H.R. 5243

119th CONGRESS 1st Session

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 · Sponsor: Ms. McClellan

Table of contents

• H.R. 5243
  • SEC. 1. Increasing data transparency for supplemental benefits under Medicare Advantage

SEC. 1. Increasing data transparency for supplemental benefits under Medicare Advantage

• (a) In general
  • Section 1857(e) of the Social Security Act () is amended by adding at the end the following new paragraph: 42 U.S.C. 1395w–27(e)
  • In general
    • (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).
        • In general
      • (B) Data access
        • (i) 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—
        • In general
        • evaluations and other analysis to support the program under this title; and
        • other health care related research.
        • (ii) 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) 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 , published in the Federal Register on March 14, 2023 (88 Fed. Reg. 15726). Agency Information Collection Activities: Proposed Collection; Comment Request