II 

114TH CONGRESS 

1ST SESSION S. 2104 

To amend title XVIII of the Social Security Act to provide relief to Medicare 

Advantage plans with a significant number of dually eligible or lowincome subsidy beneficiaries and to prevent the termination of two star 

plans. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 30, 2015 

Mr. PORTMAN (for himself and Mr. CASEY) 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 provide 

relief to Medicare Advantage plans with a significant 

number of dually eligible or low-income subsidy beneficiaries and to prevent the termination of two star plans. 

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 ‘‘Preserving Medicare 

5 Advantage for all Medicare Beneficiaries Act of 2015’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) In the IMPACT Act of 2014 (Public Law 

2 113–185), Congress recognized the potential effects 

3 of socioeconomic status and dual eligible populations 

4 on the Medicare Advantage STARS rating system 

5 by requesting the Assistant Secretary of Planning 

6 and Evaluation in the Department of Health and 

7 Human Services undertake studies on this popu8 lation and the Medicare program. 

9 (2) Studies published in the past year have 

10 shown the need for an interim policy until the com11 prehensive results of the studies undertaken as part 

12 of the IMPACT Act of 2014 are published. An ad13 justment for 2016 is necessary while Congress con14 tinues to work to achieve an appropriate policy for 

15 a temporary bridge until the results from the studies 

16 undertaken by the Assistant Secretary of Planning 

17 and Evaluation in the Department of Health and 

18 Human Services under such Act are finalized. 

19 SEC. 3. DELAY IN AUTHORITY TO TERMINATE CONTRACTS 

20 FOR CERTAIN MEDICARE ADVANTAGE PLANS 

21 FAILING TO ACHIEVE MINIMUM QUALITY 

22 RATINGS. 

23 Section 1857(h) of the Social Security Act (42 U.S.C. 

24 1395w–27(h)) is amended by adding at the end the fol25 lowing new paragraph: 


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1 ‘‘(3) DELAY IN CONTRACT TERMINATION AU2 THORITY FOR CERTAIN PLANS FAILING TO ACHIEVE

3 MINIMUM QUALITY RATING.— 

4 ‘‘(A) IN GENERAL.—Subject to subpara5 graph (B), the Secretary may not terminate a 

6 contract under this section with respect to the 

7 offering of an MA plan by a Medicare Advan8 tage organization solely because the MA plan 

9 has failed to achieve a minimum quality rating 

10 under the 5-star rating system established 

11 under section 1853(o) during the period begin12 ning on the date of the enactment of this para13 graph and through the end of plan year 2018. 

14 ‘‘(B) APPLICATION ONLY TO PLANS RE15 CEIVING A QUALITY RATING OF AT LEAST 2

16 STARS.—Subparagraph (A) shall only apply 

17 with respect to a contract with respect to the 

18 offering of an MA plan that has a quality rat19 ing under section 1853(o)(4) of at least 2 stars 

20 for the most recent plan year.’’. 

21 SEC. 4. DEMONSTRATION PROJECT TO DIRECT QUALITY 

22 IMPROVEMENT PROGRAMS TO ADDRESS SO23 CIOECONOMIC STATUS DISPARITIES IN MEDI24 CARE ADVANTAGE PLANS. 

25 (a) ESTABLISHMENT.— 


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1 (1) IN GENERAL.—The Secretary of Health and 

2 Human Services (in this section referred to as the 

3 ‘‘Secretary’’) shall establish a demonstration project 

4 under this section to provide funds to MA organiza5 tions offering one or more qualified MA plans for 

6 use in developing or expanding programs or services 

7 with respect to such plans that seek to improve 

8 health care delivery and outcomes of care for enroll9 ees with low socioeconomic status. 

10 (2) DURATION.—The demonstration project 

11 under this section shall be conducted for a period of 

12 1 year beginning in plan year 2016. 

13 (b) DEFINITIONS.—In this section: 

14 (1) MA ORGANIZATION; MA PLAN.—The terms 

15 ‘‘MA organization’’ and ‘‘MA plan’’ have the mean16 ing given such terms in subsections (a)(1) and 

17 (b)(1), respectively, of section 1859 of the Social Se18 curity Act (42 U.S.C. 1395w–28). 

19 (2) QUALIFIED MA PLAN.— 

20 (A) The term ‘‘qualified MA plan’’ means 

21 an MA plan described in subparagraph (B) or 

22 (C). 

