[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3307 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 3307

    To amend title XVIII of the Social Security Act to require the 
   inclusion of certain information in encounter data under Medicare 
                               Advantage.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 15, 2023

   Ms. Cortez Masto (for herself, Mr. Cassidy, Ms. Warren, and Mrs. 
  Blackburn) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to require the 
   inclusion of certain information in encounter data under Medicare 
                               Advantage.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Encounter Data Enhancement Act''.

SEC. 2. INCLUSION OF CERTAIN INFORMATION IN ENCOUNTER DATA UNDER 
              MEDICARE ADVANTAGE.

    Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is 
amended by adding at the end the following new subsection:
    ``(j) Inclusion of Certain Information in Encounter Data.--
            ``(1) In general.--In the case of any encounter data 
        submitted by a Medicare Advantage plan with respect to an item 
        or service furnished to an individual under such plan during a 
        plan year beginning on or after January 1, 2026, the Secretary 
        shall require that such data include--
                    ``(A) the type of payment from the plan to the 
                provider, such as, but not limited to capitation, 
                value-based, or fee-for-service;
                    ``(B) the allowed amount for such item or service;
                    ``(C) the amount of cost sharing (including 
                deductibles, copayments, and coinsurance) imposed for 
                such item or service;
                    ``(D) an indicator identifying encounter records 
                including the provision of an at-home health risk 
                assessment by a specified assessment entity;
                    ``(E) an indicator identifying encounter records 
                including the provision of an at-home health risk 
                assessment by an assessment entity not described in 
                subparagraph (D);
                    ``(F) an indicator identifying encounter records 
                including the provision of an at-home health risk 
                assessment by an entity not described in subparagraph 
                (D) or (E);
                    ``(G) an indicator identifying encounter records 
                including the provision of a health risk assessment 
                outside of the home by any entity;
                    ``(H) an indicator of whether the item or service 
                was provided in-network for the plan; and
                    ``(I) the standard unique health identifier 
                (described in section 1173(b)) of the ordering 
                provider, in the case of data submitted with respect 
                to--
                            ``(i) durable medical equipment, 
                        prosthetics, orthotics, and supplies;
                            ``(ii) laboratory tests;
                            ``(iii) imaging services;
                            ``(iv) home health services; and
                            ``(v) other items or services as determined 
                        by the Secretary.
            ``(2) Definitions.--For purposes of this subsection:
                    ``(A) Assessment entity.--The term `assessment 
                entity' means an entity with a focus on furnishing in-
                home health risk assessments, as specified by the 
                Secretary.
                    ``(B) Specified assessment entity.--The term 
                `specified assessment entity' means, with respect to an 
                MA organization and a plan year, an assessment entity 
                with respect to which such organization (or any person 
                with an ownership or control interest (as defined in 
                section 1124(a)(3)) in such organization) is a person 
                with an ownership or control interest (as so 
                defined).''.
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