This bill amends the Social Security Act to add prompt-payment rules for Medicare Advantage (MA) organizations. MA plans must pay at least 95% of "clean claims" for covered items or services within set deadlines. A "clean claim" must include required data on standard claim forms and follow electronic standards. Deadlines are 14 calendar days for electronically submitted claims that are from a provider with a contract with the MA organization, and 30 calendar days for other claims. There is a rebuttable presumption about when a claim was received (verified electronic status date or the fifth business day after postmark/timestamp). If a clean claim is not paid on time, the MA organization must pay interest at the rate used for federal prompt-payment penalties (31 U.S.C. 3902(a)). The Secretary may assess civil money penalties up to $25,000 for each determination that an MA organization is not in compliance. Plans must report data about prompt-payment performance, including numbers and percentages of claims paid, in-contract vs out-of-contract claim counts, timeliness, interest payments, and total interest paid. The rules apply to items and services furnished on or after January 1, 2027, and to contract years beginning on or after that date.
No publicly available information on overall federal or program-wide costs or savings is provided in the bill text. The bill requires MA organizations to pay interest on late clean claims and allows civil money penalties, but it does not estimate total amounts or budget effects.
No publicly available information in the bill text about proponents' statements, rationales, or supporting arguments.
No publicly available information in the bill text about opponents' statements, concerns, or objections.