Prompt and Fair Pay Act
Sponsored By: Representative Doggett
Introduced
Summary
Establishes payment parity and prompt-pay rules for Medicare Advantage providers. This bill would require Medicare Advantage contracts to ensure in-network providers receive no less than the original Medicare fee-for-service payment for covered items and services starting with plan years on or after January 1, 2027, and would create enforceable timelines and clearer denial transparency for claims.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Medicare Advantage would match Medicare rates
Starting with plan years on or after January 1, 2027, Medicare Advantage plans would have to pay at least what original Medicare would pay for the same service. The payment floor would follow Parts A and B rates on the date of service, including cost‑based methods. This could raise or protect provider pay and help keep access for Medicare patients.
Faster Medicare Advantage payments and interest
For contract years on or after January 1, 2027, in‑network providers would get faster pay on clean claims. Plans would have 14 days to pay electronic claims and 30 days to pay non‑electronic claims. If a plan does not flag missing info within 10 days (electronic) or 15 days (non‑electronic), the claim would be treated as clean. Late payments would owe interest at the weighted average 3‑month Treasury rate plus 0.1%, and HHS could waive interest in disasters. The Secretary could use enforcement tools if plans do not follow these prompt‑pay rules.
Sponsors & CoSponsors
Sponsor
Doggett
TX • D
Cosponsors
Murphy
NC • R
Sponsored 7/21/2025
Harris (MD)
MD • R
Sponsored 10/31/2025
Sewell
AL • D
Sponsored 10/31/2025
Johnson (TX)
TX • D
Sponsored 2/23/2026
Edwards
NC • R
Sponsored 2/23/2026
Roll Call Votes
No roll call votes available for this bill.
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