PROMPT Act

Legislative Summary: HR 5873 – PROMPT Act

Overview

The Prompt Reporting and Oversight for Medicare Providing Transparency Act (PROMPT Act) is a targeted piece of legislation designed to increase financial transparency for beneficiaries of the Medicare program. The bill focuses on the timing and delivery of "Explanation of Benefits" (EOB) documents, ensuring that patients receive timely information regarding what Medicare has paid for their healthcare services.

Purpose and Intent

The primary intent of the PROMPT Act is to eliminate delays in reporting healthcare costs to Medicare recipients. By mandating a strict deadline for the delivery of benefit explanations, the bill aims to provide patients with a clearer, more immediate understanding of their healthcare expenditures, the amounts covered by the government, and any remaining out-of-pocket costs they may owe.

Key Provisions

The bill proposes a specific amendment to Section 1806(a) of the Social Security Act (42 U.S.C. 1395b–7(a)).

• 30-Day Reporting Mandate: The Secretary of Health and Human Services (HHS) would be required to provide an explanation of benefits to the beneficiary not later than 30 days after a payment is made (or would have been made) for an item or service furnished under the Medicare program.
• Transparency of Costs: These notices must clearly outline the payment details, specifically focusing on the amount paid after the deductible has been applied.

Affected Parties

• Department of Health and Human Services (HHS): The agency would be responsible for implementing and enforcing the new 30-day reporting timeline.
• Medicare Beneficiaries: Patients enrolled in Medicare would benefit from faster access to their billing information, reducing the timeframe in which they might receive unexpected "surprise" bills from providers.
• Healthcare Providers: While the mandate is on the Secretary, the administrative flow of claims and payments may be affected to ensure the 30-day window is met.

Procedural Status and Timeline

• Introduced: October 31, 2025.
• Current Status: The bill has been referred to two key committees for review:
  • Committee on Ways and Means
  • Committee on Energy and Commerce
• Next Steps: The committees will determine the period for consideration and evaluate the bill's feasibility before it can move toward a floor vote in the House.