119-hr2610

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2610 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 2610

To amend title XVIII of the Social Security Act to address significant 
 under projection of MA local area growth due to wage index 
 reclassification.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 April 2, 2025

Ms. Tenney (for herself, Mr. Langworthy, Mr. Tonko, Mr. Lawler, and Ms. 
 Stefanik) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
 and Commerce, for a period to be subsequently determined by the 
 Speaker, in each case for consideration of such provisions as fall 
 within the jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

To amend title XVIII of the Social Security Act to address significant 
 under projection of MA local area growth due to wage index 
 reclassification.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Protecting Options for Seniors Act 
of 2025''.

SEC. 2. ADDRESSING SIGNIFICANT UNDER PROJECTION OF MA LOCAL AREA GROWTH 
 DUE TO WAGE INDEX RECLASSIFICATION.

    (a) Local Adjustment Method and Applicability.--

Section 1853
            (c) of 
the Social Security Act (42 U.S.C. 1395w-23
            (c) ) is amended--

    (1) in paragraph

    (1) --
        (A) in the text preceding subparagraph
        (A) , by 
 striking ``and

    (7) '' and inserting ``,

    (6)
            (D) , and

    (7) ''; and
        (B) in subparagraph
            (C) 
            (v) 
            (II) , by inserting ``, 
 taking into account any adjustment under paragraph

    (6)
            (D) '' before ``, but not''; and

    (2) in paragraph

    (6) --
        (A) in the heading, by inserting ``; local growth 
 percentage adjustment'' after ``defined''; and
        (B) by adding at the end the following new 
 subparagraph:
 ``
            (D) Additional adjustment for significant under 
 projection of local area growth.--
 ``
            (i) In general.--Beginning with rates 
 calculated for 2026, for purposes of computing 
 rates for an MA payment area and a year as 
 described in paragraph

    (1) , if such area is an 
 applicable area described in clause
            (ii) , the 
 Secretary shall, with respect to such area, 
 increase the national per capita MA growth 
 percentage determined under this paragraph for 
 such year by the number of percentage points 
 specified in clause
            (iii) 
            (I) for such area and 
 year.
 ``
            (ii) Applicable area.--For purposes of 
 clause
            (i) , an applicable area described in 
 this clause is an MA local area with respect to 
 which the weighted average hospital wage index 
 in effect in such area for 2025 (or a 
 subsequent year), as calculated under clause
            (iv) , increased by more than 20 percent as 
 compared to the weighted average hospital wage 
 index in effect in such area during the 
 preceding year (as so calculated).
 ``
            (iii) Local growth percentage.--
 ``
            (I) In general.--For purposes of 
 clause
            (i) , with respect to an 
 applicable area described in clause
            (ii) and a year, the number of 
 percentage points specified in this 
 clause is equal to the product of--
 ``

    (aa) the percentage 
 calculated under subclause
            (II) for the area and year, and
 ``

    (bb) the weighting factor 
 calculated under subclause
            (III) for the area and year.
 ``
            (II) Percentage.--For purposes of 
 subclause
            (I) , the percentage 
 calculated under this subclause for an 
 applicable area and a year is--
 ``

    (aa) for 2026, the 
 percentage by which the 
 weighted average hospital wage 
 index in effect in the 
 applicable area for such year, 
 as calculated under clause
            (iv) , increased as compared to 
 the weighted average hospital 
 wage index in effect in such 
 area for 2024 (as so 
 calculated); and
 ``

    (bb) for 2027 and each 
 subsequent year, the percentage 
 by which the weighted average 
 hospital wage index in effect 
 in the applicable area for such 
 year, as calculated under 
 clause
            (iv) , increased as 
 compared to the weighted 
 average hospital wage index in 
 effect in such area during the 
 preceding year (as so 
 calculated).
 ``
            (III) Weighting factor.--For 
 purposes of subclause
            (I) , the 
 weighting factor calculated under this 
 subclause for an applicable area and a 
 year is equal to--
 ``

