[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2582 Referred in Senate (RFS)]
114th CONGRESS
1st Session
H. R. 2582
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 18, 2015
Received; read twice and referred to the Committee on Finance
_______________________________________________________________________
AN ACT
To amend title XVIII of the Social Security Act to delay the authority
to terminate Medicare Advantage contracts for MA plans failing to
achieve minimum quality ratings, to make improvements to the Medicare
Adjustment risk adjustment system, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Seniors' Health Care Plan Protection
Act of 2015''.
SEC. 2. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR MEDICARE
ADVANTAGE PLANS FAILING TO ACHIEVE MINIMUM QUALITY
RATINGS.
(a) Findings.--Consistent with the studies provided under the
IMPACT Act of 2014 (Public Law 113-185), it is the intent of Congress--
(1) to continue to study and request input on the effects
of socioeconomic status and dual-eligible populations on the
Medicare Advantage STARS rating system before reforming such
system with the input of stakeholders; and
(2) pending the results of such studies and input, to
provide for a temporary delay in authority of the Centers for
Medicare & Medicaid Services (CMS) to terminate Medicare
Advantage plan contracts solely on the basis of performance of
plans under the STARS rating system.
(b) Delay in MA Contract Termination Authority for Plans Failing To
Achieve Minimum Quality Ratings.--Section 1857(h) of the Social
Security Act (42 U.S.C. 1395w-27(h)) is amended by adding at the end
the following new paragraph:
``(3) Delay in contract termination authority for plans
failing to achieve minimum quality rating.--The Secretary may
not terminate a contract under this section with respect to the
offering of an MA plan by a Medicare Advantage organization
solely because the MA plan has failed to achieve a minimum
quality rating under the 5-star rating system established under
section 1853(o) during the period beginning on the date of the
enactment of this paragraph and through the end of plan year
2018.''.
SEC. 3. IMPROVEMENTS TO MA RISK ADJUSTMENT SYSTEM.
Section 1853(a)(1)(C) of the Social Security Act (42 U.S.C. 1395w-
23(a)(1)(C)) is amended by adding at the end the following new clauses:
``(iv) Evaluation and subsequent revision
of the risk adjustment system to account for
chronic conditions and other factors for the
purpose of making the risk adjustment system
more accurate, transparent, and regularly
updated.--
``(I) Revision based on number of
chronic conditions.--The Secretary
shall revise for 2017 and periodically
thereafter, the risk adjustment system
under this subparagraph so that a risk
score under such system, with respect
to an individual, takes into account
the number of chronic conditions with
which the individual has been
diagnosed.
``(II) Evaluation of different risk
adjustment models.--The Secretary shall
evaluate the impact of including 2
years of data to compare the models
used to determine risk scores for 2013
and 2014 under such system.
``(III) Evaluation and analysis on
chronic kidney disease (ckd) codes.--
The Secretary shall evaluate the impact
of removing the diagnosis codes related
to chronic kidney disease in the 2014
risk adjustment model and conduct an
analysis of best practices of MA plans
to slow disease progression related to
chronic kidney disease.
``(IV) Evaluation and
recommendations on use of encounter
data.--The Secretary shall evaluate the
impact of including 10 percent of
encounter data in computing payment for
2016 and the readiness of the Centers
for Medicare & Medicaid Services to
incorporate encounter data in risk
scores. In conducting such evaluation,
the Secretary shall use data collected
as encounter data on or after January
1, 2012, shall analyze such data for
accuracy and completeness and issue
recommendations for improving such
accuracy and completeness, and shall
not increase the percentage of such
encounter data used unless the
Secretary releases the data publicly,
indicates how such data will be
weighted in computing the risk scores,
and ensures that the data reflects the
degree and cost of care coordination
under MA plans.
