Sponsors (2)
The bill increases price transparency and government oversight of Medicare Advantage assessments, improving beneficiaries' ability to see costs and detect conflicts, but it raises privacy concerns and imposes new reporting burdens and potential market impacts on providers and plans.
Medicare beneficiaries (and policymakers) will get MA encounter records that include allowed amounts and per‑item patient cost‑sharing (deductibles, copays, coinsurance), improving price transparency and making it easier to track out‑of‑pocket burden.
Medicare beneficiaries and state governments will gain better oversight to detect potential conflicts of interest because encounter data will flag at‑home assessments performed by entities owned or controlled by MA organizations.
Medicare Advantage plans (and potentially beneficiaries through higher premiums or less generous offerings) will face increased administrative and reporting costs to collect and submit allowed amounts, cost‑sharing, and assessment ownership indicators.
Medicare beneficiaries face greater privacy risks if detailed encounter records and assessment ownership/indicator flags are linked to individuals without strong data protections and safeguards.
Smaller assessment entities, hospitals, and health systems may face operational disruption or increased scrutiny if identified as owned/controlled by MA organizations, which could reduce contracting options and narrow provider choice for beneficiaries.
Based on analysis of 2 sections of legislative text.
Requires MA encounter data (from plan years starting Jan 1, 2027) to report allowed amounts, patient cost‑sharing, and flags about prior in‑home health risk assessments and their ownership ties.
Official title: To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data.
Introduced June 23, 2026 by Diana DeGette · Last progress June 23, 2026
Requires Medicare Advantage encounter data (for plan years starting on or after Jan 1, 2027) to include the allowed amount and patient cost-sharing for each item or service, and to flag whether a beneficiary previously received an in‑home health risk assessment and whether that assessment came from an assessment entity in which the MA organization (or its owner/controller) has an ownership or control interest. Also defines “assessment entity” and “specified assessment entity” for this reporting purpose.