Transparency in Medicare Advantage Steering Act in plain language
1: Short title
This section would let the Act be called the Transparency in Medicare Advantage Steering Act.
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1. Short title This Act may be cited as the Transparency in Medicare Advantage Steering Act .
2: Requiring reporting on certain agent and broker information
This section would add new reporting requirements to the Medicare Advantage (MA) contracts that organizations sign with the federal government under section 1857 of the Social Security Act. Starting with plan years beginning on or after January 1, 2028, every contract between the Secretary of Health and Human Services and an MA organization would have to require that organization to report to the Secretary each year: for every individual enrolled in one of its MA plans that year, whether an agent, broker, or other third party representing the organization enrolled that person, and if so, the amount of any compensation paid to that agent, broker, or third party for enrolling the person and the form that compensation took; the total compensation the organization paid to all such agents, brokers, and third parties for enrolling people in all of its MA plans that year; and any other information about those agents, brokers, and third parties that the Secretary requires. Starting with plan years beginning on or after January 1, 2030, the Secretary would have to add an indicator to the Chronic Condition Data Warehouse (a CMS database) showing whether each individual was enrolled in an MA plan by an agent, broker, or other third party, based on the per-person information reported above, and would have to post publicly on the CMS website the total-compensation figures and the additional agent/broker information the organizations report, but not the per-person enrollment details.
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2. Requiring reporting on certain agent and broker information Section 1857(e) of the Social Security Act ( 42 U.S.C. 1395w–27(e) ) is amended by adding at the end the following new paragraph: (7) Requirement to report certain agent and broker information (A) In general Beginning with plan years beginning on or after January 1, 2028, a contract under this section with an MA organization shall require the organization to annually report to the Secretary— (i) with respect to each individual enrolled in an MA plan offered by such organization for such year— (I) whether such individual was so enrolled by an agent, broker, or other third party representing the organization; and (II) in the case that such individual was so enrolled by such an agent, broker, or third party— (aa) the amount of compensation, if any, paid to such agent, broker, or third party in connection with enrolling such individual; and (bb) the form of such compensation; (ii) the total amount of compensation paid to all such agents, brokers, and third parties representing the organization in connection with enrolling individuals in all MA plans offered by such organization for such year; and (iii) such other information relating to such agents, brokers, and third parties representing the organization as the Secretary may require. (B) Transparency Beginning with plan years beginning on or after January 1, 2030, the Secretary shall— (i) include in the Chronic Condition Data Warehouse maintained by the Centers for Medicare & Medicaid Services pursuant to section 723 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 an indicator to identify whether an individual was enrolled in an MA plan by an agent, broker, or other third party representing the organization offering such plan (as determined based on the information reported under subparagraph (A)(i) ); and (ii) make publicly available on the internet website of the Centers for Medicare & Medicaid services the information reported by an MA organization under clauses (ii) and (iii) of subparagraph (A) . .