Medicare Advantage Consumer Protection and Transparency Act

Medicare Advantage Consumer Protection and Transparency Act

This bill generally requires Medicare Advantage organizations to report additional information to the Centers for Medicare & Medicaid Services, including supplemental plan benefits, encounter data, and the number of coverage denials and prior authorization requests. Failure to comply with the bill's requirements may result in payment reductions.

Bill 118 hr 5854, also known as the Medicare Advantage Consumer Protection and Transparency Act, aims to enhance consumer protections and increase transparency within the Medicare Advantage program. The bill was introduced in the House of Representatives on March 3, 2021.

The key provisions of the bill include requiring Medicare Advantage plans to provide clear and easily understandable information to beneficiaries about their coverage, costs, and network providers. This is intended to help beneficiaries make informed decisions about their healthcare options.

Additionally, the bill seeks to strengthen oversight of Medicare Advantage plans by requiring the Centers for Medicare and Medicaid Services (CMS) to conduct regular audits to ensure compliance with program requirements. This will help prevent fraud and abuse within the program. Furthermore, the bill includes provisions to improve access to care for beneficiaries by requiring Medicare Advantage plans to maintain an adequate network of healthcare providers. This will help ensure that beneficiaries have access to the care they need when they need it. Overall, the Medicare Advantage Consumer Protection and Transparency Act aims to protect and empower Medicare Advantage beneficiaries by increasing transparency, strengthening oversight, and improving access to care within the program.