To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.
This bill would strengthen data transparency for Medicare Advantage (MA) by requiring MA contracts to provide enrollee-level data on supplemental benefits starting with plan years after January 1, 2029. The data would cover eligibility, the types of supplemental benefit categories offered, utilization, payments, total plan spending for enrollees who used these benefits, and each enrollee’s out-of-pocket costs per use (identified by item/service or category and by National Provider Identifier). Beginning in 2030, the Secretary of Health and Human Services would make this data available to researchers and other health care entities for program evaluation and research, and would publish a public-use data file on the CMS website. The bill also requires privacy protections to safeguard individually identifiable information. A rule of construction clarifies that the bill does not change existing information collection activities proposed in a 2023 Federal Register notice.
Key Points
- 1Enrollee-level data on MA supplemental benefits: Starting with plan years after January 1, 2029, MA contracts must submit to the Secretary enrollee-level data for each MA plan offered, including eligibility, benefit categories, utilization, payments, total plan spending per enrollee who used the benefits, and per-use out-of-pocket costs (data by item/service or category and by National Provider Identifier).
- 2Data access for analysis: Beginning on the first Monday in October 2030, the Secretary must make the submitted data available to individuals and entities for program evaluation and health care research.
- 3Public-use data file: No later than October 1, 2030, a public-use data file containing the submitted data must be published on the CMS website, enabling broader public access (in a de-identified or appropriately protected form).
- 4Privacy protections: The bill requires procedures to safeguard the privacy of any individually identifiable enrollee information when data are accessed or released.
- 5Legislative note: The amendment contains a rule of construction stating that it does not affect information collection activities proposed in the March 14, 2023 Federal Register notice.