Protecting Options for Seniors Act of 2025

Bill Number: H.R. 2610
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-04-02: 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.
Last Updated: 2026-05-21T19:58:08Z

AI-Generated Summary

Purpose

The Protecting Options for Seniors Act of 2025 aims to fix underestimations in payment growth rates for Medicare Advantage (MA) plans in certain local areas. These underestimations occur when hospital wage indexes—factors used to adjust payments based on local labor costs—suddenly increase due to reclassifications (e.g., hospitals shifting to higher-wage areas for payment purposes). The bill ensures more accurate funding projections to maintain stable MA options for seniors.

Key Provisions

Adjustment for Local Growth Under-Projections: Starting in 2026, the Secretary of Health and Human Services (via the Centers for Medicare & Medicaid Services, or CMS) must increase the national per capita MA growth percentage for "applicable areas." These are MA local areas where the weighted average hospital wage index rises by more than 20% compared to the prior year.
The increase is calculated as a product of:
The percentage wage index growth (comparing the current year to 2024 for 2026, or to the prior year thereafter).
A weighting factor based on total wage-adjusted payments to hospitals in the area (under Medicare Parts A and B, including disproportionate share hospital payments) divided by total Medicare fee-for-service payments in the area (excluding certain demonstration projects).
The weighted average hospital wage index is computed using the most recent published data, weighted by payments to hospitals in the area.
Benchmark Neutrality: Any adjustments must be budget-neutral across all MA areas, meaning the overall average benchmark amount (the cap on MA payments) remains unchanged nationally.
Updates to Related Calculations:
Adjusts the MA benchmark cap and base payment amounts to incorporate the new growth adjustment.
For applicable areas, the base payment uses the higher of the adjusted or unadjusted amount.
Transparency Requirements: CMS must publish total Medicare payments (separately for Parts A and B) to each "area hospital" (hospitals physically located in the MA area, regardless of reclassification) starting in 2026, using the most recent data available when issuing annual advance notices.

Significant Changes to Existing Law

Amends Section 1853(c) of the Social Security Act (governing MA payment rates) by adding a new subparagraph (D) to paragraph (6), introducing the growth adjustment and related definitions.
Modifies cross-references in paragraphs (1), (6), and (k)(1)(B) to integrate the adjustment into existing local area payment formulas.
Updates Section 1853(n)(2)(E) to allow higher base payments in applicable areas.
Adds data publication requirements to Section 1853(b)(4), enhancing transparency on hospital payments without altering core payment rules.

These changes target discrepancies from wage index reclassifications under Medicare's inpatient and outpatient hospital payment systems (Sections 1886 and 1833), which previously could lead to unaccounted-for local cost increases in MA projections.

Potential Impacts

On Government Agencies: CMS will need to compute and apply new adjustments annually using existing wage index data, potentially increasing administrative workload for rate notices but ensuring more precise projections without net cost increases due to neutrality.
On Citizens (Seniors and Beneficiaries): Could stabilize or expand MA plan availability and benefits in affected rural or reclassified areas by preventing payment shortfalls, preserving health care options for Medicare enrollees.
On MA Plans and Providers: MA organizations in high-growth wage areas may receive higher payments, supporting plan sustainability; hospitals benefit indirectly through better-aligned MA funding tied to local wages.
On International Relations: No direct impacts, as this is a domestic Medicare policy.

Main Stakeholders Affected

Medicare Beneficiaries: Primarily seniors in MA plans, who gain from more reliable plan options in areas with wage index shifts.
Medicare Advantage Plans: Insurers offering MA coverage, who receive adjusted payments to cover rising local costs.
Hospitals: Especially those in reclassified areas, as their wage adjustments influence MA rates; data transparency aids planning.
CMS and Federal Government: Responsible for implementation, with bipartisan congressional sponsors (from New York districts) highlighting regional interests.
Taxpayers: Neutrality ensures no overall increase in Medicare spending.

Notable Legal, Constitutional, or Political Implications

Legal: The bill maintains compliance with existing Medicare payment statutes by building on established wage index mechanisms, avoiding challenges to administrative procedures. The neutrality requirement upholds budget rules under the Social Security Act.
Constitutional: No apparent issues, as it involves congressional authority over federal spending programs like Medicare.
Political: Bipartisan introduction (by Reps. Tenney, Langworthy, Tonko, Lawler, and Stefanik) signals cross-aisle support for rural and upstate New York health care, potentially setting a precedent for addressing geographic disparities in MA funding without broad entitlement expansions. Referred to Ways and Means and Energy and Commerce Committees, indicating focus on fiscal and health policy scrutiny.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Tenney, Claudia [R-NY-24]

Cosponsors (8)

Rep. Langworthy, Nicholas A. [R-NY-23], Rep. Tonko, Paul [D-NY-20], Rep. Lawler, Michael [R-NY-17], Rep. Stefanik, Elise M. [R-NY-21], Rep. Morelle, Joseph D. [D-NY-25], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Riley, Josh [D-NY-19], Rep. Mannion, John [D-NY-22]

Recent Actions

2025-04-02: 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.
2025-04-02: 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.
2025-04-02: Introduced in House
2025-04-02: Introduced in House

Bill Versions

Protecting Options for Seniors Act of 2025 — issued 2025-04-02 — PDF (9 pages)