``(V) Conduct of evaluations.--
Evaluations and analyses under
subclause (II) through (IV) shall
include an actuarial opinion from the
Chief Actuary of the Centers for
Medicare & Medicaid Services about the
reasonableness of the methods,
assumptions, and conclusions of such
evaluations and analyses. The Secretary
shall consult with the Medicare Payment
Advisory Commission and accept and
consider comments of stakeholders, such
as managed care organizations and
beneficiary groups, on such evaluation
and analyses. The Secretary shall
complete such evaluations and analyses
in a manner that permits the results to
be applied for plan years beginning
with the second plan year that begins
after the date of the enactment of this
clause.
``(VI) Implementation of revisions
based on evaluations.--If the Secretary
determines, based on such an evaluation
or analysis, that revisions to the risk
adjustment system to address the
matters described in any of subclauses
(II) through (IV) would make the risk
adjustment system under this
subparagraph better reflect and
appropriately weight for the population
that is served by the plan, the
Secretary shall, beginning with 2017,
and periodically thereafter, make such
revisions.
``(VII) Periodic reporting to
congress.--With respect to plan years
beginning with 2017 and every third
year thereafter, the Secretary shall
submit to Congress a report on the most
recent revisions (if any) made under
this clause, including the evaluations
conducted under subclauses (II) through
(IV).
``(v) No changes to adjustment factors that
prevent activities consistent with national
health policy goals.--In making any changes to
the adjustment factors, including adjustment
for health status under paragraph (3), the
Secretary shall ensure that the changes do not
prevent Medicare Advantage organizations from
performing or undertaking activities that are
consistent with national health policy goals,
including activities to promote early detection
and better care coordination, the use of health
risk assessments, care plans, and programs to
slow the progression of chronic diseases.
``(vi) Opportunity for review and public
comment regarding changes to adjustment
factors.--For changes to adjustment factors
effective for 2017 and subsequent years, in
addition to providing notice of such changes in
the announcement under subsection (b)(2), the
Secretary shall provide an opportunity for
review of proposed changes of not less than 60
days and a public comment period of not less
than 30 days before implementing such
changes.''.
SEC. 4. SENSE OF CONGRESS RELATING TO MEDICARE ADVANTAGE STAR RATING
SYSTEM.
It is the sense of Congress that--
(1) the Centers for Medicare & Medicaid Services has
inadvertently created a star rating system under section
1853(o)(4) of the Social Security Act (42 U.S.C. 1395w-
23(o)(4)) for Medicare Advantage plans that lacks proper
accounting for the socioeconomic status of enrollees in such
plans and the extent to which such plans serve individuals who
are also eligible for medical assistance under title XIX of
such Act; and
(2) Congress will work with the Centers for Medicare &
Medicaid Services and stakeholders, including beneficiary
groups and managed care organizations, to ensure that such
rating system properly accounts for the socioeconomic status of
enrollees in such plans and the extent to which such plans
serve such individuals described in paragraph (1).
SEC. 5. SENSE OF CONGRESS RELATING TO MEDICARE ADVANTAGE RISK
ADJUSTMENT.
It is the sense of Congress that--
(1) the Secretary of Health and Human Services should
periodically monitor and improve the Medicare Advantage risk
adjustment model to ensure that it accurately accounts for
beneficiary risk, including for those individuals with complex
chronic comorbid conditions;
(2) the Secretary should closely examine the current
Medicare Advantage risk adjustment methodology to ensure that
plans enrolling beneficiaries with the greatest health care
needs receive adequate reimbursement to deliver high-quality
care and other services to help beneficiaries avoid costly
complications and further progression of chronic conditions and
to the extent data indicate this to be the case, the Secretary
should make necessary adjustment to the risk adjustment
methodology; and
(3) the Secretary should reconsider the implementation of
changes in the Medicare Advantage risk adjustment methodology
finalized for 2016 and to use to the extent appropriate the
methodology finalized in 2015 for one additional year.
Passed the House of Representatives June 17, 2015.
Attest:
KAREN L. HAAS,
Clerk.