    (aa) the total amount of 
 payments made under sections 
 1833

    (t) and 1886 to all area 
 hospitals in such area 
 (including disproportionate 
 share payments made under 
 

section 1886
            (d) (5)
        (F) ) that 
 were subject to adjustment for 
 wage or labor costs, divided by
 ``

    (bb) the total amount of 
 payments made under parts A and 
 B of this title attributable to 
 the payment of claims for items 
 and services furnished in such 
 area, excluding any such 
 payment attributable to a 
 payment and service delivery 
 model being tested under 
 

section 1115A,
 determined using payment information 
 with respect to the most recent 
 calendar year for which information was 
 computed and published under subsection

    (b)

    (4) , as of the date on which the 
 advance notice under subsection

    (b)

    (2) is provided for the year.
 ``
            (iv) Weighted average hospital wage 
 index.--The weighted average hospital wage 
 index in effect in an MA local area for a year 
 is equal to the average area wage index 
 applicable under 

section 1886
            (d) (3)
        (E) for all 
 area hospitals for such area as of the date on 
 which the advance notice under subsection

    (b)

    (2) is provided for the year, weighted by 
 the total amount of payments made under parts A 
 and B of this title to each such area hospital, 
 determined using payment information with 
 respect to the most recent calendar year for 
 which information was computed and published 
 under subsection

    (b)

    (4) , as of such date.
 ``
            (v) Area hospital defined.--In this 
 subparagraph, the term `area hospital' means, 
 with respect to an MA local area and a year, a 
 hospital that is geographically located in such 
 area at any point during such year (without 
 regard to whether such hospital was 
 reclassified to a new geographic area pursuant 
 to 

section 1886
            (d) (8)
        (B) , a decision of the 
 Medicare Geographic Classification Review Board 
 under 

section 1886
            (d) (10) , or a decision of the 
 Secretary).
 ``
            (vi) Requirement of benchmark 
 neutrality.--Any adjustment made under this 
 subparagraph for an MA payment area and a year 
 shall be made in a manner that ensures that the 
 enrollment-weighted average applicable amount 
 under subsection

    (k)

    (1)
        (B) for all MA payment 
 areas and such year is not greater or less than 
 what it would have been without such 
 adjustment.''.

    (b) Adjusting the Benchmark Cap.--

Section 1853

    (k)

    (1)
        (B)
            (i) of the 
Social Security Act (42 U.S.C. 1395w-23

    (k)

    (1)
        (B)
            (i) ) is amended by 
inserting ``, taking into account any adjustment under subparagraph
            (D) of such subsection'' before ``, but not''.
            (c) Adjusting the Base Payment Amount.--

Section 1853

    (n)

    (2)
        (E)
            (ii) of the Social Security Act (42 U.S.C. 1395w-23

    (n)

    (2)
        (E)
            (ii) ) is 
amended--

    (1) in subclause
            (I) , by inserting ``, taking into account 
 any adjustment under subparagraph
            (D) of such subsection'' 
 before ``, but not''; and

    (2) in subclause
            (II) , by inserting ``or, in the case that 
 the area is an applicable area (as determined under subsection
            (c) (6)
            (D) ), the amount specified in subclause
            (I) or the amount 
 specified in subsection
            (c) (1)
            (D) for the area for the year, 
 whichever is greater'' before the period at the end.
            (d) Transparency and Data Sharing.--

    (1) In general.--

Section 1853

    (b)

    (4) of the Social Security 
 Act (42 U.S.C. 1395w-23

    (b)

    (4) ) is amended by adding at the end 
 the following new subparagraph:
 ``
        (E) Total amount paid to each area hospital (as 
 defined in subsection
            (c) (6)
            (D) ) for the year, computed 
 separately for part A and for part B.''.

    (2) Effective date.--The amendments made by paragraph

    (1) shall apply beginning with the computation and publication of 
 information for each MA payment area for 2026.
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