S 1105 · in committee · significant

No UPCODE Act

What this bill does

This bill changes how Medicare Advantage insurance plans are paid by Medicare based on patient health conditions.
Medicare Advantage insurers and elderly patients enrolled in these plans are affected by payment adjustments.
The Centers for Medicare & Medicaid Services must use two years of diagnostic data and account for coding differences when calculating payments.

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Community Threads

Started by Cosponsor

01
How might requiring two years of diagnostic data instead of one year affect payment accuracy for plans serving patients with complex or newly diagnosed conditions?
02
What coding differences between providers does CMS need to account for, and how could standardizing these adjustments change plan profitability across different regions?
03
Which Medicare Advantage beneficiaries could see changes in plan availability or benefits if insurers receive lower payments under this new calculation method?

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