US SB1105

Requires the Secretary of HHS to use 2 years of diagnostic data (when available) for Medicare Advantage risk adjustment calculations starting in 2026

Prohibits diagnoses collected from chart reviews and health risk assessments from being used to establish payment adjustment factors or adjust payments based on health status, effective 2026

Mandates the Secretary to establish procedures for identifying and verifying diagnoses collected from chart reviews and health risk assessments

Requires annual evaluation of coding pattern differences between Medicare Advantage plans and traditional Medicare (Parts A and B) providers, with public reporting of results

Directs the Secretary to ensure coding adjustments fully account for identified coding pattern differences, including adjustments at the plan or contract level