Medicare Advantage Integrity Act of 2025

119 HR 6031 IH: Medicare Advantage Integrity Act of 2025 U.S. House of Representatives 2025-11-12 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I 119th CONGRESS 1st Session H. R. 6031 IN THE HOUSE OF REPRESENTATIVES November 12, 2025 Mr. Hernández (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 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. 1. Short title This Act may be cited as the Medicare Advantage Integrity Act of 2025 . 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). .