Ensuring appropriate payment of Federally qualified health center services furnished to Medicare Advantage enrollees

(a) Clarifying wraparound payments Not later than December 31, 2026, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall— (1) issue guidance to Federally qualified health centers (as defined in section 1861(aa)(4) of the Social Security Act (42 U.S.C. 1395x(aa)(4))) on— (A) the calculation of payment amounts under section 1833(a)(3)(B) of such Act (42 U.S.C. 1395l(a)(3)(B)); and (B) procedures for submitting a claim for such a payment; (2) issue guidance to Medicare administrative contractors to ensure timely and accurate payment of amounts owed under such section that— (A) outlines a standardized process for providing Federally qualified health centers such payments; and (B) clarifies that such contractors may not require such a center (or any entity acting on behalf of such center) to submit the Medicare Advantage plan contract at issue to such contractor as a prerequisite to receiving such payments; and (3) establish a mechanism by which such a center may seek review by the Secretary of such a contractor’s determination of amounts payable to the center under such section. (b) Evaluation of access to FQHCs in MA networks Not later than 180 days after the date of the enactment of this paragraph, the Comptroller General of the United States shall submit to Congress a report that examines the inclusion of Federally qualified health centers in Medicare Advantage plan provider networks. Such report shall include recommendations for actions to be taken to ensure adequate access to Federally qualified health centers for rural and underserved populations.