[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2610 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 2610
To amend title XVIII of the Social Security Act to address significant
under projection of MA local area growth due to wage index
reclassification.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 2, 2025
Ms. Tenney (for herself, Mr. Langworthy, Mr. Tonko, Mr. Lawler, and Ms.
Stefanik) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to address significant
under projection of MA local area growth due to wage index
reclassification.
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 ``Protecting Options for Seniors Act
of 2025''.
SEC. 2. ADDRESSING SIGNIFICANT UNDER PROJECTION OF MA LOCAL AREA GROWTH
DUE TO WAGE INDEX RECLASSIFICATION.
(a) Local Adjustment Method and Applicability.--Section 1853(c) of
the Social Security Act (42 U.S.C. 1395w-23(c)) is amended--
(1) in paragraph (1)--
(A) in the text preceding subparagraph (A), by
striking ``and (7)'' and inserting ``, (6)(D), and
(7)''; and
(B) in subparagraph (C)(v)(II), by inserting ``,
taking into account any adjustment under paragraph
(6)(D)'' before ``, but not''; and
(2) in paragraph (6)--
(A) in the heading, by inserting ``; local growth
percentage adjustment'' after ``defined''; and
(B) by adding at the end the following new
subparagraph:
``(D) Additional adjustment for significant under
projection of local area growth.--
``(i) In general.--Beginning with rates
calculated for 2026, for purposes of computing
rates for an MA payment area and a year as
described in paragraph (1), if such area is an
applicable area described in clause (ii), the
Secretary shall, with respect to such area,
increase the national per capita MA growth
percentage determined under this paragraph for
such year by the number of percentage points
specified in clause (iii)(I) for such area and
year.
``(ii) Applicable area.--For purposes of
clause (i), an applicable area described in
this clause is an MA local area with respect to
which the weighted average hospital wage index
in effect in such area for 2025 (or a
subsequent year), as calculated under clause
(iv), increased by more than 20 percent as
compared to the weighted average hospital wage
index in effect in such area during the
preceding year (as so calculated).
``(iii) Local growth percentage.--
``(I) In general.--For purposes of
clause (i), with respect to an
applicable area described in clause
(ii) and a year, the number of
percentage points specified in this
clause is equal to the product of--
``(aa) the percentage
calculated under subclause (II)
for the area and year, and
``(bb) the weighting factor
calculated under subclause
(III) for the area and year.
``(II) Percentage.--For purposes of
subclause (I), the percentage
calculated under this subclause for an
applicable area and a year is--
``(aa) for 2026, the
percentage by which the
weighted average hospital wage
index in effect in the
applicable area for such year,
as calculated under clause
(iv), increased as compared to
the weighted average hospital
wage index in effect in such
area for 2024 (as so
calculated); and
``(bb) for 2027 and each
subsequent year, the percentage
by which the weighted average
hospital wage index in effect
in the applicable area for such
year, as calculated under
clause (iv), increased as
compared to the weighted
average hospital wage index in
effect in such area during the
preceding year (as so
calculated).
``(III) Weighting factor.--For
purposes of subclause (I), the
weighting factor calculated under this
subclause for an applicable area and a
year is equal to--
``(aa) the total amount of
payments made under sections
1833(t) and 1886 to all area
hospitals in such area
(including disproportionate
share payments made under
section 1886(d)(5)(F)) that
were subject to adjustment for
wage or labor costs, divided by
``(bb) the total amount of
payments made under parts A and
B of this title attributable to
the payment of claims for items
and services furnished in such
area, excluding any such
payment attributable to a
payment and service delivery
model being tested under
section 1115A,
determined using payment information
with respect to the most recent
calendar year for which information was
computed and published under subsection
(b)(4), as of the date on which the
advance notice under subsection (b)(2)
is provided for the year.
``(iv) Weighted average hospital wage
index.--The weighted average hospital wage
index in effect in an MA local area for a year
is equal to the average area wage index
applicable under section 1886(d)(3)(E) for all
area hospitals for such area as of the date on
which the advance notice under subsection
(b)(2) is provided for the year, weighted by
the total amount of payments made under parts A
and B of this title to each such area hospital,
determined using payment information with
respect to the most recent calendar year for
which information was computed and published
under subsection (b)(4), as of such date.
``(v) Area hospital defined.--In this
subparagraph, the term `area hospital' means,
with respect to an MA local area and a year, a
hospital that is geographically located in such
area at any point during such year (without
regard to whether such hospital was
reclassified to a new geographic area pursuant
to section 1886(d)(8)(B), a decision of the
Medicare Geographic Classification Review Board
under section 1886(d)(10), or a decision of the
Secretary).
``(vi) Requirement of benchmark
neutrality.--Any adjustment made under this
subparagraph for an MA payment area and a year
shall be made in a manner that ensures that the
enrollment-weighted average applicable amount
under subsection (k)(1)(B) for all MA payment
areas and such year is not greater or less than
what it would have been without such
adjustment.''.
(b) Adjusting the Benchmark Cap.--Section 1853(k)(1)(B)(i) of the
Social Security Act (42 U.S.C. 1395w-23(k)(1)(B)(i)) is amended by
inserting ``, taking into account any adjustment under subparagraph (D)
of such subsection'' before ``, but not''.
(c) Adjusting the Base Payment Amount.--Section 1853(n)(2)(E)(ii)
of the Social Security Act (42 U.S.C. 1395w-23(n)(2)(E)(ii)) is
amended--
(1) in subclause (I), by inserting ``, taking into account
any adjustment under subparagraph (D) of such subsection''
before ``, but not''; and
(2) in subclause (II), by inserting ``or, in the case that
the area is an applicable area (as determined under subsection
(c)(6)(D)), the amount specified in subclause (I) or the amount
specified in subsection (c)(1)(D) for the area for the year,
whichever is greater'' before the period at the end.
(d) Transparency and Data Sharing.--
(1) In general.--Section 1853(b)(4) of the Social Security
Act (42 U.S.C. 1395w-23(b)(4)) is amended by adding at the end
the following new subparagraph:
``(E) Total amount paid to each area hospital (as
defined in subsection (c)(6)(D)) for the year, computed
separately for part A and for part B.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply beginning with the computation and publication of
information for each MA payment area for 2026.
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