DeGette, Joyce Advance Medicare Advantage Cost Transparency Act

WASHINGTON, D.C. - Today, the Energy & Commerce Subcommittee on Health passed the Medicare Advantage Cost Transparency Act, a bill introduced by Congresswoman Diana DeGette (CO-01) and Congressman John Joyce (PA-13). The bill will now go to the full committee for further action.

This bill would require Medicare Advantage (MA) organizations to incorporate additional data, including cost information, in encounter data submitted to the Centers for Medicare and Medicaid Services (CMS) to facilitate Medicare payment validation and to identify improper MA practices.

"Understanding what Medicare Advantage plans actually pay for care and what they force patients to pay out of their own pockets is critical to ensuring those plans are working for Americans," said Congresswoman DeGette. "If we want to make sure these plans are working for the seniors who rely on them, we have to see how they operate. This bill shines a light on their business practices so we can hold them accountable and protect the people Medicare is supposed to serve."

Under this legislation, plans would be required to include the following in encounter data:

• What the plan paid for an item or service furnished;
• The cost sharing amount (deductibles, copay, and coinsurance) imposed for each item or service;
• Information about whether an MA plan facilitated a health risk assessment for the beneficiary.

The Office of the Inspector General (OIG) has identified instances of MA plans using at-home risk assessments to add questionable enrollee diagnoses that ultimately increase risk-adjusted payment from CMS without providing services related to the additional diagnoses.

Medicare Advantage plans have been criticized for their high out-of-pocket cost for patients and the shifting provider networks.

Read the full bill text here.(link is external)

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