A bill to amend title XVIII of the Social Security Act to improve risk adjustment under Medicare Advantage.

Hozzl · 2025-03-26T10:56:28Z

Explore the details of Senate Bill 1105 A bill to amend title XVIII of the Social Security Act to improve risk adjustment under Medicare Advantage. currently in Congress. Get insights into its purpose, current status, sponsors, and potential impact on undefined. Stay informed on legislative developments.

3/26/2025, 10:56 AM

Summary of Bill S 1105

Bill 119 s 1105, also known as the "Medicare Advantage Risk Adjustment Improvement Act," aims to make changes to the way risk adjustment is calculated for Medicare Advantage plans.

Currently, Medicare Advantage plans receive payments from the government based on the health status of their enrollees. This is known as risk adjustment, and it is meant to ensure that plans with sicker patients receive higher payments to cover their increased healthcare costs.

The bill proposes to improve the accuracy of risk adjustment by using more up-to-date data and accounting for additional factors that may impact a patient's health status. This could help ensure that Medicare Advantage plans are adequately compensated for the care they provide to their enrollees. Overall, the goal of this bill is to make the Medicare Advantage program more efficient and effective by ensuring that payments to plans accurately reflect the health status of their enrollees. This could ultimately lead to better care for Medicare beneficiaries and a more sustainable program for the future.

Congressional Summary of S 1105

No Unreasonable Payments, Coding, Or Diagnoses for the Elderly Act or the No UPCODE Act

This bill modifies certain factors that are used to determine Medicare Advantage (MA) payments, particularly relating to health status and related data.

Specifically, the bill requires the Centers for Medicare & Medicaid Services (CMS) to use two years of diagnostic data in its risk adjustment methodology for MA payments. It also prohibits the CMS from using diagnoses that are collected from chart reviews or health risk assessments when adjusting payments based on health status. The CMS must also take into account any differences in coding patterns between MA and traditional Medicare when determining MA payment adjustments.

Current Status of Bill S 1105

Bill S 1105 is currently in the status of Bill Introduced since March 25, 2025. Bill S 1105 was introduced during Congress 119 and was introduced to the Senate on March 25, 2025. Bill S 1105's most recent activity was Read twice and referred to the Committee on Finance. as of March 25, 2025