No UPCODE Act (S. 1105)

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.