Ways and Means Committee, Energy and Commerce Committee
Introduced
In Committee
On Floor
Passed Chamber
Enacted
This bill proposes amendments to Title XVIII of the Social Security Act to refine Medicare Advantage (MA) payment calculations. It specifically addresses the issue of under-projected MA local area growth resulting from significant hospital wage index reclassifications. The legislation aims to ensure that MA payment rates accurately reflect local cost changes, particularly in areas experiencing substantial shifts in hospital wage indexes. Beginning in 2026, the bill mandates an additional adjustment to the national per capita MA growth percentage for "applicable areas." An area qualifies if its weighted average hospital wage index increases by over 20% compared to the prior year. For these areas, the Secretary must increase the growth percentage by a factor derived from the wage index increase and the proportion of Medicare payments subject to wage adjustment in that locality. The bill also clarifies how the weighted average hospital wage index is calculated for an MA local area, including all geographically located hospitals. Crucially, any adjustments must maintain benchmark neutrality , ensuring the overall enrollment-weighted average applicable amount for all MA payment areas remains unchanged. Additionally, the legislation requires increased transparency by mandating the publication of total Part A and Part B payments to each area hospital, effective for 2026 data.
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Timeline
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.
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.
Health
Protecting Options for Seniors Act of 2025
USA119th CongressHR-2610| House
| Updated: 4/2/2025
This bill proposes amendments to Title XVIII of the Social Security Act to refine Medicare Advantage (MA) payment calculations. It specifically addresses the issue of under-projected MA local area growth resulting from significant hospital wage index reclassifications. The legislation aims to ensure that MA payment rates accurately reflect local cost changes, particularly in areas experiencing substantial shifts in hospital wage indexes. Beginning in 2026, the bill mandates an additional adjustment to the national per capita MA growth percentage for "applicable areas." An area qualifies if its weighted average hospital wage index increases by over 20% compared to the prior year. For these areas, the Secretary must increase the growth percentage by a factor derived from the wage index increase and the proportion of Medicare payments subject to wage adjustment in that locality. The bill also clarifies how the weighted average hospital wage index is calculated for an MA local area, including all geographically located hospitals. Crucially, any adjustments must maintain benchmark neutrality , ensuring the overall enrollment-weighted average applicable amount for all MA payment areas remains unchanged. Additionally, the legislation requires increased transparency by mandating the publication of total Part A and Part B payments to each area hospital, effective for 2026 data.
Get AI-generated questions to help you understand this bill better
Timeline
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.
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.