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Union Calendar No. 116 

114TH CONGRESS 

1ST SESSION H. R. 2579 

[Report No. 114–160, Part I] 

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 HOUSE OF REPRESENTATIVES 

MAY 29, 2015 

Mrs. BLACK (for herself, Mr. BLUMENAUER, Mr. GUTHRIE, and Mr. 

LOEBSACK) 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 

JUNE 16, 2015 

Additional sponsor: Ms. SINEMA

JUNE 16, 2015 

Reported from the Committee on Ways and Means with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

JUNE 16, 2015 

The Committee on Energy and Commerce discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be 

printed 

[For text of introduced bill, see copy of bill as introduced on May 29, 2015] 


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•HR 2579 RH

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. 


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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 2015’’. 

6 SEC. 2. IMPROVEMENTS TO MA RISK ADJUSTMENT SYSTEM. 

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

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

9 end the following new clauses: 

10 ‘‘(iv) EVALUATION AND SUBSEQUENT

11 REVISION OF THE RISK ADJUSTMENT SYS12 TEM TO ACCOUNT FOR CHRONIC CONDITIONS

13 AND OTHER FACTORS FOR THE PURPOSE OF

14 MAKING THE RISK ADJUSTMENT SYSTEM

15 MORE ACCURATE, TRANSPARENT, AND REG16 ULARLY UPDATED.— 

17 ‘‘(I) REVISION BASED ON NUMBER

18 OF CHRONIC CONDITIONS.—The Sec19 retary shall revise for 2017 and peri20 odically thereafter, the risk adjustment 

21 system under this subparagraph so 

22 that a risk score under such system, 

23 with respect to an individual, takes 

24 into account the number of chronic 


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1 conditions with which the individual 

2 has been diagnosed. 

3 ‘‘(II) EVALUATION OF DIFFERENT

4 RISK ADJUSTMENT MODELS.—The Sec5 retary shall evaluate the impact of in6 cluding two years of data to compare 

7 the models used to determine risk 

8 scores for 2013 and 2014 under such 

9 system. 

10 ‘‘(III) EVALUATION AND ANALYSIS

11 ON CHRONIC KIDNEY DISEASE (CKD)

12 CODES.—The Secretary shall evaluate 

13 the impact of removing the diagnosis 

14 codes related to chronic kidney disease 

15 in the 2014 risk adjustment model and 

16 conduct an analysis of best practices of 

17 MA plans to slow disease progression 

18 related to chronic kidney disease. 

19 ‘‘(IV) EVALUATION AND REC20 OMMENDATIONS ON USE OF ENCOUN21 TER DATA.—The Secretary shall evalu22 ate the impact of including 10 percent 

23 of encounter data in computing pay24 ment for 2016 and the readiness of the 

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1 ices to incorporate encounter data in 

2 risk scores. In conducting such evalua3 tion, the Secretary shall use data col4 lected as encounter data on or after 

5 January 1, 2012, shall analyze such 

6 data for accuracy and completeness 

7 and issue recommendations for im8 proving such accuracy and complete9 ness, and shall not increase the per10 centage of such encounter data used 

11 unless the Secretary releases the data 

12 publicly, indicates how such data will 

13 be weighted in computing the risk 

14 scores, and ensures that the data re15 flects the degree and cost of care coordi16 nation under MA plans. 

17 ‘‘(V) CONDUCT OF EVALUA18 TIONS.—Evaluations and analyses 

19 under subclause (II) through (IV) shall 

20 include an actuarial opinion from the 

21 Chief Actuary of the Centers for Medi22 care & Medicaid Services about the 

23 reasonableness of the methods, assump24 tions, and conclusions of such evalua25 tions and analyses. The Secretary shall 


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1 consult with the Medicare Payment 

2 Advisory Commission and accept and 

3 consider comments of stakeholders, such 

4 as managed care organizations and 

5 beneficiary groups, on such evaluation 

6 and analyses. The Secretary shall com7 plete such evaluations and analyses in 

8 a manner that permits the results to be 

9 applied for plan years beginning with 

10 the second plan year that begins after 

11 the date of the enactment of this clause. 

12 ‘‘(VI) IMPLEMENTATION OF REVI13 SIONS BASED ON EVALUATIONS.—If the 

14 Secretary determines, based on such an 

15 evaluation or analysis, that revisions 

16 to the risk adjustment system to ad17 dress the matters described in any of 

18 subclauses (II) through (IV) would 

19 make the risk adjustment system under 

20 this subparagraph better reflect and 

21 appropriately weight for the popu22 lation that is served by the plan, the 

23 Secretary shall, beginning with 2017, 

24 and periodically thereafter, make such 

25 revisions. 


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1 ‘‘(VII) PERIODIC REPORTING TO

2 CONGRESS.—With respect to plan 

3 years beginning with 2017 and every 

4 third year thereafter, the Secretary 

5 shall submit to Congress a report on 

6 the most recent revisions (if any) made 

7 under this clause, including the evalua8 tions conducted under subclauses (II) 

9 through (IV). 

10 ‘‘(v) NO CHANGES TO ADJUSTMENT

11 FACTORS THAT PREVENT ACTIVITIES CON12 SISTENT WITH NATIONAL HEALTH POLICY

13 GOALS.—In making any changes to the ad14 justment factors, including adjustment for 

15 health status under paragraph (3), the Sec16 retary shall ensure that the changes do not 

17 prevent Medicare Advantage organizations 

18 from performing or undertaking activities 

19 that are consistent with national health pol20 icy goals, including activities to promote 

21 early detection and better care coordination, 

22 the use of health risk assessments, care 

23 plans, and programs to slow the progression 

24 of chronic diseases. 


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1 ‘‘(vi) OPPORTUNITY FOR REVIEW AND

2 PUBLIC COMMENT REGARDING CHANGES TO

3 ADJUSTMENT FACTORS.—For changes to ad4 justment factors effective for 2017 and sub5 sequent years, in addition to providing no6 tice of such changes in the announcement 

7 under subsection (b)(2), the Secretary shall 

8 provide an opportunity for review of pro9 posed changes of not less than 60 days and 

10 a public comment period of not less than 30 

11 days before implementing such changes.’’. 

12 SEC. 3. SENSE OF CONGRESS. 

13 It is the sense of Congress that— 

14 (1) the Centers for Medicare & Medicaid Services 

15 has inadvertently created a star rating system under 

16 section 1853(o)(4) of the Social Security Act (42 

17 U.S.C. 1395w–23(o)(4)) for Medicare Advantage 

18 plans that lacks proper accounting for the socio19 economic status of enrollees in such plans and the ex20 tent to which such plans serve individuals who are 

21 also eligible for medical assistance under title XIX of 

22 such Act; and 

23 (2) Congress will work with the Centers for 

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1 zations, to ensure that such rating system properly 

2 accounts for the socioeconomic status of enrollees in 

3 such plans and the extent to which such plans serve 

4 such individuals described in paragraph (1). 


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Union Calendar No. 116 

114TH CONGRESS 

1ST SESSION H. R. 2579 

[Report No. 114–160, Part I] 

A BILL 

To amend title XVIII of the Social Security Act to 

Advantage program, and for other purposes. improve the risk adjustment under the Medicare 

JUNE 16, 2015 

Reported from the Committee on Ways and Means with 

J

an amendment 

UNE 16, 2015 

The Committee on Energy and Commerce discharged; 

the State of the Union and ordered to be printed committed to the Committee of the Whole House on 


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