H.R. 6031

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6031 Introduced in House (IH)]

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119th CONGRESS
1st Session
H. R. 6031

To amend title XVIII of the Social Security Act to establish a floor in 
Medicare Advantage benchmark rates for regions with low Medicare fee-
for-service penetration.

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IN THE HOUSE OF REPRESENTATIVES

November 12, 2025

Mr. Hernandez (for himself, Ms. Salazar, and Mr. Soto) 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

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A BILL

To amend title XVIII of the Social Security Act to establish a floor in 
Medicare Advantage benchmark rates for regions with low Medicare fee-
for-service penetration.

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Medicare Advantage Integrity Act of 
2025''.

SEC. 2. ADDRESSING DISPARITIES IN MEDICARE ADVANTAGE BENCHMARK LEVELS 
BASED ON PENETRATION.

(a) In General.--Section 1853(n) of the Social Security Act (42 
U.S.C. 1395w-23(n)) is amended--
(1) in paragraph (1)(B), by striking ``subsequent year'' 
and inserting ``subsequent year, subject to paragraph (6),''; 
and
(2) by adding at the end the following new paragraph:
``(6) Average geographic adjustment floor.--For 2026 and 
subsequent years, when calculating the adjusted average per 
capita cost under section 1876(a)(4) for the purposes of 
establishing the base payment amount specified in paragraph 
(2)(E), the average geographic adjustment shall not be less 
than 0.70 for any area. For the purposes of the previous 
sentence, the Secretary may define the term `average geographic 
adjustment' under subparagraph (A) by program instruction or 
otherwise.''.
(b) Ensuring Plan Payments Flow to Providers and Patients.--Section 
1854(a)(6) of the Social Security Act (42 U.S.C. 1395w-24(a)(6)) is 
amended by adding at the end the following new subparagraph:
``(C) Ensuring increased payments support care.--
With respect to the increase in blended benchmark 
amount attributable to the application of section 
1853(n)(6), no less than 50 percent shall be directed 
toward payment for basic benefits as defined in section 
1852(a)(1)(B).''.
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