23 (B) An MA plan is described in this sub24 paragraph if the MA plan meets each of the fol25 lowing criteria: 


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1 (i) The plan has a quality rating 

2 under section 1853(o)(4) of the Social Se3 curity Act (42 U.S.C. 1395w–23(o)(4)) of 

4 at least 3.25 stars but not more than 4 

5 stars for the most recent plan year. 

6 (ii) Not less than 45 percent of enroll7 ees in the plan are one or both of the fol8 lowing: 

9 (I) Eligible for a low income sub10 sidy under section 1860D–14 of such 

11 Act (42 U.S.C. 1395w–114). 

12 (II) Dually eligible for benefits 

13 under the Medicare program under 

14 title XVIII of such Act (42 U.S.C. 

15 1395 et seq.) and the Medicaid pro16 gram under title XIX of such Act (42 

17 U.S.C. 1396 et seq.). 

18 (C) An MA plan is described in this sub19 paragraph if the MA plan meets each of the fol20 lowing criteria: 

21 (i) The plan has a quality rating 

22 under section 1853(o)(4) of the Social Se23 curity Act (42 U.S.C. 1395w–23(o)(4)) of 

24 at least 3.0 stars but not more than 4 

25 stars for the most recent plan year. 


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1 (ii) Not less than 60 percent of enroll2 ees in the plan are one or both of the fol3 lowing: 

4 (I) Eligible for a low income sub5 sidy under section 1860D–14 of such 

6 Act (42 U.S.C. 1395w–114). 

7 (II) Dually eligible for benefits 

8 under the Medicare program under 

9 title XVIII of such Act (42 U.S.C. 

10 1395 et seq.) and the Medicaid pro11 gram under title XIX of such Act (42 

12 U.S.C. 1396 et seq.). 

13 (c) USE OF FUNDS.— 

14 (1) IN GENERAL.—Subject to paragraph (2), 

15 funds received under the demonstration project by 

16 an MA organization with respect to a qualified MA 

17 plan shall be used under the Quality Improvement 

18 Program of the organization under section 1852(e) 

19 of the Social Security Act (42 U.S.C. 1395w–22(e)) 

20 to target improvement by the qualified MA plan with 

21 respect to two or more triple-weighted measures 

22 under the 5-star rating system under section 

23 1853(o)(4) of such Act (42 U.S.C. 1395w–23(o)(4)). 

24 (2) FOCUS ON OUTCOME MEASURE.— 


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1 (A) IN GENERAL.—Except as provided in 

2 subparagraph (B), at least one of the measures 

3 targeted under paragraph (1) shall be an out4 come measure. 

5 (B) EXCEPTION.—An MA organization 

6 may apply to the Secretary for an exception to 

7 subparagraph (A) in order to focus on only 

8 process measures under this subsection. 

9 (d) INCLUSION IN ANNUAL QUALITY IMPROVEMENT

10 PROGRAM REPORT.—An MA organization receiving funds 

11 under the demonstration project shall include, as part of 

12 the annual report to the Secretary on the Quality Improve13 ment Program of the organization under such section 

14 1852(e) for each year of the demonstration project, with 

15 respect to each qualified MA plan offered by the organiza16 tion, the results of the targeting of plan improvement on 

17 measures under subsection (c) during the preceding year. 

18 (e) FUNDING.— 

19 (1) IN GENERAL.—For purposes of carrying out 

20 the demonstration project under this section, subject 

21 to paragraph (2), the Secretary shall provide for the 

22 transfer from the Federal Hospital Insurance Trust 

23 Fund under section 1817 of the Social Security Act 

24 (42 U.S.C. 1395i) and the Federal Supplementary 

25 Medical Insurance Trust Fund under section 1841 


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1 of such Act (42 U.S.C. 1395t), in such proportion 

2 as the Secretary determines appropriate, of an 

3 amount equal to the amount the Secretary deter4 mines is equal to the estimated total savings to the 

5 Medicare program as a result of the implementation 

6 of the amendment made by section 2 to the Centers 

7 for Medicare & Medicaid Services Program Manage8 ment Account. 

9 (2) ADMINISTRATION.—The Secretary may re10 tain up to 10 percent of the funds transferred under 

11 paragraph (1) to administer the demonstration 

12 project under this section and the remainder of such 

13 funds shall be distributed in accordance with this 

14 section to MA organizations offering qualified MA 

15 plans based on the enrollment in such plans of indi16 viduals described in each of subclauses (I) and (II) 

17 of subsections (b)(2)(B)(ii) and (b)(2)(C)(ii). 

18 (3) AVAILABILITY.—Amounts transferred under 

19 paragraph (1) shall remain available until expended. 

Æ 


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