No UPCODE Act

# No UPCODE Act Summary **What the Bill Does** The No UPCODE Act would change how the federal government pays Medicare Advantage insurance plans—private insurance alternatives to traditional Medicare that serve seniors. Currently, these plans receive payments based partly on how sick their patients are (determined by medical diagnoses).

This bill would restrict that system by: requiring the government to use two years of diagnostic data instead of potentially more; preventing the use of diagnoses found during special health reviews or assessments; and accounting for differences in how Medicare Advantage plans versus traditional Medicare code medical conditions. **Who It Affects** The bill primarily affects Medicare Advantage enrollees (about 28 million seniors), the private insurance companies offering these plans, and the Medicare program's budget. The bill aims to prevent what supporters view as excessive payments to Medicare Advantage plans by tightening rules around how diagnoses are counted when determining payment amounts. **Current Status** The bill was introduced by Senator Bill Cassidy (R-LA) in the 119th Congress and is currently in committee, meaning it has not yet been debated or voted on by the full Senate.