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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.
Introduced
Mar 25, 2025
Last Action
Mar 25, 2025
Session
119th Congress
Sponsors
1 primary · 1 co
Passage Probability
2% — Very Low
Introduced in Senate
Read twice and referred to the Committee on Finance.
Get a plain-English explanation of what this bill does, who it affects, and why it matters.
2%
Estimate based on legislative signals
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Upgrade to ProRead twice and referred to the Committee on Finance.