Medicare Advantage Integrity Act of 2023

Medicare Advantage Integrity Act of 2023

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 payments for basic benefits.

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4411 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 4411

To amend title XVIII of the Social Security Act to establish a floor in 
 Medicare Advantage benchmark rates for regions with low Medicare fee-
                        for-service penetration.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 30, 2023

Mrs. Gonzalez-Colon (for herself, Mr. Soto, and Ms. Salazar) 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 establish a floor in 
 Medicare Advantage benchmark rates for regions with low Medicare fee-
                        for-service penetration.

    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 Integrity Act of 
2023''.

SEC. 2. ADDRESSING DISPARITIES IN MEDICARE ADVANTAGE BENCHMARK LEVELS 
              BASED ON PENETRATION.

    (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 (6),''; 
        and
            (2) by adding at the end the following new paragraph:
            ``(6) Average geographic adjustment floor.--For 2024 and 
        subsequent years, when calculating the adjusted average per 
        capita cost under section 1876(a)(4) for the purposes of 
        establishing the base payment amount specified in paragraph 
        (2)(E), the average geographic adjustment shall not be less 
        than 0.70 for any area. For the purposes of the previous 
        sentence, the Secretary may define the term `average geographic 
        adjustment' under subparagraph (A) by program instruction or 
        otherwise.''.
    (b) Ensuring Plan Payments Flow to Providers and Patients.--Section 
1854(a)(6) of the Social Security Act (42 U.S.C. 1395w-24(a)(6)) is 
amended by adding at the end the following new subparagraph:
                    ``(C) Ensuring increased payments support care.--
                With respect to the increase in blended benchmark 
                amount attributable to the application of section 
                1853(n)(6), no less than 50 percent shall be directed 
                toward payment for basic benefits as defined in section 
                1852(a)(1)(B).''.
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