I 

112TH CONGRESS 

2D SESSION H. R. 4254 

To amend title XVIII of the Social Security Act to enhance Medicare 

Advantage program integrity. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 22, 2012 

Mr. STARK introduced the following bill; which was referred to the Committee 

on Ways and Means, and in addition to the Committee on Energy and 

Commerce, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to enhance 

Medicare Advantage program integrity. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Advantage 

5 Program Integrity Act of 2012’’. 


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1 SEC. 2. MEDICARE ADVANTAGE CODING INTENSITY AD2 JUSTMENT. 

3 Section 1853(a)(1)(C)(ii)(III) of the Social Security 

4 Act (42 U.S.C. 1395w–23(a)(1)(C)(ii)(III)) is amended to 

5 read as follows: 

6 ‘‘(III) In calculating each year’s ad7 justment, the adjustment factor shall be 

8 for 2014, not less than the adjustment fac9 tor applied for 2010, plus 1.3 percentage 

10 points; for each of years 2015 through 

11 2018, not less than the adjustment factor 

12 applied for the previous year, plus 0.6 per13 centage point; and for 2019 and each sub14 sequent year, not less than 7.1 percent.’’. 

15 SEC. 3. IMPLEMENTATION OF OFFICE OF INSPECTOR GEN16 ERAL RECOMMENDATION TO DELAY CERTAIN 

17 MEDICARE PLAN PREPAYMENTS. 

18 (a) MEDICARE ADVANTAGE PAYMENTS.—Section 

19 1853(a)(1) of the Social Security Act (42 U.S.C. 1395w– 

20 23(a)(1)) is amended— 

21 (1) in subparagraph (A), in the matter pre22 ceding clause (i)— 

23 (A) by striking ‘‘subsections (e), (g), (i), 

24 and (l)’’ and inserting ‘‘subparagraph (I), sub25 sections (e), (g), (i), and (l),’’; and 


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1 (B) by inserting ‘‘(or, for months begin2 ning with January 2013, on the date specified 

3 in subparagraph (I))’’ after ‘‘in advance’’; and 

4 (2) by adding at the end the following new sub5 paragraph: 

6 ‘‘(I) TIMING OF PAYMENTS.— 

7 ‘‘(i) IN GENERAL.—With respect to 

8 monthly payments under this section for 

9 months beginning with January 2013, sub10 ject to clause (ii), the date specified in this 

11 subparagraph with respect to a payment 

12 for— 

13 ‘‘(I) January is January 2nd; 

14 ‘‘(II) February is February 15th; 

15 ‘‘(III) March is March 30th; and 

16 ‘‘(IV) April or any succeeding 

17 month in a year is the 15th day of the 

18 2nd succeeding month. 

19 ‘‘(ii) HOLIDAYS, WEEKENDS, ETC.—If 

20 the date otherwise specified in clause (i) is 

21 a holiday or weekend, the date specified in 

22 this subparagraph shall be the first week23 day before such date.’’. 

24 (b) APPLICATION UNDER PART D.—Section 1860D– 

25 15(d)(1) of the Social Security Act (42 U.S.C. 1395w– 


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1 115(d)(1)) is amended by inserting ‘‘and shall be made 

2 consistent with the timing of monthly payments to MA 

3 organizations under section 1853(a)(1)(I)’’ after ‘‘as the 

4 Secretary determines’’. 

Æ 


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