Securing Care for Seniors Act of 2013

Summary: Securing Care for Seniors Act of 2013 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act to terminate after 2013 the permission to disenroll, between January 1 and March 15 of each year, only from a MedicareAdvantage (MA) plan to elect enrollment in the original Medicare fee-for-service program.  Restores the option under previous law to elect to change from an MA plan to the original Medicare fee-for-service plan, or from the original Medicare fee-for-service to an MA plan, once a year during the first three months. Permits an MA organization to offer individuals enrolled in one of its MA plans one or more incentive programs designed to improve their health care. Permits an MA plan, through mechanisms such as value based insurance design (VBID) practices, to vary cost sharing for the purpose of encouraging enrollees to use providers that the MA organization has identified as performing well on quality metrics. Directs the Secretary of Health and Human Services (HHS) to evaluate and, as appropriate, revise for 2017 and periodically thereafter the risk adjustment system so that a risk score, with respect to an individual, takes into account the number of chronic conditions with which the individual has been diagnosed, and, to the extent available, at least two years of diagnostic data including data obtained during the individual's health risk assessments. Requires the Secretary to take steps necessary to ensure that the MA 5-star rating system: (1) does not disadvantage a plan that enrolls a disproportionately high proportion of enrollees who are full-benefit dual eligible individuals, subsidy eligible individuals, or other individuals with complex health care needs such as individuals with multiple conditions; and (2) allows adjustments to account for differences in socioeconomic and demographic characteristics of enrollees and geographic variation in health outcomes.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Securing Care for Seniors Act of 
2013''.

SEC. 2. REINSTATEMENT OF 3-MONTH OPEN ENROLLMENT AND DISENROLLMENT 
              PERIOD FOR MEDICARE ADVANTAGE.

    Section 1851(e)(2) of the Social Security Act (42 U.S.C. 1395w-
1(e)(2)) is amended--
            (1) in subparagraph (C), by inserting ``and ending with 
        2013'' after ``(beginning with 2011''; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) Continuous open enrollment and disenrollment 
                for first 3 months in subsequent years.--
                            ``(i) In general.--Subject to subparagraph 
                        (D), at any time during the first 3 months of a 
                        year (beginning with 2014), or, if the 
                        individual first becomes a Medicare Advantage 
                        eligible individual during a year after 2014, 
                        during the first 3 months of such year in which 
                        the individual is a Medicare Advantage eligible 
                        individual, a Medicare Advantage eligible 
                        individual may change the election under 
                        subsection (a)(1).
                            ``(ii) Limitation of one change during open 
                        enrollment period each year.--An individual may 
                        exercise the right under clause (i) only once 
                        during the applicable 3-month period described 
                        in such clause in each year. The limitation 
                        under this clause shall not apply to changes in 
                        elections effected during an annual, 
                        coordinated election period under paragraph (3) 
                        or during a special election period under 
                        paragraph (4).
                            ``(iii) Application to part d for 
                        individuals changing enrollment from ma to fee-
                        for-service.--The previous provisions of this 
                        subparagraph shall only apply with respect to 
                        changes in enrollment in a prescription drug 
                        plan under part D in the case of an individual 
                        who, previous to such change in enrollment, is 
                        enrolled in a Medicare Advantage plan.''.

SEC. 3. PERMITTING INCENTIVES FOR PARTICIPATION IN HEALTH CARE 
              IMPROVEMENT PROGRAMS.

    (a) In General.--Section 1859 of the Social Security Act (42 U.S.C. 
1395w-28) is amended by adding at the end the following new subsection:
    ``(h) Permitting MA Organizations To Provide Incentives for 
Participation in Health Care Improvement Programs.--
            ``(1) In general.--An MA organization may offer to 
        individuals enrolled in an MA plan offered by such organization 
        one or more incentive programs that are designed to improve the 
        health care of such individuals by providing one or more 
        incentives, such as the reducing or waiving of copayment 
        amounts, that reward individuals for participation in such a 
        program, if--
                    ``(A) the incentive program meets the requirements 
                described in paragraph (2); and
                    ``(B) the MA organization provides to the Secretary 
                such information on participation and performance in 
                the incentive program as the Secretary may specify.
            ``(2) Requirements.--The requirements described in this 
        paragraph, with respect to an incentive program offered by an 
        MA organization to individuals enrolled in an MA plan offered 
        by such organization, are as follows:
                    ``(A) Incentive only upon completion of program.--
                In the case of a program that consists of multiple 
                sessions or other multiple activities, any incentive 
                offered under the program is offered only upon 
                completion of all such sessions or activities.
                    ``(B) Nondiscrimination.--Participation in the 
                program is offered to all such individuals.
                    ``(C) No cash or monetary incentive.--
                            ``(i) In general.--No incentive under the 
                        program is in the form of cash or any other 
                        monetary rebate.
                            ``(ii) Construction.--Nothing in clause (i) 
                        may be construed as preventing the offering of 
                        an incentive in the form of a reduction or 
                        waiver of copayment amounts or deductibles.
            ``(3) Waiver authority.--The Secretary may waive such 
        requirements of this title and title XI, except for sections 
        1128A, 1128B(b), and 1877, as may be necessary to carry out the 
        purposes of the program established under this subsection.
            ``(4) Program not taken into account for bid amount.--The 
        program may not be taken into account for purposes of the 
        monthly bid amount submitted by the organization under section 
        1854(a)(6) and provisions relating to the monthly bid amount.
            ``(5) Encouragement to participate in activities offered by 
        certain persons or entities.--An MA organization may, as part 
        of an incentive program offered by such organization to 
        individuals under this subsection, require or otherwise 
        encourage such individuals to participate in activities 
        designed to improve the health care of such individuals that 
        are offered by persons or entities specified by such 
        organization, such as persons or entities that the organization 
        has identified as performing well on quality metrics identified 
        by the organization.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect for plan years beginning on or after the date of the 
enactment of this Act.

