119-s2879

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2879 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2879

 To amend title XVIII of the Social Security Act to apply improved 
 prompt payment requirements to Medicare Advantage organizations.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 September 18 (legislative day, September 16), 2025

 Ms. Cortez Masto (for herself and Mrs. Blackburn) introduced the 
 following bill; which was read twice and referred to the Committee on 
 Finance

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to apply improved 
 prompt payment requirements to Medicare Advantage organizations.

 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 ``Medicare Advantage Prompt Pay Act''.

SEC. 2. APPLICATION OF IMPROVED PROMPT PAYMENT REQUIREMENTS TO MEDICARE 
 ADVANTAGE ORGANIZATIONS.

    (a) Requirements.--

    (1) In general.--

Section 1857 of the Social Security Act 
 (42 U.S.C. 1395w-27) is amended--
        (A) in subsection

    (f) , by striking paragraph

    (1) and inserting the following:
 ``

    (1) Requirements.--
 ``
        (A) Items and services furnished by in-network 
 and out-of-network providers of services and 
 suppliers.--
 ``
            (i) In general.--A contract under this 
 part between the Secretary and a Medicare 
 Advantage organization offering a Medicare 
 Advantage plan shall require the organization 
 to provide prompt payment for not less than 95 
 percent of clean claims submitted to the 
 organization, with respect to covered items or 
 services furnished to enrollees by a provider 
 of services or supplier, within the applicable 
 number of calendar days after the date of 
 initial receipt of such clean claim, regardless 
 of whether such items or services are furnished 
 under a contract between the organization and 
 the provider of services or supplier.
 ``
            (ii) Applicable number of calendar 
 days.--In clause
            (i) , the term `applicable 
 number of calendar days' means--
 ``
            (I) in the case of a claim 
 submitted electronically, by a provider 
 of services or supplier for items or 
 services furnished under a contract 
 between the organization and the 
 provider of services or supplier, 14 
 days; and
 ``
            (II) in the case of a claim not 
 described in subclause
            (I) , 30 days.
 ``
        (B) Clean claim defined.--In this paragraph, the 
 term `clean claim' means a claim that--
 ``
            (i) has a complete data set, with respect 
 to the UB-04 or CMS 1500 form, as applicable 
 (or successor to such applicable form) for all 
 entries identified as mandatory entries by the 
 National Uniform Billing Committee; and
 ``
            (ii) in the case of a claim submitted 
 electronically, is completed in accordance with 
 the applicable standards and data elements 
 adopted under 

section 1173

    (a) .
 ``
            (C) Rebuttable presumption for receipt of 
 claim.--
 ``
            (i) In general.--For purposes of this 
 paragraph, there shall be a rebuttable 
 presumption that a claim has been received by 
 an MA organization--
 ``
            (I) in the case of a claim 
 submitted electronically, on the date 
 verified in the health care claim 
 status request and response transaction 
 that is for such claim and meets 
 applicable standards and data elements 
 adopted under 

section 1173

    (a) for such 
 electronic requests and responses; and
 ``
            (II) in the case of a claim 
 submitted otherwise, on the fifth 
 business day after the postmark date of 
 the claim or the date specified in the 
 time stamp of the transmission.
 ``
            (ii) Business day defined.--In clause
            (i) 
            (II) , the term `business day' means any day 
 other than Saturday, Sunday, or a legal public 
 holiday described in 

section 6103 of title 5, 
 United States Code.
 ``
            (D) Interest applied for clean claims not 
 promptly paid.--If payment for such covered items or 
 services is not issued, mailed, or otherwise 
 transmitted to the provider of services or supplier for 
 such claims that are clean claims, in accordance with 
 subparagraph
        (A) , by not later than the deadline for 
 such payment under such subparagraph, the MA 
 organization shall pay the provider of services or 
 supplier interest at the rate used for purposes of 
 

section 3902

    (a) of title 31, United States Code 
 (relating to interest penalties for failure to make 
 prompt payments) for the period beginning on the day 
 after such required payment date and ending on the date 
 on which payment is made.''; and
        (B) in subsection

    (g) --
            (i) by redesignating paragraph

    (4) as 
 paragraph

    (5) ;
            (ii) by inserting after paragraph

    (3) the 
 following new paragraph:
 ``

    (4) Application of civil money penalties to prompt pay 
 violations.--If the Secretary determines that an MA 
 organization with a contract under this section is not in 
 compliance with subsection

    (f)

    (1) , the Secretary shall provide, 
 in addition to any other remedies authorized by law, for civil 
 money penalties of not more than $25,000 for each such 
 determination. In making a determination under the previous 
 sentence, the Secretary may take into account information 
 collected pursuant to 

section 1851
            (d) (4)
            (D) 
            (v) .''; and
            (iii) in paragraph

    (5) , as redesignated by 
 clause
            (i) , by striking ``or

    (3) '' and 
 inserting ``,

    (3) , or

    (4) ''.

    (2) Effective date.--The amendments made by this subsection 
 shall apply with respect to items and services furnished on or 
 after January 1, 2027, and contract years beginning on or after 
 such date.

    (b) Provision of Information Regarding Compliance With Prompt 
Payment Requirements.--

Section 1851
            (d) (4)
            (D) of the Social Security Act 
(42 U.S.C. 1395w-21
            (d) (4)
            (D) ) is amended--

    (1) in clause
            (iii) , by striking ``and'' at the end;

    (2) in clause
            (iv) , by striking the period and inserting 
 ``, and''; and

    (3) by adding at the end the following new clause:
 ``
            (v) information regarding compliance of 
 the plan with the prompt payment requirements 
 under 

section 1857

    (f)

    (1) , including, with 
 respect to the most recent 12-month period for 
 which data are available--
 ``
            (I) the number and percent of 
 submitted claims for which payment was 
 made by the plan;
 ``
            (II) the number and percent of 
 submitted claims--
 ``

    (aa) that were for items 
 or services furnished by a 
 provider of services or 
 supplier under a contract 
 between the organization 
 offering the plan and the 
 provider of services or 
 supplier; and
 ``

    (bb) that were for items 
 or services not furnished under 
 such a contract;
 ``
            (III) the number and percent of 
 submitted claims described in each of 
 items

    (aa) and

    (bb) of subclause
            (II) for which payment was made by the plan 
 by the deadline required pursuant to 
 

section 1857

    (f)

    (1)
        (A) ;
 ``
            (IV) the number and percent of 
 submitted claims described in each of 
 items

    (aa) and

    (bb) of subclause
            (II) for which interest was paid by the plan 
 pursuant to 

section 1857

    (f)

    (1)
            (D) ; and
 ``
            (V) the total amount of interest 
 paid by the plan pursuant to such 
 section.''.
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