Medicare Advantage MLR Transparency Act

119 HR 9644 IH: Medicare Advantage MLR Transparency Act
U.S. House of Representatives
2026-07-13
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I119th CONGRESS2d SessionH. R. 9644IN THE HOUSE OF REPRESENTATIVESJuly 13, 2026Mr. Moran 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 concernedA BILLTo amend title XVIII of the Social Security Act to promote transparency of Medicare Advantage plan information. 
1.Short titleThis Act may be cited as the Medicare Advantage MLR Transparency Act. 2.Promoting transparency of Medicare Advantage plan information (a)Overhead costs and claim payment informationSection 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph: 
 
(7)Overhead costs and claim payment information 
(A)In generalBeginning with plan years beginning on or after January 1, 2029, a contract under this section with an MA organization shall require the organization, with respect to each MA plan offered by such organization during such plan year, to submit to the Secretary and publish on the public website of such organization the following information in a consumer-friendly format specified by the Secretary:  (i) The amount of total revenue (as determined in accordance with section 422.2420(c) of title 42, Code of Federal Regulations (or a successor regulation)) of such plan.
                             
(ii)The amount and percentage of such revenue expended on incurred claims (as determined in accordance with paragraphs (2) through (4) of section 422.2420(b) of title 42, Code of Federal Regulations (or a successor regulation)). (iii)The amount and percentage of such revenue expended on non-claims costs (as defined in section 422.2401 of title 42, Code of Federal Regulations (or a successor regulation)). 

                                (iv)
 The amount of the difference between the MLR numerator (as determined in accordance with paragraph (b) of section 422.2420 of title 42, Code of Federal Regulations (or a successor regulation)) and the MLR denominator (as determined in accordance with paragraph (c) of such section (or a successor regulation)).
                             
(v)The amount described in clause (iv), expressed as a percentage of such revenue. (B)Manner of publicationThe Secretary may require information submitted and published by an MA organization under subparagraph (A), in addition to being so published and submitted at the MA plan level, to be so submitted and published in the aggregate in such manner as specified by the Secretary (such as across all MA plans offered by such organization).

                            (C)
                            Application of certain provisions
 In applying section 422.2420 of title 42, Code of Federal Regulations (or a successor regulation), for purposes determining any amount or percentage under subparagraph (A), any reference to an MA contract, MSA contract, contract, or contract year shall be treated as a reference to an MA plan, MSA plan, plan, or plan year, respectively.
                        . 
(b)Ensuring comparability of benefit informationSection 1851(d)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395w–21(d)(2)(A)(ii)) is amended by adding at the end the following new sentence: With respect to any such information that is provided in an electronic format on or after the first day of the first plan year that begins at least 1 year after the date of the enactment of this sentence, such information shall, to the greatest extent practicable, be presented in the same uniform format applicable to information required to be made available by group health plans and health insurance issuers under section 2715 of the Public Health Service Act..