H.R. 9392

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9392 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 9392

To amend title XVIII of the Social Security Act to require the 
inclusion of certain information in Medicare Advantage encounter data.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

June 23, 2026

Ms. DeGette (for herself and Mr. Joyce of Pennsylvania) 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 require the 
inclusion of certain information in Medicare Advantage encounter data.

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 Cost Transparency 
Act''.

SEC. 2. REQUIRING THE INCLUSION OF CERTAIN INFORMATION IN ENCOUNTER 
DATA.

Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is 
amended by adding at the end the following new subsection:
``(j) Inclusion of Certain Information in Encounter Data.--
``(1) In general.--In the case of any encounter data 
submitted by a Medicare Advantage plan with respect to an item 
or service furnished to an individual under such plan during a 
plan year beginning on or after January 1, 2027, the Secretary 
shall require that such data include--
``(A) the allowed amount for such item or service;
``(B) the amount of cost sharing (including 
deductibles, copayments, and coinsurance) imposed for 
such item or service;
``(C) in the case such individual was furnished, 
during such plan year before such item or service was 
so furnished, an at-home health risk assessment from a 
specified assessment entity, an indicator that such 
individual was so furnished such an assessment by such 
an entity; and
``(D) in the case such individual was furnished, 
during such plan year before such item or service was 
so furnished, an at-home health risk assessment from an 
assessment entity not described in subparagraph (C), an 
indicator (distinct from the indicator described in 
such subparagraph) that such individual was so 
furnished such an assessment by such an entity.
``(2) Definitions.--In this subsection:
``(A) Assessment entity.--The term `assessment 
entity' means an entity with a focus on furnishing in-
home health risk assessments, as specified by the 
Secretary.
``(B) Specified assessment entity.--The term 
`specified assessment entity' means, with respect to an 
MA organization and a plan year, an assessment entity 
with respect to which such organization (or any person 
with an ownership or control interest (as defined in 
section 1124(a)(3)) in such organization) is a person 
with an ownership or control interest (as so 
defined).''.
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