119-hr5243

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5243 Introduced in House

    (IH) ]

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119th CONGRESS
 1st Session
 H. R. 5243

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

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 September 10, 2025

Ms. McClellan 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 increase data 
 transparency for supplemental benefits under Medicare Advantage.

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

SECTION 1. INCREASING DATA TRANSPARENCY FOR SUPPLEMENTAL BENEFITS UNDER 
 MEDICARE ADVANTAGE.

    (a) In General.--

Section 1857

    (e) of the Social Security Act (42 
U.S.C. 1395w-27

    (e) ) is amended by adding at the end the following new 
paragraph:
 ``

    (6) Reporting of enrollee-level data on supplemental 
 benefits.--
 ``
        (A) In general.--Beginning with plan years 
 beginning on or after January 1, 2029, a contract under 
 this section with an MA organization shall require the 
 organization to submit to the Secretary, for each MA 
 plan offered by the organization, enrollee-level data 
 on supplemental benefits (by item or service, or 
 category of item or service, as determined appropriate 
 by the Secretary, and national provider identifier), 
 including eligibility for such benefits, the types of 
 benefit categories offered, data on utilization of and 
 payments for such benefits (including the total amount 
 spent by the plan for each enrollee who utilized such 
 benefits and the total out-of-pocket cost per 
 utilization for each enrollee).
 ``
        (B) Data access.--
 ``
            (i) In general.--On the first Monday in 
 October of each year (beginning with 2030), the 
 Secretary shall make data submitted under 
 subparagraph
        (A) available to individuals and 
 entities for the purpose of conducting--
 ``
            (I) evaluations and other 
 analysis to support the program under 
 this title; and
 ``
            (II) other health care related 
 research.
 ``
            (ii) Public use data file.--Not later 
 than October 1 of each year (beginning with 
 2030), the Secretary shall make a public use 
 data file containing the data submitted under 
 subparagraph
        (A) available on the internet 
 website of the Centers for Medicare & Medicaid 
 Services.
 ``
            (iii) Confidentiality.--In making data 
 available under this subparagraph, the 
 Secretary shall have in place procedures to 
 safeguard the privacy of any individually 
 identifiable enrollee information.''.

    (b) Rule of Construction.--Nothing in the amendments made by this 
section shall affect the collection of information as proposed pursuant 
to the notice entitled ``Agency Information Collection Activities: 
Proposed Collection; Comment Request'', published in the Federal 
Register on March 14, 2023 (88 Fed. Reg. 15726).
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