Ways and Means Committee, Energy and Commerce Committee
Introduced
In Committee
On Floor
Passed Chamber
Enacted
This bill, titled the "Prompt and Fair Pay Act," seeks to significantly reform payment practices within the Medicare Advantage program. Its primary objectives are to establish payment parity between Medicare Advantage and original Medicare fee-for-service, and to implement robust prompt payment requirements for providers contracting with MA organizations. Beginning January 1, 2027, Medicare Advantage organizations would be required to ensure that their contracts with providers and suppliers mandate payments for services are not less than the amounts paid under the original Medicare fee-for-service program. This provision aims to standardize reimbursement rates and prevent MA plans from paying providers less than traditional Medicare. Furthermore, the bill introduces new prompt payment rules for in-network providers under Medicare Advantage. It defines a "clean claim" and sets specific deadlines for MA organizations to process and pay these claims: 14 calendar days for electronically submitted claims and 30 calendar days for claims submitted otherwise. If an MA organization determines a claim is not clean, it must notify the provider within 10 or 15 days, detailing all deficiencies. Should an MA organization fail to pay a clean claim within the specified timeframe, it would be obligated to pay interest to the provider at a rate tied to Treasury securities, plus an additional 0.1 percentage point. The bill also includes provisions to protect claimants from retaliation and grants the Secretary of Health and Human Services authority to enforce these new prompt payment requirements, ensuring greater accountability and timely compensation for healthcare services.
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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
Prompt and Fair Pay Act
USA119th CongressHR-4559| House
| Updated: 7/21/2025
This bill, titled the "Prompt and Fair Pay Act," seeks to significantly reform payment practices within the Medicare Advantage program. Its primary objectives are to establish payment parity between Medicare Advantage and original Medicare fee-for-service, and to implement robust prompt payment requirements for providers contracting with MA organizations. Beginning January 1, 2027, Medicare Advantage organizations would be required to ensure that their contracts with providers and suppliers mandate payments for services are not less than the amounts paid under the original Medicare fee-for-service program. This provision aims to standardize reimbursement rates and prevent MA plans from paying providers less than traditional Medicare. Furthermore, the bill introduces new prompt payment rules for in-network providers under Medicare Advantage. It defines a "clean claim" and sets specific deadlines for MA organizations to process and pay these claims: 14 calendar days for electronically submitted claims and 30 calendar days for claims submitted otherwise. If an MA organization determines a claim is not clean, it must notify the provider within 10 or 15 days, detailing all deficiencies. Should an MA organization fail to pay a clean claim within the specified timeframe, it would be obligated to pay interest to the provider at a rate tied to Treasury securities, plus an additional 0.1 percentage point. The bill also includes provisions to protect claimants from retaliation and grants the Secretary of Health and Human Services authority to enforce these new prompt payment requirements, ensuring greater accountability and timely compensation for healthcare services.
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.