HR8561FEDERALin_committee

Medicare Advantage Payment Adjustment Act (H.R. 8561)

Original title: To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification.

April 28, 2026

Medicare Healthcare Policy Medicare Advantage Federal Budget Healthcare Finance

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Where This Stands

Introduced

Committee

Floor Vote

Passed

Signed

Currently in_committee. The next step in the legislative lifecycle is Floor Vote.

Last action

Referred to the Subcommittee on Health.Dec 17, 2024

Lead sponsor

Claudia Tenney

Version history

Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.

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The Frame

What this does

This bill changes how federal payments are calculated for certain Medicare Advantage plans, which directly impacts the funding levels available to health insurance providers in specific regions experiencing rapid shifts.

Who is mentioned in the record

Potentially affected actors named in the source documents. Mention is not a position.

Medicare Advantage Plan Providers

These entities may request adjustments to their benchmark payment rates if they operate in areas meeting the 20% wage index growth threshold.

Department of Health and Human Services

The Secretary is tasked with recalculating growth percentages and updating capitation rates for eligible plans.

What changed

Current stage: in_committee.

What's next

Floor Vote.

Summary

This bill directs the Secretary of Health and Human Services to adjust payment rates for plans in areas where local changes caused significant under-projections of growth. It mandates these adjustments starting in 2025 to ensure payment benchmarks accurately reflect local economic conditions.

Key Facts

Requires the Secretary of Health and Human Services to adjust growth percentage calculations for Medicare Advantage (MA) plans starting in 2025.
Applies to MA plans in service areas where the area wage index increased by more than 20% in a prior year.
Allows for retroactive growth estimate adjustments back to 2024.
Mandates that the Secretary issue adjustments upon request from an applicable plan as soon as practicable.
Amends Section 1853(c)(6), 1853(k)(1), and 1853(n)(2)(E) of the Social Security Act.
Authorizes immediate implementation of 2025 Medicare Advantage Capitation Rates without standard prior notice requirements.
Requires that if notice of rate changes is required, it must be published in the Federal Register within 30 days of the action.

Frequently Asked Questions

Who does this bill affect?

It affects Medicare Advantage plans operating in areas where the local has increased by more than 20% in a prior year.

When do these changes take effect?

The adjustments apply to rates calculated for the 2025 calendar year.

Does this bill require public notice before changing rates?

The bill allows the Secretary to take immediate action to adjust rates without the standard prior notice, provided that notice is published in the Federal Register within 30 days.

Why It Matters

News Coverage

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Discoveries

Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.

policy shift90% confidence

Waiver of Notice Requirements

The bill explicitly grants the Secretary authority to bypass standard notice requirements for 2025 rate adjustments, indicating an urgent need to correct payment projections.

Department of Health and Human Services

Connected Entities

personClaudia Tenney“Representative from New York who introduced the bill.”Map →

organizationCommittee on Energy and Commerce“House committee assigned to review the bill.”Map →

personBrandon Williams“Representative from New York.”Map →

otherSocial Security Act“The primary federal law being amended.”Map →

personMarc Molinaro“Representative from New York.”Map →

organizationCommittee on Ways and Means“House committee assigned to review the bill.”Map →

personElise Stefanik“Representative from New York.”Map →

personNick Langworthy“Representative from New York.”Map →

personPaul Tonko“Representative from New York.”Map →

personJoseph Morelle“Representative from New York.”Map →

Analysis Score

0–100

Significance65
How much this matters to a regular citizen
Controversy20
Intensity of disagreement among stakeholders
Entertainment5
Compellingness for a non-policy-wonk reader
Buzz15
Current news / social attention level

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