Save MEDICARE Act of 2026

Bill Number: H.R. 9544
Origin Chamber: House
Congress: 119th Congress, Session 2
Status: Introduced
Latest Action: 2026-06-30: Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and Veterans' Affairs, 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: 2026-07-07T08:05:28Z

AI-Generated Summary

Summary of H.R. 9544 (Save MEDICARE Act of 2026)

Purpose of the Legislation

This bill amends Title XVIII of the Social Security Act to adjust payments and oversight under the Medicare Advantage program. It aims to promote accurate risk adjustment, limit certain payment incentives, enhance audit processes, recover costs for veterans' care, and allow greater state involvement in enforcement.

Key Provisions Outlined

Risk Adjustment Reforms (Section 2): Requires the Secretary of Health and Human Services to identify and exclude diagnosis codes prone to variation or discretionary coding from payment adjustments starting in 2028. Prohibits use of diagnoses from chart reviews or health risk assessments for Medicare Advantage and Part D plans. Mandates a MedPAC study on using survey data for risk adjustments.
Quality Bonus Program (Section 3): Ends the Medicare Advantage quality bonus program after 2028.
Benchmark Payments (Section 4): Eliminates the county quartile system for benchmarks after 2027. Introduces adjustments to base payment amounts for favorable selection between Medicare Advantage and traditional Medicare, using a specific methodology from MedPAC reports.
Risk Adjustment Data Validation (Section 5): Sets deadlines for contract-level audits (one year), medical record reviews (60 days), and appeals stages (90 days each). Allows extrapolation of audit results, imposes a 0.02% payment reduction for audit funding, and authorizes recovery audit contractors with penalties up to triple overpayments plus interest.
Veterans' Health Care Recovery (Section 6): Creates authority for the Department of Veterans Affairs to recover costs from Medicare Advantage and Part D plans for care provided to enrolled veterans, regardless of plan requirements. Modifies recovery procedures, adds timelines for third-party payments, interest penalties, and civil penalties for noncompliance.
State Enforcement (Section 7): Permits states to require Medicare Advantage organizations to meet federal requirements and allows collaborative enforcement agreements with the Secretary.
Provider Incentive Contracts (Section 8): Prohibits Medicare Advantage contracts from using percentage-of-premium arrangements or other financial incentives tied to coding starting in 2028.

Significant Changes to Existing Law Introduced

Shifts Medicare Advantage payment calculations by removing certain data sources and introducing selection adjustments, replacing prior quartile-based benchmarks.
Limits the duration of the quality bonus program and expands audit and recovery powers, including judicial review restrictions and extrapolation authority.
Extends VA recovery rights to Medicare Advantage plans and adds new third-party obligations, penalties, and reporting requirements under Title 38.
Adds state-level enforcement options to federal Medicare Advantage standards.

Potential Impacts on Government Agencies, Citizens, or International Relations

Government Agencies: Increases administrative responsibilities for the Department of Health and Human Services and Centers for Medicare & Medicaid Services in audits, data analysis, and coordination with states; expands recovery functions for the Department of Veterans Affairs.
Citizens: May affect Medicare Advantage enrollees through changes in plan payments and risk scoring; veterans enrolled in these plans could see improved cost recovery for VA-provided services.
International Relations: No direct provisions or impacts identified in the legislation.

Main Stakeholders Affected

Medicare Advantage organizations and plans.
Traditional Medicare beneficiaries and enrollees.
Department of Health and Human Services, Centers for Medicare & Medicaid Services, and Department of Veterans Affairs.
State governments and insurance regulators.
Health care providers participating in Medicare Advantage.
Medicare Payment Advisory Commission (MedPAC).

Notable Legal, Constitutional, or Political Implications

Limits judicial review of certain Risk Adjustment Data Validation determinations, potentially affecting due process considerations.
Introduces new civil penalties and interest requirements for third parties, expanding enforcement mechanisms under existing Medicare and VA statutes.
Creates overlapping federal and state enforcement roles, which may require coordination agreements to avoid conflicts.
Relies on administrative rulemaking and analysis for implementation, with specific timelines beginning in 2028.

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

Sponsor

Rep. Doggett, Lloyd [D-TX-37]

Cosponsors (48)

Rep. Ansari, Yassamin [D-AZ-3], Rep. Balint, Becca [D-VT-At Large], Rep. Casar, Greg [D-TX-35], Rep. Chu, Judy [D-CA-28], Rep. Clarke, Yvette D. [D-NY-9], Rep. Cleaver, Emanuel [D-MO-5], Rep. Cohen, Steve [D-TN-9], Rep. Davis, Danny K. [D-IL-7], Rep. DeLauro, Rosa L. [D-CT-3], Rep. Deluzio, Christopher R. [D-PA-17], Rep. Dingell, Debbie [D-MI-6], Rep. Garamendi, John [D-CA-8], Rep. García, Jesús G. "Chuy" [D-IL-4], Rep. Garcia, Robert [D-CA-42], Rep. Grijalva, Adelita S. [D-AZ-7], Rep. Huffman, Jared [D-CA-2], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Jayapal, Pramila [D-WA-7], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. Khanna, Ro [D-CA-17], Rep. Mfume, Kweisi [D-MD-7], Rep. Nadler, Jerrold [D-NY-12], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Ocasio-Cortez, Alexandria [D-NY-14], Rep. Omar, Ilhan [D-MN-5], Rep. Pingree, Chellie [D-ME-1], Rep. Pocan, Mark [D-WI-2], Rep. Randall, Emily [D-WA-6], Rep. Schakowsky, Janice D. [D-IL-9], Rep. Scott, Robert C. "Bobby" [D-VA-3], Rep. Smith, Adam [D-WA-9], Rep. Takano, Mark [D-CA-39], Rep. Thanedar, Shri [D-MI-13], Rep. Thompson, Bennie G. [D-MS-2], Rep. Tlaib, Rashida [D-MI-12], Rep. Velázquez, Nydia M. [D-NY-7], Rep. Waters, Maxine [D-CA-43], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Green, Al [D-TX-9], Rep. Carson, André [D-IN-7], Rep. McGovern, James P. [D-MA-2], Rep. Tokuda, Jill N. [D-HI-2], Rep. DeSaulnier, Mark [D-CA-10], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Menefee, Christian D. [D-TX-18], Rep. Ramirez, Delia C. [D-IL-3], Rep. Latimer, George [D-NY-16], Rep. Williams, Nikema [D-GA-5]

Recent Actions

2026-06-30: Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and Veterans' Affairs, 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.
2026-06-30: Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and Veterans' Affairs, 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.
2026-06-30: Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and Veterans' Affairs, 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.
2026-06-30: Introduced in House
2026-06-30: Introduced in House

Bill Versions

Saving Medicare Enrollees from Deceptive Insurers and Creating Ample Resources for Everyone Act of 2026 — issued 2026-06-30 — PDF (27 pages)