Source: United States House of Representatives – Congressman Lloyd Doggett (D-TX)
Contact: Alexis Torres
Washington, D.C.—U.S. Representatives Lloyd Doggett (D-TX), Ranking Member of the Ways and Means Health Subcommittee, and Health Subcommittee member Greg Murphy, M.D. (R-NC) introduced bipartisan legislation to require Medicare Advantage (MA) to adequately reimburse health care providers for services offered to enrollees of these private plans. The Prompt and Fair Pay Act establishes a floor requiring MA plans to reimburse for all covered health care items and services at least what would have been paid under Medicare Parts A and B; plans and providers may continue to negotiate higher reimbursement rates. The legislation also establishes prompt payment rules for clean in-network claims, which are requirements that would mirror those under Medicare Part D.
“A rapidly growing Medicare DisAdvantage market is straining our health care system and threatening consumers’ access to necessary health care,” said Rep. Doggett. “Providers are having to choose between substantial reimbursement delays that are often less than what is truly owed, administrative burdens, and care denials, or an outright withdrawal from MA contracts. With many providers already at risk of closure and MA now covering more than half of enrollees, it is essential that we ensure prompt and fair payments before every community is a health care desert. Our bill is an important step to protect patients and providers.”
“Medicare Advantage was conceived with good intentions, but absent updates and reforms, insurers will continue to exploit and abuse the program to bilk the federal government at the expense of patients and physicians,” said Congressman Greg Murphy, M.D. “Doctors who see MA beneficiaries not only experience major delays in reimbursement and senseless prior authorization denials, but often receive less compensation for services rendered than they earn through traditional Medicare. I am proud to support the Prompt and Fair Pay Act to guarantee parity between MA reimbursements and Medicare Parts A and B, ensure our physicians are treated with dignity, and preserve access to high-quality, affordable care for patients.”
Although Traditional Medicare spending serves as the benchmark for MA payments, the law currently does not require MA plans to reimburse providers at the same rates. As a result, many hospitals, provider groups, and other health systems are operating in the red and are forced to withdraw from MA contracts. This year alone, 27 health systems have left the MA program. It’s also estimated that skilled nursing facilities lost $13.8 billion in 2024 because MA plans reimbursed significantly less than Traditional Medicare. Without Congress’s intervention, MA plans will continue to skirt an obligation to promptly and fairly pay providers.
Committed to a more just and equitable health care system for patients, providers and taxpayers, Reps. Doggett and Murphy have previously worked together to introduce legislation to strengthen veterans’ health care for those dually enrolled in MA and Medicare Part D plans. The members have also requested that the Government Accountability Office conduct an independent investigation into vertical consolidation of Medicare Advantage Organizations.
The Prompt and Fair Pay Act is endorsed by America’s Essential Hospitals, American Academy of Family Physicians, American College of Physicians, American Occupational Therapy Association, LeadingAge, National Rural Health Association, Premier, Texas Hospital Association, Texas Organization of Rural and Community Hospitals, Texas Association for Home Care and Hospice, and the American Association of Nurse Anesthesiology.
“By establishing a payment floor for Medicare Advantage (MA) plans that aligns with amounts paid under traditional Medicare, the Prompt and Fair Pay Act helps ensure rural providers are not disadvantaged as MA enrollment continues to grow. The National Rural Health Association also appreciates the addition of enforceable prompt payment standards as rural providers often face administrative burdens to receiving timely payment from plans, creating cash flow issues. This bill marks an important step toward improving predictability and sustainability for rural health systems. NRHA thanks Rep. Doggett and Rep. Murphy for their thoughtful approach to addressing long-standing challenges rural providers face in the MA program and we are proud to endorse this legislation.” – Alan Morgan, CEO of National Rural Health Association
Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, said: “To Congress and to regulators, we’ve repeatedly expressed concerns that Medicare Advantage plans, by underpaying and delaying provider reimbursement, are threatening the financial stability of our nonprofit and mission-driven provider members, which jeopardizes access to necessary care and services for older adults. This legislation, which establishes a rate floor and prompt payment requirements, is a vital step toward ensuring that providers are fairly and promptly compensated for the care they deliver. It will bring much-needed financial stability to our nursing homes and home health members–particularly those located in underserved and rural communities. We strongly support this legislation and urge its swift passage.”
