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HR 9544

Save MEDICARE Act of 2026

119th Congress Introduced by Yassamin Ansari and 46 co-sponsors

Tightens Medicare Advantage payments by curbing upcoding, adds selection-adjusted base payments, speeds RADV audits, and enables VA cost-recovery for MA-related care.

Introduced in House
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WeVote Research Nonpartisan
Bill Summary · HR 9544

Overview

  • Bill: HR 9544, “Saving Medicare Enrollees from Deceptive Insurers and Creating Ample Resources for Everyone Act of 2026” (Save MEDICARE Act of 2026)
  • Purpose: Amend title XVIII of the Social Security Act to ensure more accurate and appropriate payments under Medicare Advantage (MA), reduce potential overpayments driven by coding variations, improve risk adjustment integrity, and strengthen protections and enforcement related to MA plans and cost recovery for Veterans, among other provisions.
  • Introduced: June 30, 2026, by Rep. Doggett and multiple sponsors.

Main Objective

  • Reforms to Medicare Advantage payments and risk adjustment to curb upcoding, ensure valid health-status data, and promote more accurate, cost-aware payment benchmarks.
  • Strengthens oversight, auditing, and enforcement related to MA plans and associated funding flows.
  • Expands cost-recovery mechanisms involving the Department of Veterans Affairs (VA) for services that overlap with MA coverage.
  • Adds protections against deceptive practices and prohibits certain provider incentives tied to coding.

Key Provisions and Changes

  1. Risk Adjustment and Diagnostic Coding (Sections 2 and 4)

    • Rulemaking for 2028 and later: HHS Secretary must analyze diagnosis codes with high differential coding between MA and traditional Medicare, high discretionary coding, or limited treatment implications; exclude or adjust such codes from data used to determine payment adjustments.
    • Exclusion of Diagnoses from Chart Reviews and Health Risk Assessments:
      • MA plans and Prescription Drug Plans (PDPs) cannot rely on diagnoses from chart reviews or health risk assessments (HRAs) for 2028 onward when calculating health-status-based payment adjustments.
      • The Secretary must establish procedures to identify and verify diagnoses obtained via chart reviews and HRAs.
    • Parallel prohibition in Part D: Similar exclusion for standardized bid adjustments based on health status, with identification/verification procedures.

  2. MedPAC Study (Section 2)

    • Mandates a MedPAC study on extrapolating CAPHS-sized consumer surveys to MA contracts to inform risk-adjusted payments.
    • MedPAC must report to Congress within 3 years with methodology recommendations and possible legislative/administrative actions.

  3. Quality Bonus Program (Section 3)

    • Extends the quality bonus program window, adding 2028 as an ending year for certain quality incentives, aligning with other timing changes.

  4. Benchmark and Payment Adjustments (Section 4)

    • Eliminates the County Quadruple System for benchmarks.
    • Reconfigures 2028 and later base payment amounts:
      • Introduces a selection-adjusted base payment amount to account for favorable selection between MA and original Medicare FFS.
      • Requires an annual analysis of selection differences by demographic subgroups and health status; results to be incorporated into 2029 and later payments.
      • Uses the Medicare Payment Advisory Commission’s (MedPAC) March 2026 method to compute a “selection percentage.”
      • MedPAC must review the analysis and any adjustments within 2 years of implementation, then biennially.

  5. Risk Adjustment Data Validation (RADV) (Section 5)

    • Sets tight timelines and procedures to speed RADV audits:
      • Contract-level audits completed within one year.
      • RADV medical record reviews completed within 60 days.
      • Appeals stages (reconsideration and hearing) completed within 90 days each.
      • Imposes a small 0.02% fee reduction on MA plan payments to fund RADV.
      • Limits judicial review of RADV determinations.
      • Allows extrapolation of audit results to the broader MA population.
    • Adds enhanced authorities to identify and recoup overpayments, with penalties, contingency fees for recovery contractors, and streamlined processes for clean claims and interest on late payments.

  6. Cost Recovery from VA for MA and PDM Plan Costs (Section 6)

    • Establishes a new VA section (1729C) to recover costs incurred by VA care that Medicare beneficiaries receive when enrolled in MA or MA-PD plans, aligning with VA’s collections framework.
    • Requires reimbursement of MA/MA-PD items and services to the Secretary of Veterans Affairs, with enforcement and procedures modeled after 1729 recovery processes.
    • Applies to MA and PDP years beginning January 1, 2028.
    • Amends cross-referenced SS Act sections to reflect these cost-recovery provisions.
    • Expands authority to recover charges from third parties for non-service-connected care that VA is obligated to provide or pay for.

  7. State Enforcement and Coordination (Section 7)

    • Allows states to require MA organizations to meet program standards in their states.
    • Requires coordination between the Secretary and states in licensing and enforcement, including potential collaborative enforcement agreements.

  8. Provider Incentives and Coding Practices (Section 8)

    • Prohibits use of percentage-of-premium contracts or other financial incentives for providers related to coding for MA enrollees (effective plan years beginning 2028).

Who Would Be Affected

  • Medicare Advantage organizations and MA-PD plans, including their contracting providers and risk-adjustment practices.
  • MA enrollees, through potentially more accurate risk-adjusted payments and stricter coding practices.
  • CMS, MedPAC, and the HHS Inspector General (IG) for rulemaking, data validation, and oversight.
  • Veterans enrolled in MA/MA-PD plans and VA, due to new cost-recovery provisions.
  • States and MA organizations through potential state-enforcement alignment.
  • Providers and recovery auditors, due to RADV reforms and penalties on improper reimbursements.

Procedural and Timeline Details

  • Effective date for many new restrictions on chart-review/HRA data and the cost-recovery framework: plans year beginning January 1, 2028.
  • Selection-adjusted base payments and favorable-selection analyses apply to 2028 and beyond; finalized adjustments for 2029 onward.
  • RADV reforms (audits, timelines, penalties) apply to plan years beginning after January 1, 2028.
  • VA cost-recovery provisions require VA-related recoveries for 2028 and later.
  • MedPAC study and report due within three years of enactment (i.e., roughly by 2029).

Summary

The Save MEDICARE Act of 2026 focuses on tightening the accuracy and integrity of Medicare Advantage payments by curbing upcoding and excessive chart-review-driven diagnoses, introducing selection-adjusted base payments, enhancing RADV auditing efficiency, enabling VA cost-recovery for MA-related care, empowering states to enforce MA standards, and banning provider incentive schemes that promote coding. It also directs research via MedPAC to refine risk-adjustment methodologies and requires phased implementation starting in 2028, with several provisions tying into 2029 and beyond.

Compiled from official sources — confirm details with the bill’s official record.

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