I 

113TH CONGRESS 

1ST SESSION H. R. 2753 

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

Advantage, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 19, 2013 

Mrs. BLACK 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 improve 

Medicare Advantage, and for other purposes. 

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 ‘‘Securing Care for Sen5 iors Act of 2013’’. 


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1 SEC. 2. REINSTATEMENT OF 3-MONTH OPEN ENROLLMENT 

2 AND DISENROLLMENT PERIOD FOR MEDI3 CARE ADVANTAGE. 

4 Section 1851(e)(2) of the Social Security Act (42 

5 U.S.C. 1395w–1(e)(2)) is amended— 

6 (1) in subparagraph (C), by inserting ‘‘and end7 ing with 2013’’ after ‘‘(beginning with 2011’’; and 

8 (2) by adding at the end the following new sub9 paragraph: 

10 ‘‘(F) CONTINUOUS OPEN ENROLLMENT

11 AND DISENROLLMENT FOR FIRST 3 MONTHS IN

12 SUBSEQUENT YEARS.— 

13 ‘‘(i) IN GENERAL.—Subject to sub14 paragraph (D), at any time during the 

15 first 3 months of a year (beginning with 

16 2014), or, if the individual first becomes a 

17 Medicare Advantage eligible individual dur18 ing a year after 2014, during the first 3 

19 months of such year in which the indi20 vidual is a Medicare Advantage eligible in21 dividual, a Medicare Advantage eligible in22 dividual may change the election under 

23 subsection (a)(1). 

24 ‘‘(ii) LIMITATION OF ONE CHANGE

25 DURING OPEN ENROLLMENT PERIOD EACH

26 YEAR.—An individual may exercise the 


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1 right under clause (i) only once during the 

2 applicable 3-month period described in 

3 such clause in each year. The limitation 

4 under this clause shall not apply to 

5 changes in elections effected during an an6 nual, coordinated election period under 

7 paragraph (3) or during a special election 

8 period under paragraph (4). 

9 ‘‘(iii) APPLICATION TO PART D FOR

10 INDIVIDUALS CHANGING ENROLLMENT

11 FROM MA TO FEE-FOR-SERVICE.—The pre12 vious provisions of this subparagraph shall 

13 only apply with respect to changes in en14 rollment in a prescription drug plan under 

15 part D in the case of an individual who, 

16 previous to such change in enrollment, is 

17 enrolled in a Medicare Advantage plan.’’. 

18 SEC. 3. PERMITTING INCENTIVES FOR PARTICIPATION IN 

19 HEALTH CARE IMPROVEMENT PROGRAMS. 

20 (a) IN GENERAL.—Section 1859 of the Social Secu21 rity Act (42 U.S.C. 1395w–28) is amended by adding at 

22 the end the following new subsection: 

23 ‘‘(h) PERMITTING MA ORGANIZATIONS TO PROVIDE

24 INCENTIVES FOR PARTICIPATION IN HEALTH CARE IM25 PROVEMENT PROGRAMS.— 


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1 ‘‘(1) IN GENERAL.—An MA organization may 

2 offer to individuals enrolled in an MA plan offered 

3 by such organization one or more incentive programs 

4 that are designed to improve the health care of such 

5 individuals by providing one or more incentives, such 

6 as the reducing or waiving of copayment amounts, 

7 that reward individuals for participation in such a 

8 program, if— 

9 ‘‘(A) the incentive program meets the re10 quirements described in paragraph (2); and 

11 ‘‘(B) the MA organization provides to the 

12 Secretary such information on participation and 

13 performance in the incentive program as the 

14 Secretary may specify. 

15 ‘‘(2) REQUIREMENTS.—The requirements de16 scribed in this paragraph, with respect to an incen17 tive program offered by an MA organization to indi18 viduals enrolled in an MA plan offered by such orga19 nization, are as follows: 

20 ‘‘(A) INCENTIVE ONLY UPON COMPLETION

21 OF PROGRAM.—In the case of a program that 

22 consists of multiple sessions or other multiple 

23 activities, any incentive offered under the pro24 gram is offered only upon completion of all such 

25 sessions or activities. 


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1 ‘‘(B) NONDISCRIMINATION.—Participation 

2 in the program is offered to all such individuals. 

3 ‘‘(C) NO CASH OR MONETARY INCEN4 TIVE.— 

5 ‘‘(i) IN GENERAL.—No incentive 

6 under the program is in the form of cash 

7 or any other monetary rebate. 

8 ‘‘(ii) CONSTRUCTION.—Nothing in 

9 clause (i) may be construed as preventing 

10 the offering of an incentive in the form of 

11 a reduction or waiver of copayment 

12 amounts or deductibles. 

13 ‘‘(3) WAIVER AUTHORITY.—The Secretary may 

14 waive such requirements of this title and title XI, 

15 except for sections 1128A, 1128B(b), and 1877, as 

16 may be necessary to carry out the purposes of the 

17 program established under this subsection. 

18 ‘‘(4) PROGRAM NOT TAKEN INTO ACCOUNT FOR

19 BID AMOUNT.—The program may not be taken into 

20 account for purposes of the monthly bid amount 

21 submitted by the organization under section 

22 1854(a)(6) and provisions relating to the monthly 

23 bid amount. 

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1 TIES.—An MA organization may, as part of an in2 centive program offered by such organization to indi3 viduals under this subsection, require or otherwise 

4 encourage such individuals to participate in activities 

5 designed to improve the health care of such individ6 uals that are offered by persons or entities specified 

7 by such organization, such as persons or entities 

8 that the organization has identified as performing 

9 well on quality metrics identified by the organiza10 tion.’’. 

