Govwatch

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9392 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9392

    To amend title XVIII of the Social Security Act to require the 
 inclusion of certain information in Medicare Advantage encounter data.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 23, 2026

Ms. DeGette (for herself and Mr. Joyce of Pennsylvania) 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 within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL

 
    To amend title XVIII of the Social Security Act to require the 
 inclusion of certain information in Medicare Advantage encounter data.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Advantage Cost Transparency 
Act''.

SEC. 2. REQUIRING THE INCLUSION OF CERTAIN INFORMATION IN ENCOUNTER 
              DATA.

    Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is 
amended by adding at the end the following new subsection:
    ``(j) Inclusion of Certain Information in Encounter Data.--
            ``(1) In general.--In the case of any encounter data 
        submitted by a Medicare Advantage plan with respect to an item 
        or service furnished to an individual under such plan during a 
        plan year beginning on or after January 1, 2027, the Secretary 
        shall require that such data include--
                    ``(A) the allowed amount for such item or service;
                    ``(B) the amount of cost sharing (including 
                deductibles, copayments, and coinsurance) imposed for 
                such item or service;
                    ``(C) in the case such individual was furnished, 
                during such plan year before such item or service was 
                so furnished, an at-home health risk assessment from a 
                specified assessment entity, an indicator that such 
                individual was so furnished such an assessment by such 
                an entity; and
                    ``(D) in the case such individual was furnished, 
                during such plan year before such item or service was 
                so furnished, an at-home health risk assessment from an 
                assessment entity not described in subparagraph (C), an 
                indicator (distinct from the indicator described in 
                such subparagraph) that such individual was so 
                furnished such an assessment by such an entity.
            ``(2) Definitions.--In this subsection:
                    ``(A) Assessment entity.--The term `assessment 
                entity' means an entity with a focus on furnishing in-
                home health risk assessments, as specified by the 
                Secretary.
                    ``(B) Specified assessment entity.--The term 
                `specified assessment entity' means, with respect to an 
                MA organization and a plan year, an assessment entity 
                with respect to which such organization (or any person 
                with an ownership or control interest (as defined in 
                section 1124(a)(3)) in such organization) is a person 
                with an ownership or control interest (as so 
                defined).''.
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Medicare Advantage Cost Transparency Act

Full Text
