Bill · S. 1105· Senate(119-S-1105)
No UPCODE Act
- Introduced
- 3/25/2025
- Last activity
- 3/25/2025 — Read twice and referred to the Committee on Finance.
- Sponsored by
- Bill Cassidy
- Cosponsors
- - 0 - 1
- Introduced
- In Committee
What this bill would do
This bill, titled the "No Unreasonable Payments, Coding, Or Diagnoses for the Elderly Act," aims to amend the Social Security Act to improve risk adjustment for Medicare Advantage. It requires the Secretary to use two years of diagnostic data for risk adjustment starting in 2026. The Act also prohibits the use of diagnoses obtained from chart reviews or health risk assessments when establishing payment factors. Additionally, it mandates that the Secretary evaluate how coding pattern differences between Medicare Advantage plans and traditional Medicare providers affect risk scores. The Secretary must also publicly report the results of these evaluations.
Yes
Would people over 65 be better off under this?+5
The bill aims to improve risk adjustment for Medicare Advantage, which directly impacts elderly enrollees.
Would retired people be better off under this?+5
The bill targets Medicare Advantage risk adjustment, which is a key component of healthcare for retirees.
Does this make what the government does easier for the public to see?+5
The bill requires the Secretary to publicly report the results of coding pattern evaluations to increase transparency.
The opposite
No question was scored the opposite.
Who it would affect, and how
Potential Positive Impacts for People
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Use of more historical data: Starting in 2026, the Secretary will use two years of diagnostic data for risk adjustment methodology under Section 2(a). This change aims to improve how risk is adjusted for Medicare Advantage.
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Restrictions on certain diagnosis collection methods: Under Section 2(b), the Secretary will no longer take into account diagnoses collected from chart reviews or health risk assessments for establishing payment adjustment factors. This is intended to exclude certain types of collected diagnoses from the payment process.
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Increased transparency and accountability regarding coding: Section 2(c) requires the Secretary to evaluate the impact of differences in coding patterns between Medicare Advantage plans and traditional Medicare providers. The Secretary must also publicly report the results of this evaluation to account for those differences.
Potential Negative Impacts for People
- No specific negative impacts are explicitly detailed in the provided text.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Retirees+5Good For Seniors+5
- Governance And Ideology
- Improves Government Transparency+5
- 3/25/2025
- Read twice and referred to the Committee on Finance.
- 1 Cosponsor added.
- Introduced in Senate
One bill Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.
Jeff MerkleyDemocrat · Oregon