To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5243 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 5243

   To amend title XVIII of the Social Security Act to increase data
    transparency for supplemental benefits under Medicare Advantage.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 10, 2025

Ms. McClellan 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 increase data
    transparency for supplemental benefits under Medicare Advantage.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. INCREASING DATA TRANSPARENCY FOR SUPPLEMENTAL BENEFITS UNDER
              MEDICARE ADVANTAGE.

    (a) In General.--Section 1857(e) of the Social Security Act (42
U.S.C. 1395w-27(e)) is amended by adding at the end the following new
paragraph:
            ``(6) Reporting of enrollee-level data on supplemental
        benefits.--
                    ``(A) In general.--Beginning with plan years
                beginning on or after January 1, 2029, a contract under
                this section with an MA organization shall require the
                organization to submit to the Secretary, for each MA
                plan offered by the organization, enrollee-level data
                on supplemental benefits (by item or service, or
                category of item or service, as determined appropriate
                by the Secretary, and national provider identifier),
                including eligibility for such benefits, the types of
                benefit categories offered, data on utilization of and
                payments for such benefits (including the total amount
                spent by the plan for each enrollee who utilized such
                benefits and the total out-of-pocket cost per
                utilization for each enrollee).
                    ``(B) Data access.--
                            ``(i) In general.--On the first Monday in
                        October of each year (beginning with 2030), the
                        Secretary shall make data submitted under
                        subparagraph (A) available to individuals and
                        entities for the purpose of conducting--
                                    ``(I) evaluations and other
                                analysis to support the program under
                                this title; and
                                    ``(II) other health care related
                                research.
                            ``(ii) Public use data file.--Not later
                        than October 1 of each year (beginning with
                        2030), the Secretary shall make a public use
                        data file containing the data submitted under
                        subparagraph (A) available on the internet
                        website of the Centers for Medicare & Medicaid
                        Services.
                            ``(iii) Confidentiality.--In making data
                        available under this subparagraph, the
                        Secretary shall have in place procedures to
                        safeguard the privacy of any individually
                        identifiable enrollee information.''.
    (b) Rule of Construction.--Nothing in the amendments made by this
section shall affect the collection of information as proposed pursuant
to the notice entitled ``Agency Information Collection Activities:
Proposed Collection; Comment Request'', published in the Federal
Register on March 14, 2023 (88 Fed. Reg. 15726).
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