and inserting ‘‘subsequent year, subject 7 to paragraph (6),’’; and 8 (2) by adding at the end the following new 9 paragraph: 10 ‘‘(6) AVERAGE GEOGRAPHIC ADJUSTMENT 11 FLOOR.—For 2022 and each subsequent year, when 12 calculating the adjusted average per capita cost 13 under section 1876(a)(4) for the purposes of estab- 14 lishing the base payment amount specified in para- 15 graph (2)(E), the average geographic adjustment 16 shall not be less than 0.70 for any area. For pur- 17 poses of the previous sentence, the Secretary may 18 define the term ‘average geographic adjustment’ by 19 program instruction or otherwise.’’. 20 (b) ENSURING PLAN PAYMENTS FLOW TO PRO- 21 VIDERS.—Section 1857(e) of the Social Security Act (42 22 U.S.C. 1395w–27(e)) is amended by adding at the end 23 the following new paragraph: 24 ‘‘(6) STRENGTHENING SUPPORT TO HEALTH 25 CARE PROVIDERS.—A contract under this section 26 VerDate Sep 11 2014 05:08 May 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 1969 IH with an MA organization shall require that, with re- 1 spect to any increase in blended benchmark amount 2 attributable to section 1853(n)(6), the plan shall 3 provide that no less than 50 percent of such increase 4 is directed toward provider compensation.’’. 5 Æ VerDate Sep 11 2014 05:08 May 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6301 E:\BILLS\H1969.IH H1969 kjohnson on DSK79L0C42PROD with BILLS