HR 4559 — Prompt and Fair Pay Act

Bill Text

• Introduced Introduced in House Current html July 21, 2025

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill establishes payment parity between Medicare Advantage and fee-for-service Medicare and sets enforceable prompt payment requirements for Medicare Advantage.

• 42 U.S.C. 1395w-27(e)

  `(6) Payment parity with fee-for-service medicare.-- Beginning with plan years beginning on or after January 1, 2027, a contract under this part shall require an MA organization to provide, in any contract between the organization and a provider or supplier, that payment for items and services furnished to an enrollee by such provider or supplier shall be in an amount that is not less than the amount of payment applicable on the date of service for such items and services under the original Medicare fee-for-service program under parts A and B, including cost-based payment methodologies.`

  This adds a requirement for Medicare Advantage organizations to ensure payment for services is at least equal to what original Medicare would pay.

• 42 U.S.C. 1395w-27(f)

  `compliance with paragraph (1)` → `compliance with paragraph (1) or (2)`

  This expands the compliance requirements for prompt payment to include new provisions regarding in-network providers.

• 42 U.S.C. 1395w-27(f)

  `(2)` → `(3)`

  This renumbers existing paragraphs to accommodate the addition of a new requirement.

• 42 U.S.C. 1395w-27(f)

  `(2) Requirement applicable with respect to in-network providers of services and suppliers.--`

  This introduces a new section that outlines prompt payment requirements specifically for in-network providers.

• 42 U.S.C. 1395w-27(f)(2)

  `(A) Prompt payment of clean claims.--`

  This begins the specification of requirements for prompt payment of clean claims.

• 42 U.S.C. 1395w-27(f)(2)

  `(B) Procedures and rules for determining whether claims are clean claims.--`

  This outlines procedures for determining and notifying providers about clean claims.

• 42 U.S.C. 1395w-27(f)(2)(B)

  `(i) Clean claim defined.-- In this paragraph, the term `clean claim` means--`

  This defines what constitutes a clean claim for the purpose of prompt payment.

• 42 U.S.C. 1395w-27(f)(2)(B)(ii)

  `(ii) Claim deemed to be clean when timely notice of any deficiency is not provided.--`

  This sets conditions under which a claim is considered clean if the MA organization fails to give timely notice of deficiencies.

• 42 U.S.C. 1395w-27(f)(2)(B)(iii)

  `(iii) Required notifications and treatment of claims initially determined to not be clean claims.--`

  This mandates how an MA organization must handle claims initially deemed not clean.

• 42 U.S.C. 1395w-27(f)(2)(C)

  `(C) Obligation to pay.--`

  This establishes obligations for MA organizations regarding the timely payment of clean claims.

• 42 U.S.C. 1395w-27(f)(2)(D)

  `(D) Interest payment.--`

  This introduces interest payment requirements for late payments on clean claims.

• 42 U.S.C. 1395w-27(f)(2)(E)

  `(E) Protecting the rights of claimants.--`

  This protects the rights of individuals or organizations against potential retaliation when they exercise rights under the bill.

• 42 U.S.C. 1395w-27(g)(1)

  `or` → `or`

  This updates compliance conditions for secretarial enforcement to include new prompt payment failure provisions.

• 42 U.S.C. 1395w-27(g)(1)

  `(L) fails to comply with the provisions of subsection (f)(2);`

  This adds a new basis for enforcement actions related to failure in compliance with the new prompt payment requirements.

Action History

1. July 21, 2025

   Introduced in House

2. July 21, 2025

   Introduced in House

3. July 21, 2025

   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.

4. July 21, 2025

   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.

Sponsors

• Gregory F. Murphy · Cosponsor
• Andy Harris · Cosponsor
• Terri A. Sewell · Cosponsor
• Julie Johnson · Cosponsor
• Chuck Edwards · Cosponsor
• Glenn Thompson · Cosponsor
• Zoe Lofgren · Cosponsor
• Lloyd Doggett · Primary

Subjects