Section 1 Short title
This Act may be cited as the “Puerto Rico Integrity in Medicare Advantage Act”.
Puerto Rico Integrity in Medicare Advantage Act
A BILL
To amend title XVIII of the Social Security Act to provide for temporary stabilization of Medicare Advantage payments following Hurricane Maria.
Sec. 2 Temporary stabilization of Medicare Advantage payments following Hurricane Maria
in paragraph (1)(B), by striking “subsequent year” and inserting “subsequent year, subject to paragraph (7),”;
in paragraph (4), by striking “In” and inserting “Subject to paragraph (7), in”; and
by adding at the end the following new paragraph:
“(7) Average geographic adjustment floor—For each of 2019, 2020, and 2021, when calculating the adjusted average capital amount under section 1876(a)(4) for the purposes of establishing the base payment amount, the average geographic adjustment shall not be less than 0.70 for any area.”
Ensuring payments flow to Puerto Rico providers and patients— Section 1854(a)(6) of the Social Security Act (42 U.S.C. 1395w–24(a)(6)) is amended—
in subparagraph (B)(iv)—
by striking “Exception.—In the case of” and inserting
“(I) In the case of”
by adding at the end the following new subclause:
“(II) In the case of an area to which section 1853(n)(7) applies with respect to a year, clause (iii) shall be waived for bids submitted for such area and year and subparagraph (C) shall apply.”
by adding at the end the following new subparagraph:
“(C) Strengthening support to health care providers in Puerto Rico—When reviewing bids submitted by plans serving areas in Puerto Rico, the Secretary shall ensure that, of the increase in blended benchmark amount attributable to section 1853(n)(7) (above the amount that would otherwise be determined under section 1853(n)), no less than 50 percent is directed toward provider compensation.”