[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2197 Introduced in Senate (IS)]
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114th CONGRESS
1st Session
S. 2197
To amend title XVIII of the Social Security Act to improve the risk
adjustment under the Medicare Advantage program, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 22, 2015
Mr. Crapo (for himself, Mr. Bennet, and Mr. Isakson) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve the risk
adjustment under the Medicare Advantage program, 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 ``Securing Care for Seniors Act of
2015''.
SEC. 2. 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 two
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 conduct statistical
analyses on 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
results of the analyses 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
subclauses (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. 3. 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.
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