SMART Health Care Act

HR 3222, the SMART Health Care Act, aims to improve Medicare efficiency and affordability. It requires Medicare Advantage plans to use two years of diagnostic data for risk adjustment starting in 2026, affecting how these plans are funded. The bill also implements site-neutral payments for outpatient services (ending exceptions after 2025) and mandates that covered entities provide Medicare patients with drugs at the purchase price minus discounts, with public reporting of pricing data. These changes directly impact Medicare Advantage insurers, hospitals, outpatient departments, and drug providers, focusing on cost control and transparency.