Bills · HR 5454
IN COMMITTEE· 119TH CONGRESS
House BillHR 5454Health
Medicare Advantage Prompt Pay Act
INTRO SEP 18· LAST ACTION SEP 18
READING
6MIN
COSPONSORS
19BIPARTISAN
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
- Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8Introduced
In Committee
Reported
Passed House
Passed Senate
Conference
To President
Became Law
WHAT THE BILL DOES
AI-writtenThis bill matters because delayed payments from insurance companies can create significant financial challenges for healthcare providers, from small private practices to large hospital systems. These delays can affect a provider's ability to pay staff, cover operational costs, and invest in equipment, potentially leading to administrative burdens that detract from patient care or even influence which plans providers accept.
If this bill becomes law, healthcare providers would gain more reliable cash flow and a stronger mechanism to ensure they are paid promptly, along with compensation (interest) for late payments. This could alleviate financial pressures and improve the overall efficiency of the healthcare system for providers dealing with MA plans. If it doesn't pass, the current payment practices of Medicare Advantage organizations would continue, which often involve longer payment cycles and less strict penalties for delays, leaving providers to navigate complex and potentially slow reimbursement processes.
KEY PROVISIONS
5AI-extractedPROVISION 01
Medicare Advantage (MA) organizations must pay at least 95% of "clean claims" within specific deadlines: 14 days for electronic claims from in-network providers, and 30 days for all other claims.
This establishes clear, mandatory timelines for MA plans to pay healthcare providers, aiming to significantly speed up reimbursements.
PROVISION 02
If an MA organization fails to pay a clean claim by the deadline, they must pay interest to the healthcare provider on the overdue amount.
This provision creates a financial incentive for MA plans to pay on time and compensates providers for the financial impact of late payments.
PROVISION 03
The Secretary of Health and Human Services can impose civil money penalties of up to $25,000 for each instance an MA organization fails to comply with the new prompt payment requirements.
This introduces a strong enforcement mechanism to hold MA plans accountable for adhering to the prompt payment rules.
PROVISION 04
MA organizations will be required to provide detailed information to the government about their compliance with prompt payment rules, including payment rates for claims (in-network vs. out-of-network) and the total amount of interest paid for late payments.
This increases transparency regarding MA plans' payment practices and provides data for oversight and potential enforcement actions.
PROVISION 05
The bill defines what constitutes a "clean claim" based on complete data sets using standard forms and adherence to electronic submission standards.
This provides clarity for both providers and MA plans on the requirements for a claim to be considered ready for prompt payment.
SPONSORSHIP
1 + 19
R· Texas
YRS IN OFFICE
9
BILLS LED
59
COSPONSOR BREAKDOWNBIPARTISAN · 95%
DEM 9 REP 10 IND 0
ACTION TIMELINE
2 EVENTSSEP 18
Introduced in House
SEP 18
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
BILL INFO
TypeHouse Bill
NumberHR 5454
Congress119th
StatusIn Committee
IntroducedSep 18, 2025
Last actionSep 18, 2025
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IN COMMITTEE· 119TH CONGRESS · WAYS AND MEANS COMMITTEE · INTRODUCED SEP 18, 2025
House BillHR 5454Health
Medicare Advantage Prompt Pay Act
INTRODUCED SEP 18, 2025· LAST ACTION SEP 18, 2025
PASSAGE CHANCES
—%
READING
6 min
COSPONSORS
19
COMPLEXITY
Moderate
