Medicare Advantage Cost Transparency Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9392 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9392

    To amend title XVIII of the Social Security Act to require the
 inclusion of certain information in Medicare Advantage encounter data.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 23, 2026

Ms. DeGette (for herself and Mr. Joyce of Pennsylvania) 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
 inclusion of certain information in Medicare Advantage encounter data.

    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 Cost Transparency
Act''.

SEC. 2. REQUIRING THE INCLUSION OF CERTAIN INFORMATION IN ENCOUNTER
              DATA.

    Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is
amended by adding at the end the following new subsection:
    ``(j) Inclusion of Certain Information in Encounter Data.--
            ``(1) In general.--In the case of any encounter data
        submitted by a Medicare Advantage plan with respect to an item
        or service furnished to an individual under such plan during a
        plan year beginning on or after January 1, 2027, the Secretary
        shall require that such data include--
                    ``(A) the allowed amount for such item or service;
                    ``(B) the amount of cost sharing (including
                deductibles, copayments, and coinsurance) imposed for
                such item or service;
                    ``(C) in the case such individual was furnished,
                during such plan year before such item or service was
                so furnished, an at-home health risk assessment from a
                specified assessment entity, an indicator that such
                individual was so furnished such an assessment by such
                an entity; and
                    ``(D) in the case such individual was furnished,
                during such plan year before such item or service was
                so furnished, an at-home health risk assessment from an
                assessment entity not described in subparagraph (C), an
                indicator (distinct from the indicator described in
                such subparagraph) that such individual was so
                furnished such an assessment by such an entity.
            ``(2) Definitions.--In this subsection:
                    ``(A) Assessment entity.--The term `assessment
                entity' means an entity with a focus on furnishing in-
                home health risk assessments, as specified by the
                Secretary.
                    ``(B) Specified assessment entity.--The term
                `specified assessment entity' means, with respect to an
                MA organization and a plan year, an assessment entity
                with respect to which such organization (or any person
                with an ownership or control interest (as defined in
                section 1124(a)(3)) in such organization) is a person
                with an ownership or control interest (as so
                defined).''.
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