PROMPT Act
- Bill Number
- H.R. 5873
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-10-31: 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
- 2025-11-25T16:56:10Z
AI-Generated Summary
Purpose
The PROMPT Act aims to enhance transparency in the Medicare program by requiring timely delivery of explanations of benefits (EOBs) to beneficiaries. An EOB is a document that explains what medical services or items were covered, how much was paid, and any costs the beneficiary owes.
Key Provisions
- Amends Section 1806(a) of the Social Security Act, which governs the provision of EOBs under Medicare (title XVIII).
- Mandates that the Secretary of Health and Human Services (HHS) must provide an EOB to Medicare beneficiaries no later than 30 days after a payment is made for an item or service (or would have been made if applicable, such as after meeting a deductible).
Significant Changes to Existing Law
- Prior to this amendment, the Social Security Act required EOBs but did not specify a deadline for delivery.
- The bill introduces a strict 30-day timeline for issuing EOBs following payment or potential payment, ensuring faster communication about Medicare claims.
Potential Impacts
- On government agencies: The Centers for Medicare & Medicaid Services (CMS), under HHS, may face increased administrative requirements to process and distribute EOBs within the new timeframe, potentially raising operational costs or necessitating system updates.
- On citizens: Medicare beneficiaries (primarily seniors and people with disabilities) will receive benefit information more promptly, helping them better understand coverage, detect errors, and manage healthcare costs sooner.
- On international relations: No direct impacts, as this is a domestic healthcare policy focused on U.S. Medicare administration.
Main Stakeholders Affected
- Medicare beneficiaries: Primary beneficiaries who rely on timely EOBs to track claims and out-of-pocket expenses.
- HHS and CMS: Responsible for implementing and enforcing the 30-day requirement, which could affect their workflows and resources.
- Healthcare providers and insurers: Indirectly affected, as faster EOBs may lead to quicker resolution of billing disputes, though the bill does not alter provider payments directly.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens administrative accountability under the Social Security Act without creating new enforcement mechanisms; non-compliance could lead to oversight by congressional committees like Ways and Means or Energy and Commerce.
- Constitutional: No apparent challenges, as it involves routine federal regulation of entitlement programs like Medicare, which is well-established under Congress's spending power.
- Political: Promotes transparency in a major federal program serving over 65 million Americans, potentially appealing to efforts to reduce healthcare fraud and improve beneficiary trust, but may spark debates on added bureaucratic burdens during budget constraints.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (2)
Rep. Salazar, Maria Elvira [R-FL-27], Rep. Haridopolos, Mike [R-FL-8]
Recent Actions
- 2025-10-31: 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.
- 2025-10-31: 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.
- 2025-10-31: Introduced in House
- 2025-10-31: Introduced in House
Bill Versions
- Prompt Reporting and Oversight for Medicare Providing Transparency Act — issued 2025-10-31 — PDF (2 pages)