US Federal House Bill HB4559

US Federal 2025-2026 Regular Session

• Introduced: 7/21/25
• Refer: 7/21/25

Caption

Prompt and Fair Pay Act

Summary

HB4559, titled the “Prompt and Fair Pay Act,” would amend the Social Security Act to change how Medicare Advantage (MA) plans pay providers and suppliers. First, it would require MA organizations, beginning with plan years starting on or after January 1, 2027, to pay providers at least the same amount those services would receive under original Medicare fee-for-service, including cost-based payment methods. The bill is intended to establish payment parity between MA and fee-for-service Medicare so that MA plans cannot reimburse providers below traditional Medicare rates. The bill also creates new prompt-payment rules for MA plans. For in-network providers and suppliers, clean claims would generally have to be paid within 14 days if submitted electronically or 30 days if submitted otherwise. The bill defines when a claim is received, what counts as a clean claim, and requires MA plans to promptly notify providers of any defects and specify what is needed to cure them. If a clean claim is not paid on time, the plan would owe interest, and the Secretary could waive interest in exigent circumstances such as natural disasters. The bill also includes anti-retaliation language and authorizes enforcement against MA organizations that fail to comply.

Impact

If enacted, the bill would directly amend sections 1857(e) and 1857(f) of the Social Security Act and add a new enforcement basis under section 1857(g). It would affect Medicare Advantage contracts nationwide by setting a federal floor for provider reimbursement tied to original Medicare and by imposing mandatory claims-processing timelines, notice requirements, interest penalties, and electronic payment options. Providers, suppliers, MA organizations, and Medicare beneficiaries could all be affected, with the practical goal of improving payment predictability and access to care in MA networks.

Sentiment

No committee transcripts or recorded votes were provided, so there is no documented floor or committee debate to gauge sentiment. Based on the bill text and title, the measure appears to be framed positively from the perspective of providers and patient access advocates, emphasizing fairness, transparency, and timely payment. The absence of votes or hearings means there is no available evidence of formal support or opposition in the supplied materials.

Contention

The likely points of contention are the bill’s reimbursement mandate and its enforcement structure. Medicare Advantage plans may object that requiring payment at no less than fee-for-service Medicare rates would reduce plan flexibility and could increase costs, while providers are likely to support the parity requirement as a way to prevent underpayment. The prompt-payment deadlines, automatic clean-claim deeming rules, interest penalties, and detailed notice obligations may also be disputed as administratively burdensome or too rigid, especially for plans that argue they need more time to review claims or handle complex cases. The bill’s anti-retaliation language and Secretary enforcement authority could also draw attention from stakeholders concerned about compliance exposure.