Bill > HR3467

This bill introduces significant reforms to the Medicare Advantage (MA) program, set to take effect in 2028. The bill mandates that MA plans can only use capitated payments (a fixed per-patient payment method), with some exceptions for existing plans and specialized plans for specific needs populations. It reduces the blended benchmark payment rate, modifies risk adjustment calculations to only use face-to-face or telehealth visit diagnoses, and eliminates quality benchmark increases. The bill introduces an automatic enrollment system where individuals will be automatically enrolled in the lowest-premium MA plan available, with an option to opt out. Individuals enrolled in an MA plan will be required to remain in that plan for three years, with exceptions for hardship events. The bill also mandates that MA plans include hospice care and creates a new stop-loss payment system for plans experiencing higher-than-expected expenditures. Additionally, the bill includes a provision modifying the Stark Law to create an exception for certain services furnished under MA plans, such as durable medical equipment and prescription drugs. These changes aim to standardize, control costs, and potentially simplify the Medicare Advantage program.

Budget and Finance

https://www.congress.gov/bill/119th-congress/house-bill/3467/all-info