119th Congress (2025-2026)

HR 2610

Protecting Options for Seniors Act of 2025

Introduced

Jurisdiction

US Congress

Session

119th Congress (2025-2026)

Official source

Chamber

House

Session

119th Congress (2025-2026)

Jurisdiction

US Congress

Bill overview

The Protecting Options for Seniors Act of 2025 aims to improve Medicare Advantage (MA) payments to areas where hospital wages have increased significantly. Specifically, it adjusts payment calculations to account for underprojections of MA growth due to hospital wage reclassifications. The bill increases payments for Medicare Advantage plans in areas where hospital wages have risen more than 20% compared to the previous year, based on the percentage of that increase and weighted by payments to area hospitals. It also modifies benchmarks and data sharing requirements to ensure accurate payment adjustments.

Key provisions

Increases Medicare Advantage payments in areas with significant hospital wage increases (more than 20% compared to the previous year).
Adjusts payment calculations based on the percentage of hospital wage increase and weighted by payments to area hospitals.
Modifies the calculation of the weighted average hospital wage index.
Updates benchmark calculations to account for the increased payments.
Requires the sharing of total payments made to each area hospital for the year, separated by Part A and Part B.
Addresses underprojections of MA local area growth due to wage index reclassification.
Adjusts the base payment amount for Medicare Advantage plans.
Modifies the benchmark cap to account for the adjustments made under the bill.

Who is affected

Medicare beneficiaries
Medicare Advantage plans
Area hospitals
The Centers for Medicare & Medicaid Services (CMS)

Positions across the country

No public positions recorded for this legislation.

Arguments in favor

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Arguments opposed

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Legislative history

2025-04-02House

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.

2025-04-02House

2025-04-02

Introduced in House

2025-04-02

Introduced in House

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Apr 2, 2025XMLView source

119th CONGRESS — 1st Session

H. R. 2610

IN THE HOUSE OF REPRESENTATIVES

A BILL

To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification.

1.Short title

This Act may be cited as the

Protecting Options for Seniors Act of 2025

2.Addressing significant under projection of MA local area growth due to wage index reclassification

(a)Local adjustment method and applicabilitySection 1853(c) of the Social Security Act (42 U.S.C. 1395w–23(c)) is amended—

(1)

in paragraph (1)—

(A)

in the text preceding subparagraph (A), by striking and (7) and inserting , (6)(D), and (7); and

(B)

in subparagraph (C)(v)(II), by inserting , taking into account any adjustment under paragraph (6)(D) before , but not; and

(2)

in paragraph (6)—

(A)

in the heading, by inserting ; local growth percentage adjustment after defined; and

(B)

by adding at the end the following new subparagraph:

(D)Additional adjustment for significant under projection of local area growth

(i)In generalBeginning with rates calculated for 2026, for purposes of computing rates for an MA payment area and a year as described in paragraph (1), if such area is an applicable area described in clause (ii), the Secretary shall, with respect to such area, increase the national per capita MA growth percentage determined under this paragraph for such year by the number of percentage points specified in clause (iii)(I) for such area and year.

(ii)Applicable areaFor purposes of clause (i), an applicable area described in this clause is an MA local area with respect to which the weighted average hospital wage index in effect in such area for 2025 (or a subsequent year), as calculated under clause (iv), increased by more than 20 percent as compared to the weighted average hospital wage index in effect in such area during the preceding year (as so calculated).

(iii)Local growth percentage

(I)In general

For purposes of clause (i), with respect to an applicable area described in clause (ii) and a year, the number of percentage points specified in this clause is equal to the product of—

(aa)

the percentage calculated under subclause (II) for the area and year, and

(bb)

the weighting factor calculated under subclause (III) for the area and year.

(II)PercentageFor purposes of subclause (I), the percentage calculated under this subclause for an applicable area and a year is—

(aa)for 2026, the percentage by which the weighted average hospital wage index in effect in the applicable area for such year, as calculated under clause (iv), increased as compared to the weighted average hospital wage index in effect in such area for 2024 (as so calculated); and

(bb)for 2027 and each subsequent year, the percentage by which the weighted average hospital wage index in effect in the applicable area for such year, as calculated under clause (iv), increased as compared to the weighted average hospital wage index in effect in such area during the preceding year (as so calculated).

(III)Weighting factor

For purposes of subclause (I), the weighting factor calculated under this subclause for an applicable area and a year is equal to—

(aa)the total amount of payments made under sections 1833(t) and 1886 to all area hospitals in such area (including disproportionate share payments made under section 1886(d)(5)(F)) that were subject to adjustment for wage or labor costs, divided by

(bb)

the total amount of payments made under parts A and B of this title attributable to the payment of claims for items and services furnished in such area, excluding any such payment attributable to a payment and service delivery model being tested under section 1115A,

determined using payment information with respect to the most recent calendar year for which information was computed and published under subsection (b)(4), as of the date on which the advance notice under subsection (b)(2) is provided for the year.

(iv)Weighted average hospital wage index

The weighted average hospital wage index in effect in an MA local area for a year is equal to the average area wage index applicable under section 1886(d)(3)(E) for all area hospitals for such area as of the date on which the advance notice under subsection (b)(2) is provided for the year, weighted by the total amount of payments made under parts A and B of this title to each such area hospital, determined using payment information with respect to the most recent calendar year for which information was computed and published under subsection (b)(4), as of such date.

(v)Area hospital definedIn this subparagraph, the term area hospital means, with respect to an MA local area and a year, a hospital that is geographically located in such area at any point during such year (without regard to whether such hospital was reclassified to a new geographic area pursuant to section 1886(d)(8)(B), a decision of the Medicare Geographic Classification Review Board under section 1886(d)(10), or a decision of the Secretary).

(vi)Requirement of benchmark neutralityAny adjustment made under this subparagraph for an MA payment area and a year shall be made in a manner that ensures that the enrollment-weighted average applicable amount under subsection (k)(1)(B) for all MA payment areas and such year is not greater or less than what it would have been without such adjustment.

(b)Adjusting the benchmark capSection 1853(k)(1)(B)(i) of the Social Security Act (42 U.S.C. 1395w–23(k)(1)(B)(i)) is amended by inserting , taking into account any adjustment under subparagraph (D) of such subsection before , but not.

(c)Adjusting the base payment amount

Section 1853(n)(2)(E)(ii) of the Social Security Act (42 U.S.C. 1395w–23(n)(2)(E)(ii)) is amended—

(1)in subclause (I), by inserting , taking into account any adjustment under subparagraph (D) of such subsection before , but not; and

(2)in subclause (II), by inserting or, in the case that the area is an applicable area (as determined under subsection (c)(6)(D)), the amount specified in subclause (I) or the amount specified in subsection (c)(1)(D) for the area for the year, whichever is greater before the period at the end.

(d)Transparency and data sharing

(1)In generalSection 1853(b)(4) of the Social Security Act (42 U.S.C. 1395w–23(b)(4)) is amended by adding at the end the following new subparagraph:

(E)

Total amount paid to each area hospital (as defined in subsection (c)(6)(D)) for the year, computed separately for part A and for part B.

(2)Effective date

The amendments made by paragraph (1) shall apply beginning with the computation and publication of information for each MA payment area for 2026.

HR 2610

Bill overview

Key provisions

Who is affected

Sponsors

Primary sponsor

Cosponsors

Positions across the country

Arguments in favor

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Bill text

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Positions across the country