To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.
Summary
H.R. 5243 aims to amend Title XVIII of the Social Security Act, focusing on increasing data transparency for supplemental benefits under Medicare Advantage. The bill mandates that MA organizations report enrollee-level data on supplemental benefits to the Secretary of Health and Human Services. This includes data on eligibility, types of benefits offered, utilization, payments, and out-of-pocket costs, beginning with plan years in 2029.
Expected Effects
The primary effect will be increased transparency in how Medicare Advantage plans provide and utilize supplemental benefits. This data will be made available to individuals and entities for program evaluation and healthcare research starting in 2030. A public use data file will also be available on the CMS website.
Potential Benefits
- Enhanced transparency in Medicare Advantage supplemental benefits.
- Improved data availability for program evaluation and research.
- Potential for better understanding of benefit utilization and cost.
- Increased accountability for MA organizations.
- Public access to data through a user-friendly file.
Potential Disadvantages
- Potential administrative burden on MA organizations for data collection and reporting.
- Risk of privacy breaches if data is not properly anonymized.
- Delayed implementation, with data collection starting in 2029 and public availability in 2030.
- Costs associated with data collection, storage, and dissemination.
- Complexity in interpreting and utilizing the data effectively.
Constitutional Alignment
The bill aligns with the general welfare clause of the Constitution, as it aims to improve the Medicare Advantage program through increased transparency and data-driven decision-making. The collection and dissemination of data must adhere to privacy protections to align with the spirit of the Fourth Amendment regarding unreasonable searches and seizures. Article 1, Section 8, Clause 1 grants Congress the power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).