No Medicare Clawbacks Act of 2026

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9532 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9532

   To amend title XVIII of the Social Security Act to prohibit group 
        health plan payment clawbacks in certain circumstances.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 29, 2026

    Mr. Torres of New York (for himself and Ms. Clarke of New York) 
 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 prohibit group 
        health plan payment clawbacks in certain circumstances.

    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 ``No Medicare Clawbacks Act of 2026''.

SEC. 2. PROHIBITING GROUP HEALTH PLAN PAYMENT CLAWBACKS IN CERTAIN 
              CIRCUMSTANCES.

    Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is 
amended--
            (1) in paragraph (1)(A)(ii)--
                    (A) by striking ``Clause (i)'' and inserting the 
                following:
                                    ``(I) In general.--Clause (i)''; 
                                and
                    (B) by adding at the end the following new 
                subclause:
                                    ``(II) Prohibition on payment 
                                clawbacks in certain circumstances.--In 
                                the case of an item or service 
                                furnished to an individual entitled to 
                                benefits under this title under section 
                                226(a) who is also enrolled in a group 
                                health plan, if clause (i) would 
                                otherwise apply to such individual and 
                                plan but for application of subclause 
                                (I) and if such plan initially makes 
                                payment for such item or service 
                                without regard to such entitlement, 
                                such plan may not later recoup such 
                                payment, in whole or part, on the basis 
                                that such individual was so entitled to 
                                such benefits, provided that--
                                            ``(aa) such item or service 
                                        was furnished during a period 
                                        of retroactive coverage of part 
                                        A benefits applicable to such 
                                        individual; and
                                            ``(bb) at the time such 
                                        item or service was furnished, 
                                        such individual was not behind 
                                        on any employee contribution 
                                        owed by such individual with 
                                        respect to enrollment in such 
                                        plan.''; and
            (2) in paragraph (3)(A), by inserting ``or in the case of a 
        group health plan that recoups payment in violation of 
        paragraph (1)(A)(ii)(II)'' before the period.
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