The bipartisan “Prompt and Fair Pay Act” (H.R. 4559) introduced by Reps. Lloyd Doggett (D-TX) and Greg Murphy (R-NC) on July 21, 2025, would require Medicare Advantage (MA) plans to pay their contracted providers at least the current Medicare fee-for-service(FFS) reimbursement rates as the rate floor and also establishes prompt pay timelines. Nothing prohibits plans from paying more than Medicare FFS rates.

The establishment of a rate floor that MA plans must pay providers, which has the dual benefit of ensuring our skilled nursing facility and home health agency members’ financial sustainability while also giving them some bargaining power with MA plans, is a top advocacy priority for LeadingAge.

The bill also establishes prompt pay timelines for in-network providers, which have been lacking, and also permits interest penalties to be assessed when plans don’t pay promptly. Plans would be required to pay their contracted providers within 14 calendar days of receipt of a clean claim submitted electronically and 30 days for other claims. In addition, plans would be required to notify providers within 10 days if the claim is considered not clean and explain what steps would be needed to correct it.

Out of network providers already have regulatory protections that require MA plans to pay them at least Medicare FFS reimbursement rates and pay clean claims within 60 days.

In a press release announcing the bill’s introduction,  LeadingAge president and CEO Katie Smith Sloan said, “To Congress and to regulators, we’ve repeatedly expressed concerns that Medicare Advantage plans, by underpaying and delaying provider reimbursement, are threatening the financial stability of our nonprofit and mission-driven provider members, which jeopardizes access to necessary care and services for older adults. This legislation, which establishes a rate floor and prompt payment requirements, is a vital step toward ensuring that providers are fairly and promptly compensated for the care they deliver. It will bring much-needed financial stability to our nursing homes and home health members–particularly those located in underserved and rural communities. We strongly support this legislation and urge its swift passage.”

Members can access a bill fact sheet, and the bill text for more details. Contact Nicole Fallon with any questions.