Cortez Masto, Blackburn Lead Bipartisan Legislation to Require Prompt Payment from Medicare Advantage, Protect Seniors from Delayed Bills

Washington, D.C. - U.S. Senators Catherine Cortez Masto (D-Nev.) and Marsha Blackburn (R-Tenn.) introduced the Medicare Advantage Prompt Pay Act, bipartisan, bicameral legislation to improve Medicare Advantage's (MA) billing practices, offer certainty health care providers who contract with MA plans, and ensure that seniors aren't stuck with unfair, confusing, or delayed bills after receiving critical care. Companion legislation in the U.S. House of Representatives is led by Representatives Jodey Arrington (R-Texas-19) and Linda Sánchez (D-Calif.-38).

"Nevadans who rely on Medicare Advantage deserve the peace of mind that when they go to the doctor's office or hospital, their MA plan will pay providers for their care in a timely manner, and they won't be sent a delayed bill many months later," said Senator Cortez Masto. "This bipartisan legislation makes commonsense fixes to Medicare Advantage's billing practices that will help health care providers and patients by bringing transparency and stability to the program."

"Tennessee seniors should not have to worry about whether their Medicare Advantage plan will pay for their care in a timely manner," said Senator Blackburn. "The Medicare Advantage Prompt Pay Act would improve Medicare billing practices by offering certainty to health care providers who contract with MA plans, ensuring that seniors are not burdened by unfair or overdue bills."

"Medicare Advantage plans are delaying payments to rural hospitals and providers - resulting in service cuts, staff shortages, forced closures, and patients with unexpected medical bills months or even years later," said House Budget Chairman Jodey Arrington. "My bipartisan Medicare Advantage Prompt Pay Act fixes this problem by requiring plans to pay hospitals and doctors on time or face penalty. By holding plans accountable and making the process more transparent, this bill protects patients, supports the hospitals and doctors who care for them, and ensures Medicare Advantage works as intended."

"More than half of seniors eligible for Medicare are enrolled in Medicare Advantage. However, too many are hit with confusing medical bills due to delayed and inconsistent Medicare Advantage billing practices. Our bipartisan bill will bring much-needed clarity to the system, ensuring healthcare providers are paid promptly and patients aren't hit with unexpected bills long after they received care," said Representative Linda Sánchez.

In Nevada, over 56% of Medicare beneficiaries are enrolled in an MA plan, with an especially high concentration in Nye, Clark, and Washoe counties. While Medicare Advantage plans provide critical coverage to seniors, health care providers regularly report service and payment delays, inconsistent policies, and inappropriate denials by MA plans. Currently, there are no clear guidelines for how quickly an MA plan must reimburse providers for in-network claims. This creates unnecessary delays that could lead to providers dropping contracts with plans, jeopardizing in-network access to care for many who rely on Medicare Advantage. Cortez Masto and Blackburn's bipartisan bill seeks to address these issues by requiring MA plans to pay providers faster and more reliably. It defines 'clean claims' according to widely accepted national standards, sets minimum timely payment standards, and aligns rules for in-and out-of-network claims. These commonsense changes would give health care providers the certainty they need to keep partnering with MA plans and ensure that Medicare Advantage coverage continues to work for seniors.

The bill text can be found here.

This legislation is endorsed by the Federation of American Hospitals (FAH), American Hospital Association (AHA), National Rural Health Association (NRHA), American Academy of Family Physicians (AAFP), America's Essential Hospitals (AEH), American Society of Anesthesiologists, American Psychiatric Association (APA), Bipartisan Policy Center Action (BPC Action), Nevada Hospital Association, Texas Hospital Association, California Hospital Association, Vizient, and OCHIN.

"The Nevada Hospital Association supports Senator Cortez Masto's Medicare Advantage Prompt Pay Act which ensures Medicare Advantage Plans comply with stricter prompt payment requirements for healthcare providers," said Patrick Kelly, President and CEO of Nevada Hospital Association. "Establishing clear payment standards will promote timely reimbursement, reduce administrative challenges, and strengthen patient care. We appreciate Senator Cortez Masto's leadership in championing this important legislation."

"Too often, arbitrary delays and denials threaten seniors' access to care and further strain hospital finances. This commonsense, bipartisan legislation represents an important step toward increasing accountability for health insurers and creating sensible guidelines for the prompt payment of provider claims. The law has long required prompt payment in traditional Medicare, and this overdue legislation ensures Medicare Advantage plans have to play by the rules. FAH is grateful to Senators Catherine Cortez Masto (D-NV) and Marsha Blackburn (R-TN) and Representatives Jodey Arrington (R-TX) and Linda Sánchez (D-CA) for introducing the Medicare Advantage (MA) Prompt Pay Act and protecting seniors' access to 24/7 care," said Charlene MacDonald, Federation of American Hospitals (FAH) Executive Vice President of Public Affairs. FAH has 38 member facilities across Nevada, employing more than 16,000 Nevadans.

Senator Cortez Masto is a leader in the Senate in ensuring older Nevadans can access quality, affordable health care, including through Medicare Advantage. She has led efforts to lower drug costs for seniors, hold big pharma accountable, and expand Medicare drug price negotiation. She has also championed legislation to strengthen Medicare-funded behavioral health services and telehealth services, as well as protect access to ambulance services in rural and underserved areas.

###