Bill > S2793

This bill amends Medicare Advantage (MA) rules to require MA organizations to include a broader range of essential community providers in their network, focusing on improving healthcare access for low-income, rural, and medically underserved populations. Specifically, MA plans must include a sufficient number and geographic distribution of essential community providers, which are defined broadly to include Federally qualified health centers, Ryan White HIV/AIDS Program facilities, Indian Health Service facilities, hospitals (including rural and safety-net hospitals), mental health and substance use treatment facilities, and other clinics serving vulnerable populations. MA organizations must offer contracts to these providers and ensure reasonable access for underserved communities. If a plan cannot meet these provider network requirements, they must submit a detailed explanation and justification to the Secretary of Health and Human Services, who can reject plans with insufficient rationales. The bill also clarifies that while plans must include these providers, they are not required to cover specific medical procedures, and mandates that Federally qualified health centers be paid consistent with existing regulations. The goal is to enhance healthcare accessibility and equity for populations traditionally facing barriers to medical care.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/2793/all-info