Puerto Rico Integrity in Medicare Advantage Act

Puerto Rico Integrity in Medicare Advantage Act

This bill temporarily establishes geographic adjustments for certain Medicare Advantage payment formulations, and specifies that a certain percentage of corresponding payment increases must be directed toward compensating providers in Puerto Rico.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6809 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6809

    To amend title XVIII of the Social Security Act to provide for 
   temporary stabilization of Medicare Advantage payments following 
                            Hurricane Maria.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 13, 2018

   Miss Gonzalez-Colon of Puerto Rico (for herself, Mr. Serrano, Mr. 
 Bacon, Mr. Soto, and Mrs. Murphy of Florida) 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 provide for 
   temporary stabilization of Medicare Advantage payments following 
                            Hurricane Maria.

    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 ``Puerto Rico Integrity in Medicare 
Advantage Act''.

SEC. 2. TEMPORARY STABILIZATION OF MEDICARE ADVANTAGE PAYMENTS 
              FOLLOWING HURRICANE MARIA.

    (a) In General.--Section 1853(n) of the Social Security Act (42 
U.S.C. 1395w-23(n)) is amended--
            (1) in paragraph (1)(B), by striking ``subsequent year'' 
        and inserting ``subsequent year, subject to paragraph (7),'';
            (2) in paragraph (4), by striking ``In'' and inserting 
        ``Subject to paragraph (7), in''; and
            (3) by adding at the end the following new paragraph:
            ``(7) Average geographic adjustment floor.--For each of 
        2019, 2020, and 2021, when calculating the adjusted average 
        capital amount under section 1876(a)(4) for the purposes of 
        establishing the base payment amount, the average geographic 
        adjustment shall not be less than 0.70 for any area.''.
    (b) Ensuring Payments Flow to Puerto Rico Providers and Patients.--
Section 1854(a)(6) of the Social Security Act (42 U.S.C. 1395w-
24(a)(6)) is amended--
            (1) in subparagraph (B)(iv)--
                    (A) by striking ``Exception.--In the case of'' and 
                inserting ``Exceptions.--
                                    ``(I) In the case of''; and
                    (B) by adding at the end the following new 
                subclause:
                                    ``(II) In the case of an area to 
                                which section 1853(n)(7) applies with 
                                respect to a year, clause (iii) shall 
                                be waived for bids submitted for such 
                                area and year and subparagraph (C) 
                                shall apply.''; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Strengthening support to health care 
                providers in puerto rico.--When reviewing bids 
                submitted by plans serving areas in Puerto Rico, the 
                Secretary shall ensure that, of the increase in blended 
                benchmark amount attributable to section 1853(n)(7) 
                (above the amount that would otherwise be determined 
                under section 1853(n)), no less than 50 percent is 
                directed toward provider compensation.''.
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