S. 1105 · Where this bill is now
In committee
Introduced in the Senate, Mar 25, 2025
What this bill does
In plain words · AI-written from the official summaryLimits how Medicare Advantage payments are calculated
Medicare Advantage is a private insurance option for seniors that the government pays to provide coverage. Right now, the government adjusts these payments based partly on patients' health conditions, diagnosed through various methods. This bill would change how those payment adjustments work by requiring the government to use two years of diagnostic data instead of just one, and it would prevent the use of diagnoses found only through chart reviews or health risk assessments when adjusting payments. The bill also requires the government to account for differences in how doctors code diagnoses between Medicare Advantage and traditional Medicare.
How it affects you
If you're a Medicare Advantage enrollee, this could affect your coverage and care options. The bill aims to make payment calculations fairer by preventing what supporters see as inflated diagnoses that don't reflect real health conditions. The changes mainly affect how insurance companies and the government work together behind the scenes, though it could influence what benefits or care networks are available to you in your plan.
Read the official summary (Introduced in Senate, Mar 25, 2025)
No Unreasonable Payments, Coding, Or Diagnoses for the Elderly Act or the No UPCODE Act
This bill modifies certain factors that are used to determine Medicare Advantage (MA) payments, particularly relating to health status and related data.
Specifically, the bill requires the Centers for Medicare & Medicaid Services (CMS) to use two years of diagnostic data in its risk adjustment methodology for MA payments. It also prohibits the CMS from using diagnoses that are collected from chart reviews or health risk assessments when adjusting payments based on health status. The CMS must also take into account any differences in coding patterns between MA and traditional Medicare when determining MA payment adjustments.
Written by AI (Claude) using only the official summary by the Congressional Research Service, the Library of Congress’s nonpartisan research staff. It can miss nuance, so check the official summary and the bill text for details.
1st SessionS. 1105
A BILL
No UPCODE Act
Sponsor: Sen. Bill Cassidy (R-LA) · Introduced Mar 25, 2025 · Health · 1 version of the text
Sources: Congress.gov actions and votes · bill text from GovInfo · latest official action Mar 25, 2025: “Read twice and referred to the Committee on Finance.”