H.R. 6031

119 HR 6031 IH: Medicare Advantage Integrity Act of 2025
 U.S. House of Representatives
 2025-11-12
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 EN
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 I  119th CONGRESS  1st Session  H. R. 6031  IN THE HOUSE OF REPRESENTATIVES   November 12, 2025   Mr. Hernández  (for himself,  Ms. Salazar , and  Mr. Soto ) 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 establish a floor in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration.
1.
Short title
This Act may be cited as the   Medicare Advantage Integrity Act of 2025  .
2.
Addressing disparities in Medicare Advantage benchmark levels based on penetration
(a)
In general
Section 1853(n) of the Social Security Act ( 42 U.S.C. 1395w–23(n) ) is amended—
(1)
in paragraph (1)(B), by striking  subsequent year  and inserting  subsequent year, subject to paragraph (6), ; and
(2)
by adding at the end the following new paragraph:
(6)
Average geographic adjustment floor
For 2026 and subsequent years, when calculating the adjusted average per capita cost under section 1876(a)(4) for the purposes of establishing the base payment amount specified in paragraph (2)(E), the average geographic adjustment shall not be less than 0.70 for any area. For the purposes of the previous sentence, the Secretary may define the term  average geographic adjustment  under subparagraph (A) by program instruction or otherwise.
 .
(b)
Ensuring plan payments flow to providers and patients
Section 1854(a)(6) of the Social Security Act ( 42 U.S.C. 1395w–24(a)(6) ) is amended by adding at the end the following new subparagraph:
(C)
Ensuring increased payments support care
With respect to the increase in blended benchmark amount attributable to the application of section 1853(n)(6), no less than 50 percent shall be directed toward payment for basic benefits as defined in section 1852(a)(1)(B).
 .