H.R. 9392: Medicare Advantage Cost Transparency Act

This bill would require Medicare Advantage plans to include more detail in the claims-like data they send to the federal government for services provided starting with plan years beginning on or after January 1, 2027.

What information would have to be reported

For each item or service a Medicare Advantage enrollee receives, the plan would have to report:

• The allowed amount for the service — in other words, the amount the plan and provider agreed to for that service.
• The cost-sharing amount the patient had to pay, including deductibles, copayments, and coinsurance.
• Whether the enrollee received an at-home health risk assessment earlier in that plan year from a specified assessment entity.
• Whether the enrollee received an at-home health risk assessment earlier in that plan year from a different type of assessment entity.

What “assessment entity” means

The bill defines an assessment entity as a group or company that focuses on providing in-home health risk assessments, as the Secretary of Health and Human Services would specify.

A specified assessment entity is a type of assessment entity tied to the Medicare Advantage organization by ownership or control. In plain terms, this means the Medicare Advantage insurer or someone connected to it through ownership or control has a financial relationship with the company doing the in-home assessment.

Practical effect

The main purpose appears to be giving the federal government more complete data about:

• what Medicare Advantage plans are paying for services,
• what enrollees are paying out of pocket, and
• whether in-home health risk assessments were performed by companies connected to the plan or by unrelated companies.

That information could be used to examine spending patterns, cost-sharing, and the role of in-home assessments in Medicare Advantage.

Relevant Companies

None found