No UPCODE Act

The No UPCODE Act would modify how the Centers for Medicare and Medicaid Services (CMS) determines payment amounts for Medicare Advantage plans, which are private insurance alternatives to traditional Medicare. The bill aims to address concerns about how health status information is used in these payment calculations.

Specifically, the bill would require CMS to use two years of diagnostic data instead of potentially longer periods when calculating risk adjustments for Medicare Advantage payments. It would also prohibit CMS from using diagnoses obtained through chart reviews or health risk assessments in these payment calculations. Additionally, the bill would require CMS to account for differences in how medical conditions are coded and documented between Medicare Advantage plans and traditional Medicare when determining payment adjustments.

If enacted, these changes could affect how much money insurance companies receive for covering Medicare Advantage enrollees, potentially influencing plan premiums, benefits, and provider networks. The bill is currently in early stages and has not yet advanced to committee consideration.