Medicare Advantage Cost Transparency Act
- Bill Number
- H.R. 9392
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
- Last Updated
- 2026-07-02T21:00:14Z
AI-Generated Summary
Purpose The legislation aims to increase transparency in Medicare Advantage plans by requiring additional details in encounter data submissions. It seeks to make cost information and certain assessment indicators more visible to support oversight and analysis.
Key Provisions
- The bill, titled the Medicare Advantage Cost Transparency Act, amends Section 1859 of the Social Security Act by adding a new subsection (j).
- Starting with plan years beginning on or after January 1, 2027, Medicare Advantage plans must include the following in encounter data for each item or service:
- The allowed amount (negotiated payment rate) for the item or service.
- The beneficiary's cost-sharing amount, including deductibles, copayments, and coinsurance.
- An indicator if the beneficiary received an at-home health risk assessment from a "specified assessment entity" (an entity in which the Medicare Advantage organization or its owners have an ownership or control interest).
- A distinct indicator if the assessment came from a non-specified assessment entity.
- The Secretary of Health and Human Services defines "assessment entity" as an organization focused on in-home health risk assessments.
Significant Changes to Existing Law This measure adds new mandatory data fields to encounter data reporting requirements under Medicare Advantage. Prior law did not specifically require inclusion of allowed amounts, detailed cost-sharing information, or indicators for at-home assessments in this manner.
Potential Impacts
- Medicare Advantage organizations must update their data submission systems to capture and report the new elements, potentially increasing administrative costs.
- The Centers for Medicare & Medicaid Services (CMS) will receive more granular cost and assessment data, which could improve program monitoring and payment accuracy.
- Medicare beneficiaries may indirectly benefit from greater transparency in plan costs, though direct effects on coverage or premiums are not specified.
- No notable effects on international relations are outlined.
Main Stakeholders Affected
- Medicare Advantage organizations and plans.
- Medicare beneficiaries enrolled in these plans.
- CMS and the Department of Health and Human Services.
- Entities providing at-home health risk assessments, particularly those with ownership ties to Medicare Advantage organizations.
Notable Legal, Constitutional, or Political Implications The bill represents a targeted amendment to existing Medicare statutes with no apparent constitutional concerns, as it focuses on data reporting requirements within federal health programs. It may raise administrative and compliance considerations for plans but does not alter eligibility, benefits, or core program structures.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Recent Actions
- 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
- 2026-06-25: Subcommittee Consideration and Mark-up Session Held
- 2026-06-23: 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.
- 2026-06-23: 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.
- 2026-06-23: Referred to the Subcommittee on Health.
- 2026-06-23: Introduced in House
- 2026-06-23: Introduced in House
Bill Versions
- Medicare Advantage Cost Transparency Act — issued 2026-06-23 — PDF (3 pages)