11 (b) EFFECTIVE DATE.—The amendment made by 

12 subsection (a) shall take effect for plan years beginning 

13 on or after the date of the enactment of this Act. 

14 SEC. 4. COST SHARING VARIATION PERMITTED TO EN15 COURAGE USE OF HIGH QUALITY PRO16 VIDERS. 

17 Section 1852 of the Social Security Act (42 U.S.C. 

18 1395w–22) is amended— 

19 (1) in subsection (a)(1)(B)— 

20 (A) in clause (i), by striking ‘‘clause (iii)’’ 

21 and inserting ‘‘clauses (iii) and (vi)’’; and 

22 (B) by adding at the end the following new 

23 clause: 

24 ‘‘(vi) COST SHARING VARIATION PER25 MITTED TO ENCOURAGE USE OF HIGH


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1 QUALITY PROVIDERS.—Notwithstanding 

2 subsection (b), an MA plan offered by an 

3 MA organization may, through mecha4 nisms such as value based insurance design 

5 (VBID) practices, vary cost-sharing for the 

6 purpose of encouraging enrollees to use 

7 providers that such organization has iden8 tified as performing well on quality metrics 

9 identified by the organization. Any such 

10 variation on cost-sharing by an MA organi11 zation must occur on an annual basis. An 

12 MA organization may not vary cost-sharing 

13 pursuant to this paragraph during a plan 

14 year.’’; and 

15 (2) in subsection (b)(2), by striking ‘‘A 

16 Medicare+Choice’’ and inserting ‘‘Subject to sub17 section (a)(1)(B)(vi), a Medicare Advantage’’. 

18 SEC. 5. IMPROVEMENTS TO RISK ADJUSTMENT SYSTEM. 

19 Section 1853(a)(1)(C) of the Social Security Act (42 

20 U.S.C. 1395w–23(a)(1)(C)) is amended by adding at the 

21 end the following new clauses: 

22 ‘‘(iv) REVISION OF RISK ADJUSTMENT

23 SYSTEM TO ACCOUNT FOR CHRONIC CONDI24 TIONS AND TWO YEARS OF DIAGNOSTIC

25 DATA.— 


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1 ‘‘(I) IN GENERAL.—The Sec2 retary shall evaluate and, as the Sec3 retary determines appropriate, revise 

4 for 2017 and periodically thereafter 

5 the risk adjustment system under this 

6 subparagraph so that a risk score 

7 under such system, with respect to an 

8 individual, takes into account the 

9 number of chronic conditions with 

10 which the individual has been diag11 nosed, and at least two years of diag12 nostic data including such data ob13 tained during health risk assessments 

14 regarding the individual, to the extent 

15 that two years of such data are avail16 able. 

17 ‘‘(II) PERIODIC REPORTING TO

18 CONGRESS.—With respect to plan 

19 years beginning in 2017 and every 

20 third year thereafter, the Secretary 

21 shall submit to Congress a report on 

22 the most recent revisions (if any) 

23 made under subclause (I). 

24 ‘‘(v) NO CHANGES TO ADJUSTMENT

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1 SISTENT WITH NATIONAL HEALTH POLICY

2 GOALS.—In making any changes to the ad3 justment factors, including adjustment for 

4 health status under paragraph (3), the 

5 Secretary shall ensure that the changes do 

6 not prevent MA organizations from per7 forming or undertaking activities that are 

8 consistent with national health policy 

9 goals, including activities to promote early 

10 detection and better care coordination, the 

11 use of health risk assessments, care plans, 

12 and programs to slow the progression of 

13 chronic diseases. 

14 ‘‘(vi) OPPORTUNITY FOR REVIEW AND

15 PUBLIC COMMENT REGARDING CHANGES

16 TO ADJUSTMENT FACTORS.—For any 

17 changes to adjustment factors effective for 

18 2015 and subsequent years, in addition to 

19 providing notice of such changes in the an20 nouncement under subsection (b)(2), the 

21 Secretary shall provide an opportunity for 

22 review of proposed changes and a public 

23 comment period of not less than 60 days 

24 before implementing such changes.’’. 


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

2 SYSTEM. 

3 Section 1853(o)(4) of the Social Security Act (42 

4 U.S.C. 1395w–23(o)(4)) is amended by adding at the end 

5 the following new subparagraph: 

6 ‘‘(C) PLANS WITH DISPROPORTIONATELY

7 HIGH ENROLLMENT OF INDIVIDUALS WITH

8 COMPLEX HEALTH CARE NEEDS.— 

9 ‘‘(i) IN GENERAL.—The Secretary 

10 shall take such steps as are necessary to 

11 ensure that the 5-star rating system de12 scribed in subparagraph (A)— 

13 ‘‘(I) does not disadvantage a plan 

14 that enrolls a disproportionately high 

15 proportion of enrollees who are full16 benefit dual eligible individuals (as de17 fined in section 1935(c)(6)), subsidy 

18 eligible individuals (as defined in sec19 tion 1860D–14(a)(3)), or other indi20 viduals with complex health care 

21 needs such as individuals with mul22 tiple conditions; and 

23 ‘‘(II) allows adjustments to ac24 count for differences in socioeconomic 

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1 rollees and geographic variation in 

2 health outcomes. 

3 ‘‘(D) ANNOUNCEMENT OF CHANGES TWO

4 YEARS PRIOR TO END OF PERFORMANCE PE5 RIOD.—The Secretary may not implement any 

6 change in the 5-star rating system described in 

7 subparagraph (A) with respect to any perform8 ance period used as part of such system unless 

9 the Secretary announces such change at least 

10 one year prior to the beginning of any such pe11 riod.’’. 

Æ 


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