H.R. 5243

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5243 Introduced in House (IH)]

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119th CONGRESS
1st Session
H. R. 5243

To amend title XVIII of the Social Security Act to increase data 
transparency for supplemental benefits under Medicare Advantage.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

September 10, 2025

Ms. McClellan 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 increase data 
transparency for supplemental benefits under Medicare Advantage.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. INCREASING DATA TRANSPARENCY FOR SUPPLEMENTAL BENEFITS UNDER 
MEDICARE ADVANTAGE.

(a) In General.--Section 1857(e) of the Social Security Act (42 
U.S.C. 1395w-27(e)) is amended by adding at the end the following new 
paragraph:
``(6) Reporting of enrollee-level data on supplemental 
benefits.--
``(A) In general.--Beginning with plan years 
beginning on or after January 1, 2029, a contract under 
this section with an MA organization shall require the 
organization to submit to the Secretary, for each MA 
plan offered by the organization, enrollee-level data 
on supplemental benefits (by item or service, or 
category of item or service, as determined appropriate 
by the Secretary, and national provider identifier), 
including eligibility for such benefits, the types of 
benefit categories offered, data on utilization of and 
payments for such benefits (including the total amount 
spent by the plan for each enrollee who utilized such 
benefits and the total out-of-pocket cost per 
utilization for each enrollee).
``(B) Data access.--
``(i) In general.--On the first Monday in 
October of each year (beginning with 2030), the 
Secretary shall make data submitted under 
subparagraph (A) available to individuals and 
entities for the purpose of conducting--
``(I) evaluations and other 
analysis to support the program under 
this title; and
``(II) other health care related 
research.
``(ii) Public use data file.--Not later 
than October 1 of each year (beginning with 
2030), the Secretary shall make a public use 
data file containing the data submitted under 
subparagraph (A) available on the internet 
website of the Centers for Medicare & Medicaid 
Services.
``(iii) Confidentiality.--In making data 
available under this subparagraph, the 
Secretary shall have in place procedures to 
safeguard the privacy of any individually 
identifiable enrollee information.''.
(b) Rule of Construction.--Nothing in the amendments made by this 
section shall affect the collection of information as proposed pursuant 
to the notice entitled ``Agency Information Collection Activities: 
Proposed Collection; Comment Request'', published in the Federal 
Register on March 14, 2023 (88 Fed. Reg. 15726).
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