Bruce Siegel, MD, MPH, President and CEO of America’s Essential Hospitals, said: “Essential Hospitals across the nation are facing unprecedented financial disruptions, jeopardizing their ability to serve patients and their communities. The Prompt and Fair Pay Act is a step in the right direction, providing concrete steps to fix woefully inadequate hospital reimbursements. We will continue to support common sense legislation like this that aims to better sustain and support our hospitals, and the communities they serve.”
“The AAFP thanks Rep. Doggett for leading on this legislative effort to establish fair payment standards and enforce timely payments from Medicare Advantage plans. This legislation will help ensure that family physicians can spend less time navigating red tape and more time delivering high-quality care. We’re encouraged by the inclusion of enforcement measures, which we hope will ensure accountability and compliance by plans and help protect the financial stability of practices and the health of our communities.” — Jen Brull, MD, FAAFP, President, American Academy of Family Physicians
Soumi Saha, PharmD, JD, Senior Vice President of Government Affairs, Premier, Inc., said: “Premier applauds Reps. Doggett and Murphy for their leadership in introducing the bipartisan Prompt and Fair Pay Act. This bill will take important steps to ensure that all providers are paid in a timely and appropriate manner for the care they provide to Medicare Advantage patients. Premier has consistently voiced the need to align payment timelines and levels for in-network providers compared with out-of-network providers. Reps. Doggett and Murphy are taking meaningful action to hold insurers accountable and correct these existing inequities in a manner that will benefit patients and providers.”
John Hawkins, President and CEO of Texas Hospital Association, said: “THA is grateful for the leadership of Congressman Lloyd Doggett to ensure hospitals are paid timely for care delivered to seniors covered by private insurance plans in the Medicare Advantage program. Non-partisan studies have repeatedly shown that excessive and unnecessary denials, slow pay tactics, overly stringent prior authorization requirements, and restrictive provider networks by these plans threaten access to medically necessary care. For years, Congressman Doggett has been working to address these challenges, and The Prompt and Fair Pay Act of 2025 will bring overdue accountability and prompt pay standards to the MA program.”
“Occupational therapy services are crucial to enable Medicare beneficiaries in either traditional Fee-for-Service or Medicare Advantage programs to recover and live as independently as possible after an injury or illness,” according toKatie Jordan, OTD, MBA, OTR/L, FAOTA, Chief Executive Officer, American Occupational Therapy Association (AOTA). She notes that “The Prompt and Fair Pay Act would ensure payment parity for OT services provided to beneficiaries in either program while also requiring prompt payment of clean claims and enhancing transparency from Medicare Advantage organizations regarding questioned claims. This is critical to reduce the administrative burden related to processing claims which would allow a greater focus on actual patient treatment.”
“We appreciate Congressman Doggett’s leadership in introducing the Prompt and Fair Pay Act to ensure that Medicare Advantage plans are properly reimbursing practitioners for the care they provide,” said Jan Setnor, MSN, CRNA, Col. (Ret), USAFR, NC, President of the American Association of Nurse Anesthesiology. “This bill will ensure patients have access to nurse anesthetists and other providers and the high-quality care they deliver by holding payors accountable for proper and timely reimbursement of care. This bill will protect access to care for the growing number of Americans who utilize Medicare Advantage plans, and we strongly urge Congress to pass this critical legislation.”
“Medicare Advantage plans have been hard on rural Texas hospitals, so TORCH applauds the effort to require sustainable payments without delay.” –John Henderson, President/CEO of Texas Organization of Rural and Community Hospitals (TORCH)
A fact sheet about the bill can be found here, and the full bill text here.