SEC. 4. COST SHARING VARIATION PERMITTED TO ENCOURAGE USE OF HIGH 
              QUALITY PROVIDERS.

    Section 1852 of the Social Security Act (42 U.S.C. 1395w-22) is 
amended--
            (1) in subsection (a)(1)(B)--
                    (A) in clause (i), by striking ``clause (iii)'' and 
                inserting ``clauses (iii) and (vi)''; and
                    (B) by adding at the end the following new clause:
                            ``(vi) Cost sharing variation permitted to 
                        encourage use of high quality providers.--
                        Notwithstanding subsection (b), an MA plan 
                        offered by an MA organization may, through 
                        mechanisms such as value based insurance design 
                        (VBID) practices, vary cost-sharing for the 
                        purpose of encouraging enrollees to use 
                        providers that such organization has identified 
                        as performing well on quality metrics 
                        identified by the organization. Any such 
                        variation on cost-sharing by an MA organization 
                        must occur on an annual basis. An MA 
                        organization may not vary cost-sharing pursuant 
                        to this paragraph during a plan year.''; and
            (2) in subsection (b)(2), by striking ``A Medicare+Choice'' 
        and inserting ``Subject to subsection (a)(1)(B)(vi), a Medicare 
        Advantage''.

SEC. 5. IMPROVEMENTS TO 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) Revision of risk adjustment system 
                        to account for chronic conditions and two years 
                        of diagnostic data.--
                                    ``(I) In general.--The Secretary 
                                shall evaluate and, as the Secretary 
                                determines appropriate, 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, and 
                                at least two years of diagnostic data 
                                including such data obtained during 
                                health risk assessments regarding the 
                                individual, to the extent that two 
                                years of such data are available.
                                    ``(II) Periodic reporting to 
                                congress.--With respect to plan years 
                                beginning in 2017 and every third year 
                                thereafter, the Secretary shall submit 
                                to Congress a report on the most recent 
                                revisions (if any) made under subclause 
                                (I).
                            ``(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 MA 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 any changes to adjustment factors 
                        effective for 2015 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 and a public comment 
                        period of not less than 60 days before 
                        implementing such changes.''.

SEC. 6. IMPROVEMENTS TO MA 5-STAR QUALITY RATING SYSTEM.

    Section 1853(o)(4) of the Social Security Act (42 U.S.C. 1395w-
23(o)(4)) is amended by adding at the end the following new 
subparagraph:
                    ``(C) Plans with disproportionately high enrollment 
                of individuals with complex health care needs.--
                            ``(i) In general.--The Secretary shall take 
                        such steps as are necessary to ensure that the 
                        5-star rating system described in subparagraph 
                        (A)--
                                    ``(I) does not disadvantage a plan 
                                that enrolls a disproportionately high 
                                proportion of enrollees who are full-
                                benefit dual eligible individuals (as 
                                defined in section 1935(c)(6)), subsidy 
                                eligible individuals (as defined in 
                                section 1860D-14(a)(3)), or other 
                                individuals with complex health care 
                                needs such as individuals with multiple 
                                conditions; and
                                    ``(II) allows adjustments to 
                                account for differences in 
                                socioeconomic and demographic 
                                characteristics of enrollees and 
                                geographic variation in health 
                                outcomes.
                    ``(D) Announcement of changes two years prior to 
                end of performance period.--The Secretary may not 
                implement any change in the 5-star rating system 
                described in subparagraph (A) with respect to any 
                performance period used as part of such system unless 
                the Secretary announces such change at least one year 
                prior to the beginning of any such period.''.