Bill > S1105

This bill, known as the "No UPCODE Act," aims to improve risk adjustment methodologies for Medicare Advantage (MA), a program that allows private health insurance companies to provide Medicare benefits. The bill introduces several key changes to how MA plans calculate payments and report patient health information. Starting in 2026, the bill requires the Secretary of Health and Human Services to use two years of diagnostic data when determining risk adjustment payments, which could provide a more comprehensive view of a patient's health status. Additionally, the bill prohibits MA plans from using diagnoses collected through chart reviews and health risk assessments when calculating payment adjustment factors, addressing potential concerns about artificially inflated health risk scores. The legislation also mandates that the Secretary annually evaluate and publicly report on coding pattern differences between MA plans and traditional Medicare providers, ensuring that any payment adjustments fully account for potential discrepancies in how health conditions are documented and coded. These provisions aim to create a more accurate and fair payment system that prevents potential overpayments and ensures Medicare funds are used appropriately.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/1105/all-info