To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.
This bill would add a new requirement to the Medicare Advantage program to improve transparency around supplemental benefits (extras like vision, dental, hearing, over‑the‑counter items, fitness programs, etc.). Starting with plan years after January 1, 2029, MA organizations would have to submit enrollee‑level data on these supplemental benefits to the Secretary of Health and Human Services. The data would cover eligibility, the types of benefits offered, how they are used, and the payments associated with them, including per‑enrollee spending and out‑of‑pocket costs per use. Beginning in October 2030, the data would be accessible to researchers and other entities for evaluation and health services research, with a public use data file made available on CMS’s website. The bill also requires safeguards to protect individual privacy and clarifies that it does not alter existing authority to collect information under prior law.
Key Points
- 1ReQUIRES reporting: Beginning with plan years after January 1, 2029, MA contracts must submit enrollee‑level data on supplemental benefits for each MA plan, including eligibility, benefit types/categories, utilization, and payments (plus total per‑enrollee spend and per‑utilization out‑of‑pocket costs).
- 2Data content: Data to be reported by item/service or category (as determined by the Secretary) and include the National Provider Identifier (NPI) where appropriate.
- 3Data access: Starting the first Monday in October 2030, the Secretary must make enrolled data available to researchers and evaluators for program‑related analysis and other health care research.
- 4Public data file: A public use data file reflecting the reported information must be posted on the CMS website no later than October 1, 2030.
- 5Privacy protections: The bill requires safeguards to protect the privacy of individually identifiable enrollee information when data are released or made available.