This bill requires Medicare Advantage plans to submit more detailed information when reporting encounter data, which are records of medical services provided to beneficiaries. Starting in 2026, plans must include specifics about how providers are paid (such as capitation or fee-for-service), the allowed amounts charged, patient cost-sharing details like copayments and deductibles, whether services were provided in-network, and information about health risk assessments conducted in patients' homes. The bill also requires plans to identify the ordering provider for certain services like durable medical equipment, laboratory tests, imaging, and home health services. These enhanced data requirements affect Medicare Advantage organizations and the providers they work with, as they will need to collect and report this additional information. The legislation aims to give regulators and policymakers better visibility into how Medicare Advantage plans operate and pay for care, though it does not include specific funding provisions or costs.
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