What's Happening?
A bipartisan group of U.S. lawmakers has introduced the Medicare Advantage Prompt Pay Act, aimed at ensuring timely payments from Medicare Advantage (MA) plans to healthcare providers. The legislation, introduced by Senators Catherine Cortez Masto and Marsha Blackburn, along with Representatives Jodey Arrington and Linda Sánchez, mandates that MA plans pay electronically submitted, in-network claims within 14 days and paper or out-of-network claims within 30 days. The bill also imposes a $25,000 fine and interest accrual for non-compliance. This initiative seeks to address delays in payments that have led to service cuts, staff shortages, and unexpected medical bills for patients. The bill has garnered support from at least 13 hospital and physician organizations, emphasizing the need for transparency and stability in the program.
Why It's Important?
The introduction of this bill is significant as it addresses a critical issue affecting healthcare providers, particularly in rural areas where resources are limited. Delayed payments from Medicare Advantage plans have resulted in financial strain on hospitals and doctors, potentially leading to service reductions and closures. By enforcing prompt payment, the legislation aims to protect healthcare providers and ensure that seniors on MA plans are not burdened with unexpected bills. The bill also aligns MA payment standards with those of traditional Medicare, which could enhance the viability of MA participation for providers. However, the bill's passage may face challenges due to ongoing political disputes in Congress over healthcare funding priorities.
What's Next?
Despite its bipartisan support, the bill's progression into law may be delayed as Congress is currently embroiled in debates over a must-pass funding extension. Democrats are pushing for the inclusion of other healthcare priorities, such as extending subsidies for the Affordable Care Act marketplace, in the continuing resolution to prevent a government shutdown. The political climate, marked by President Trump's recent cancellation of a meeting with Democratic leaders, adds uncertainty to the bill's future. Stakeholders in the healthcare sector will likely continue to advocate for the bill, emphasizing its potential benefits for providers and patients.
