Encounter Data Enhancement Act

The Encounter Data Enhancement Act (S 3307) requires Medicare Advantage plans to include specific new details in their encounter data reports starting in 2026. This affects Medicare Advantage plans directly, mandating they report payment types (like capitation or fee-for-service), allowed amounts, patient cost-sharing, and indicators for different health risk assessments (in-home, outside-home, or by specific entities). Key provisions also require network status for services and provider identifiers for certain items like lab tests, durable medical equipment, and home health services. The bill aims to improve data transparency for oversight of Medicare Advantage spending and service delivery without changing coverage rules.