What does REDUCTION OF FRAUDULENT ENROLLMENT IN QUALIFIED HEALTH PLANS. of To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes. do?

This section amends Patient Protection and Affordable Care Act (ACA) Section 1411(h)(1) to establish penalties for agents and brokers who fail to provide correct information. It introduces civil penalties of $10,000 to $50,000 for negligent or disregardful agents and brokers providing incorrect information. It establishes civil penalties of up to $200,000 for agents and brokers who knowingly provide false or fraudulent information. It creates criminal penalties, including fines and imprisonment, for agents and brokers who knowingly and willfully provide false or fraudulent information. It amends ACA Section 1311(c) to establish a verification process for new enrollments and coverage changes submitted by agents or brokers, effective no later than January 1, 2028. The verification process requires documentation to establish consent for enrollment changes and delays commission payments until inconsistencies are resolved. It amends ACA Section 1312(e) to allow States to regulate field marketing organizations and third-party marketing organizations. The Secretary will establish criteria for States to determine whether to allow these organizations to participate in the enrollment chain, requiring adherence to a standard of conduct and marketing requirements. The Secretary is directed to implement a process for oversight and enforcement, including periodic audits of agents and brokers.

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To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.

Q: What does Preamble of To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes. do?

This bill, formally titled 'To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes,' aims to modify the enhanced premium tax credit. The bill is referred to the Committee on Ways and Means and the Committee on Energy and Commerce.

Q: What does TEMPORARY PREMIUM PERCENTAGES FOR 2026 AND 2027. of To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes. do?

This section amends Section 36B(b)(3)(A)(iii) of the Internal Revenue Code of 1986 to establish temporary premium percentages for the years 2026 and 2027. The amendments introduce a table specifying initial and final premium percentages based on household income tiers, expressed as a percentage of poverty line. Income tiers range from up to 150 percent to 600 percent of the poverty line, with corresponding premium percentages. Section 36B(c)(1)(E) of the Internal Revenue Code is also amended to substitute '600 percent' for '400 percent' for the years 2026 and 2027. These amendments apply to taxable years beginning after December 31, 2025.

Q: What does IMPROVING RISK ADJUSTMENT UNDER MEDICARE ADVANTAGE. of To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes. do?

This section modifies risk adjustment methodologies under Medicare Advantage. Beginning in 2026, the Secretary is required to use two years of diagnostic data when available. Diagnoses collected from chart reviews and health risk assessments will be excluded from consideration when establishing payment adjustment factors. The Secretary must establish procedures to identify and verify diagnoses collected from chart reviews and health risk assessments. The Secretary will evaluate the impact of coding pattern differences between Medicare Advantage plans and Parts A and B providers and publicly report the results.

Last updated: 11/10/2025 · Introduced: 11/10/2025

Author: Sam Liccardo (D-CA)

TL;DR (AI)

The bill modifies the Affordable Care Act’s premium tax credit for 2026 and 2027, establishing temporary premium percentages based on household income tiers up to 600% of the poverty line.
To improve Medicare Advantage risk adjustment, the bill requires the use of two years of diagnostic data and excludes certain data sources, while also mandating an evaluation of coding pattern differences.
The bill introduces civil and criminal penalties for agents and brokers who provide false or fraudulent information during enrollment in qualified health plans, and establishes a verification process for new enrollments and coverage changes.

119th Congressin committeeS. 976(In Committee)Official page

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Includes provisions on preamble, temporary premium percentages for 2026 and 2027., and 2 more.

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