Bill > HR4559

This bill, called the "Prompt and Fair Pay Act," aims to establish payment parity and prompt payment requirements for Medicare Advantage (MA), a private health insurance alternative to traditional Medicare. Beginning in 2027, the bill requires MA organizations to pay healthcare providers at least the same rates as the original Medicare fee-for-service program, ensuring that providers are not financially disadvantaged by participating in Medicare Advantage plans. The bill also establishes strict requirements for processing and paying "clean claims" (claims without defects or missing information), mandating that electronic claims must be paid within 14 days and other claims within 30 days. If MA organizations fail to pay claims within these timeframes, they must pay interest to providers at a rate tied to Treasury securities. The legislation includes detailed provisions for what constitutes a clean claim, how providers should be notified of claim deficiencies, and protections against retaliation for providers who assert their rights. Additionally, the bill gives the Secretary of Health and Human Services authority to enforce these new prompt payment requirements, with potential penalties for MA organizations that do not comply.

Budget and Finance

https://www.congress.gov/bill/119th-congress/house-bill/4559/all-info