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HR 5243119th CongressIn Committee

To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.

Introduced: Sep 10, 2025
Healthcare
Standard Summary
Comprehensive overview in 1-2 paragraphs

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.

Impact Areas

Primary group/area affected- Medicare Advantage enrollees and MA plans: Enhanced transparency about supplemental benefits and potential privacy considerations, with more publicly available information on how these benefits are used and paid for.Secondary group/area affected- Researchers, policymakers, and health services analysts: Expanded access to enrollee‑level data for evaluations, impact analyses, and other health care research related to MA supplemental benefits.Additional impacts- Administrative burden and compliance: MA organizations would incur additional data collection, data governance, and reporting requirements to submit enrollee‑level data.- Privacy and data governance considerations:New privacy protections and data handling protocols would be necessary to safeguard identifiable information in the datasets.- Market and policy implications: More transparency could influence plan design, benefit generosity, and utilization patterns as stakeholders analyze the data. The provision does not alter existing data collection authorities but aligns with broader transparency initiatives.
Generated by gpt-5-nano on Oct 8, 2025