No official summary available for this bill.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4093 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 4093
To amend title XVIII of the Social Security Act to require the
Secretary of Health and Human Services to publish information on
expenditures under the Medicare program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 24, 2025
Mr. Bean of Florida (for himself and Mr. Hern of Oklahoma) 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
Secretary of Health and Human Services to publish information on
expenditures under the Medicare program, and for other purposes.
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 ``Apples to Apples Comparison Act of
2025''.
SEC. 2. REQUIRING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO PUBLISH
INFORMATION ON EXPENDITURES UNDER THE MEDICARE PROGRAM.
Section 1874 of the Social Security Act (42 U.S.C. 1395kk) is
amended--
(1) in subsection (g)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph
(A), by inserting ``(and, beginning with 2025,
publish on the public website of the Centers
for Medicare & Medicaid Services in machine-
readable files information on)'' after ``a
report on'';
(ii) in subparagraph (A), by inserting
``(and, beginning with 2025, by county and
Metropolitan Statistical Area)'' after
``State''; and
(iii) in subparagraph (B)--
(I) in clause (ii), by striking
``and'' at the end;
(II) in clause (iii), by striking
the period and inserting ``; and''; and
(III) by adding at the end the
following new clause:
``(iv) beginning with 2025, each category
of individuals described in subsection
(h)(1).''; and
(B) by adding at the end the following new
paragraph:
``(3) Special rule for 2025 report and publication of
information.--As part of the report and publication of
information required under paragraph (1) for 2025, the
Secretary shall include enrollment information submitted under
this subsection for each preceding year (beginning with 2015),
broken down by county and Metropolitan Statistical Area and
provided for each category of individuals described in
subsection (h)(1).''; and
(2) by adding at the end the following new subsection:
``(h) Information on Expenditures.--
``(1) In general.--Not later than 30 days after the last
day of each year (beginning with 2025), the Secretary shall,
for each county and each Metropolitan Statistical Area, publish
on the public website of the Centers for Medicare & Medicaid
Services in machine-readable files the total and average
expenditures under this title for items and services furnished
to individuals entitled to benefits under part A or enrolled
under part B residing in such county or Metropolitan
Statistical Area for each month occurring in the specified
historical period and for each month occurring in the specified
projected period with respect to such year, broken down by the
following categories of individuals:
``(A) Individuals entitled to benefits under part A
and not enrolled under part B.
``(B) Individuals who are--
``(i) not entitled to benefits under part
A;
``(ii) enrolled under part B; and
``(iii) not enrolled under a Medicare
Advantage plan under part C.
``(C) Individuals who are--
``(i) entitled to benefits under part A and
enrolled under part B; and
``(ii) not enrolled under a Medicare
Advantage plan under part C.
``(D) Individuals described in subparagraph (A) who
are enrolled in a prescription drug plan under part D.
``(E) Individuals described in subparagraph (B) who
are enrolled in a prescription drug plan under part D.
``(F) Individuals described in subparagraph (C) who
are enrolled in a prescription drug plan under part D.
``(G) Individuals described in subparagraph (A) who
are not enrolled in a prescription drug plan under part
D.
``(H) Individuals described in subparagraph (B) who
are not enrolled in a prescription drug plan under part
D.
``(I) Individuals described in subparagraph (C) who
are not enrolled in a prescription drug plan under part
D.
``(J) Individuals described in subparagraph (A) who
are enrolled in a Federal health care program (as
defined in section 1128B) or a health plan under
chapter 89 of title 5, United States Code.
``(K) Individuals described in subparagraph (B) who
are enrolled in such a program or plan.
``(L) Individuals described in subparagraph (C) who
are enrolled in such a program or plan.
``(M) Individuals described in subparagraph (A) who
are not enrolled in such a program or plan.
``(N) Individuals described in subparagraph (B) who
are not enrolled in such a program or plan.
``(O) Individuals described in subparagraph (C) who
are not enrolled in such a program or plan.
``(P) Individuals described in subparagraph (A) who
are enrolled in a group health plan (as defined in
section 2791 of the Public Health Service Act) or a
medicare supplemental policy under section 1882.
``(Q) Individuals described in subparagraph (B) who
are enrolled in such a plan or policy.
``(R) Individuals described in subparagraph (C) who
are enrolled in such a plan or policy.
``(S) Individuals described in subparagraph (A) who
are not enrolled in such a plan or policy.
``(T) Individuals described in subparagraph (B) who
are not enrolled in such a plan or policy.
``(U) Individuals described in subparagraph (C) who
are not enrolled in such a plan or policy.
``(V) Individuals enrolled in a specialized MA plan
for special needs individuals, broken down by each type
of plan.
``(W) Individuals enrolled in an MA plan other than
a plan described in subparagraph (V).
``(X) Individuals enrolled in an MA plan.
``(Y) Individuals described in subparagraph (X) who
are enrolled in a Federal health care program (as
defined in section 1128B) or a health plan under
chapter 89 of title 5, United States Code.
``(Z) Individuals described in subparagraph (X) who
are not enrolled in such a program or plan.
