H.R. 6809 – Puerto Rico Integrity in Medicare Advantage Act

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Updated April 15, 2026 at 11:40 PM UTC

The Puerto Rico Integrity in Medicare Advantage Act changes the Medicare Advantage payment formula to help stabilize funding for Puerto Rico after Hurricane Maria. It sets a minimum geographic adjustment for the next three years and adds rules to make sure more of the extra money goes to local health‑care providers and patients.

Key Provisions

For 2019‑2021, the geographic adjustment used to calculate Medicare Advantage payments cannot be lower than 0.70 for any area, creating a payment floor.
When a plan bids to serve Puerto Rico, the usual bid‑restriction clause is waived for areas covered by the new geographic‑adjustment floor.
At least 50% of any increase in the benchmark payment that results from the new floor must be directed to provider compensation in Puerto Rico.

Legislative Activity

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HouseIntro Referral Latest Action

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.

Ways and Means Committee

September 13, 2018

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HouseIntro Referral

Introduced in House

September 13, 2018

HouseIntro Referral

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.

Ways and Means Committee

September 13, 2018

Floor Debate

1 member

What members said about H.R. 6809 on the floor

1 Republican

Rep. Jenniffer González-ColónR-PR · Dec 19, 2018

Mr. Speaker, healthcare infrastructure in Puerto Rico remains dangerously unstable. Unlike the mainland, most Medicare beneficiaries with part A and part B coverage receive their care through local…

Bill Text

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Introduced in HouseIssued September 13, 2018

I

115th CONGRESS

2d Session

H. R. 6809

IN THE HOUSE OF REPRESENTATIVES

September 13, 2018

Miss González-Colón of Puerto Rico (for herself, Mr. Serrano, Mr. Bacon, Mr. Soto, and Mrs. Murphy of Florida) introduced the following bill; which was 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

A BILL

To amend title XVIII of the Social Security Act to provide for temporary stabilization of Medicare Advantage payments following Hurricane Maria.

1.

Short title

This Act may be cited as the Puerto Rico Integrity in Medicare Advantage Act.

2.

Temporary stabilization of Medicare Advantage payments following Hurricane Maria

(a)

In general

Section 1853(n) of the Social Security Act (42 U.S.C. 1395w–23(n)) is amended—

(1)

in paragraph (1)(B), by striking subsequent year and inserting subsequent year, subject to paragraph (7),;

(2)

in paragraph (4), by striking In and inserting Subject to paragraph (7), in; and

(3)

by adding at the end the following new paragraph:

(7)

Average geographic adjustment floor

For each of 2019, 2020, and 2021, when calculating the adjusted average capital amount under section 1876(a)(4) for the purposes of establishing the base payment amount, the average geographic adjustment shall not be less than 0.70 for any area.

.

(b)

Ensuring payments flow to Puerto Rico providers and patients

Section 1854(a)(6) of the Social Security Act (42 U.S.C. 1395w–24(a)(6)) is amended—

(1)

in subparagraph (B)(iv)—

(A)

by striking Exception.—In the case of and inserting

Exceptions.—

(I)

In the case of

; and

(B)

by adding at the end the following new subclause:

(II)

In the case of an area to which section 1853(n)(7) applies with respect to a year, clause (iii) shall be waived for bids submitted for such area and year and subparagraph (C) shall apply.

; and

(2)

by adding at the end the following new subparagraph:

(C)

Strengthening support to health care providers in Puerto Rico

When reviewing bids submitted by plans serving areas in Puerto Rico, the Secretary shall ensure that, of the increase in blended benchmark amount attributable to section 1853(n)(7) (above the amount that would otherwise be determined under section 1853(n)), no less than 50 percent is directed toward provider compensation.

.