H.R. 9392

119 HR 9392 IH: Medicare Advantage Cost Transparency Act
 U.S. House of Representatives
 2026-06-23
 text/xml
 EN
 Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
 I  119th CONGRESS  2d Session  H. R. 9392  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.
1.
Short title
This Act may be cited as the   Medicare Advantage Cost Transparency Act  .
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).
 .