``(AA) Individuals described in subparagraph (X)
who are enrolled in a group health plan (as defined in
section 2791 of the Public Health Service Act) or a
medicare supplemental policy under section 1882.
``(BB) Individuals described in subparagraph (X)
who are not enrolled in such a plan or policy.
``(CC) Individuals described in subparagraph (X)
who are enrolled in a prescription drug plan under part
D.
``(DD) Individuals described in subparagraph (X)
who are not enrolled in such a plan.
``(EE) Individuals described in subparagraph (X)
who are enrolled in an MA-PD plan.
``(FF) Individuals described in subparagraph (X)
who are not enrolled in such a plan.
``(GG) Individuals described in subparagraph (CC)
or (EE) who are enrolled in a Federal health care
program (as defined in section 1128B) or a health plan
under chapter 89 of title 5, United States Code.
``(HH) Individuals described in subparagraph (CC)
or (EE) who are not enrolled in such a program or plan.
``(II) Individuals enrolled in an employer group
waiver plan.
``(2) Definitions.--For purposes of this subsection:
``(A) Specified historical period.--The term
`specified historical period' means, with respect to a
year, the 10-year period ending on the last day of such
year.
``(B) Specified projected period.--The term
`specified projected period' means, with respect to a
year, the period beginning on the first day of the
subsequent year of a duration specified by the
Secretary (but in no case to exceed a duration of 5
years).''.
SEC. 3. MEDPAC ANALYSIS OF MEDICARE ADVANTAGE AND FEE-FOR-SERVICE
EXPENDITURES.
Section 1805(b) of the Social Security Act (42 U.S.C. 1395b-6(b))
is amended by adding at the end the following new paragraph:
``(12) Analysis of medicare advantage and fee-for-service
expenditures.--
``(A) In general.--The Commission shall, as part of
the report described in paragraph (1)(C) submitted for
each year (beginning with 2026), include a
retrospective analysis of average expenditures under
this title for individuals enrolled in a Medicare
Advantage plan under part C compared to average
expenditures under this title for individuals entitled
to benefits under part A and enrolled under part B who
are eligible to enroll under such a plan but who are
not so enrolled.
``(B) Considerations.--In preparing each analysis
described in subparagraph (A), the Commission shall--
``(i) use data provided by the Chief
Actuary of the Centers for Medicare & Medicaid
Services and the Boards of Trustees of the
Federal Hospital Insurance Trust Fund
established under section 1817 and the Federal
Supplementary Medical Insurance Trust fund
established under section 1841 and such other
data as the Commission determines appropriate;
``(ii) take into account--
``(I) differences in value provided
under Medicare Advantage plans compared
to the value provided under parts A and
B, such as the existence of out-of-
pocket expenditure caps, supplemental
benefits available under such plans,
and the integration of benefits for
covered part D drugs under certain such
plans; and
``(II) demographic differences of
individuals enrolled in Medicare
Advantage plans compared to individuals
entitled to benefits under part A and
enrolled under part B who are not
enrolled in such a plan; and
``(iii) take into account differences in
HCC risk scores but not take into account any
favorable selection differences with respect to
enrollment in such plans.
``(C) Publication requirements.--With respect to
each analysis described in subparagraph (A), the
Commission shall--
``(i) make public all data used in
preparing such analysis in a manner that--
``(I) allows replication of such
analysis; and
``(II) protects the confidentiality
of personal information of individuals
entitled to benefits under part A and
enrolled under part B;
``(ii) not later than 60 days prior to the
submission of such analysis, make public the
methodology used to conduct such analysis and
allow at least 30 days for public comment on
such methodology; and
``(iii) make public a response to each such
comment received on the methodology prior to or
concurrent with the submission of such
analysis.''.
SEC. 4. TRUSTEES REPORT OF EXPENDITURE INFORMATION.
Section 1874 of the Social Security Act (42 U.S.C. 1395kk), as
amended by section 2, is further amended by adding at the end the
following new subsection:
``(i) Trustees' Report of Expenditure Information.--
``(1) In general.--The Boards of Trustees of the Federal
Hospital Insurance Trust Fund established under section 1817
and the Federal Supplementary Medical Insurance Trust Fund
established under section 1841 shall jointly, as part of the
reports described in sections 1817(b)(2) and 1841(b)(2)
submitted for a year (beginning with 2026), include information
on aggregate and average expenditures under this title for the
following categories of individuals, broken down, in the case
of the category described in subparagraph (C), by expenditures
under part A and expenditures under part B:
``(A) Individuals entitled to benefits under part A
and not enrolled under part B.
``(B) Individuals enrolled under part B and not
entitled to benefits under part A.
``(C) Individuals entitled to benefits under part
A, enrolled under part B, and not enrolled in a
Medicare Advantage plan under part C.
``(2) Provision of disaggregated information.--The Boards
of Trustees described in paragraph (1) shall, as part of all
expenditure data (including data tables) made public by such
Boards, disaggregate such data, to the extent practicable,
based on the categories of individuals described in paragraph
(1).''.
<all>
Introduced in House
Introduced in House
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.
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.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line