Section 1 Short title
This Act may be cited as the “Medicare Advantage Integrity Act”.
Medicare Advantage Integrity Act
A BILL
To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration.
Sec. 2 Addressing disparities in Medicare Advantage benchmark levels based on penetration
in paragraph (1)(B), by striking “subsequent year” and inserting “subsequent year, subject to paragraph (6),”; and
by adding at the end the following new paragraph:
“(6) Average geographic adjustment floor—For 2022 and each subsequent year, when calculating the adjusted average per capita cost under section 1876(a)(4) for the purposes of establishing the base payment amount specified in paragraph (2)(E), the average geographic adjustment shall not be less than 0.70 for any area. For purposes of the previous sentence, the Secretary may define the term average geographic adjustment by program instruction or otherwise.”
Ensuring plan payments flow to providers— Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:
“(6) Strengthening support to health care providers—A contract under this section with an MA organization shall require that, with respect to any increase in blended benchmark amount attributable to section 1853(n)(6), the plan shall provide that no less than 50 percent of such increase is directed toward provider compensation.”