I 

114TH CONGRESS 

1ST SESSION H. R. 2579 

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 

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. 

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’’. 


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

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

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

4 end the following new clauses: 

5 ‘‘(iv) EVALUATION AND SUBSEQUENT

6 REVISION OF THE RISK ADJUSTMENT SYS7 TEM TO ACCOUNT FOR CHRONIC CONDI8 TIONS AND OTHER FACTORS FOR THE

9 PURPOSE OF MAKING THE RISK ADJUST10 MENT SYSTEM MORE ACCURATE, TRANS11 PARENT, AND REGULARLY UPDATED.— 

12 ‘‘(I) REVISION BASED ON NUM13 BER OF CHRONIC CONDITIONS.—The 

14 Secretary shall revise for 2017 and 

15 periodically thereafter, the risk adjust16 ment system under this subparagraph 

17 so that a risk score under such sys18 tem, with respect to an individual, 

19 takes into account the number of 

20 chronic conditions with which the in21 dividual has been diagnosed. 

22 ‘‘(II) EVALUATION OF DIF23 FERENT RISK ADJUSTMENT MOD24 ELS.—The Secretary shall evaluate 

25 the impact of including two years of 

26 data to compare the models used to 


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1 determine risk scores for 2013 and 

2 2014 under such system. 

3 ‘‘(III) EVALUATION AND ANAL4 YSIS ON CHRONIC KIDNEY DISEASE

5 (CKD) CODES.—The Secretary shall 

6 evaluate the impact of removing the 

7 diagnosis codes related to chronic kid8 ney disease in the 2014 risk adjust9 ment model and conduct an analysis 

10 of best practices of MA plans to slow 

11 disease progression related to chronic 

12 kidney disease. 

13 ‘‘(IV) EVALUATION AND REC14 OMMENDATIONS ON USE OF ENCOUN15 TER DATA.—The Secretary shall 

16 evaluate the impact of including 10 

17 percent of encounter data in com18 puting payment for 2016 and the 

19 readiness of the Centers for Medicare 

20 & Medicaid Services to incorporate en21 counter data in risk scores. In con22 ducting such evaluation, the Secretary 

23 shall use data collected as encounter 

24 data on or after January 1, 2012, 

25 shall analyze such data for accuracy 


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1 and completeness and issue rec2 ommendations for improving such ac3 curacy and completeness, and shall 

4 not increase the percentage of such 

5 encounter data used unless the Sec6 retary releases the data publicly, indi7 cates how such data will be weighted 

8 in computing the risk scores, and en9 sures that the data reflects the degree 

10 and cost of care coordination under 

11 MA plans. 

12 ‘‘(V) CONDUCT OF EVALUA13 TIONS.—Evaluations and analyses 

14 under subclauses (II) through (IV) 

15 shall include an actuarial opinion 

16 from the Chief Actuary of the Centers 

17 for Medicare & Medicaid Services 

18 about the reasonableness of the meth19 ods, assumptions, and conclusions of 

20 such evaluations and analyses. The 

21 Secretary shall consult with the Medi22 care Payment Advisory Commission 

23 and accept and consider comments of 

24 stakeholders, such as managed care 

25 organizations and beneficiary groups, 


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1 on such evaluation and analyses. The 

2 Secretary shall complete such evalua3 tions and analyses in a manner that 

4 permits the results to be applied for 

5 plan years beginning with the second 

6 plan year that begins after the date of 

7 the enactment of this clause. 

8 ‘‘(VI) IMPLEMENTATION OF RE9 VISIONS BASED ON EVALUATIONS.—If 

10 the Secretary determines, based on 

11 such an evaluation or analysis, that 

12 revisions to the risk adjustment sys13 tem to address the matters described 

14 in any of subclauses (II) through (IV) 

15 would make the risk adjustment sys16 tem under this subparagraph better 

17 reflect and appropriately weight for 

18 the population that is served by the 

19 plan, the Secretary shall, beginning 

20 with 2017, and periodically thereafter, 

21 make such revisions. 

22 ‘‘(VII) PERIODIC REPORTING TO

23 CONGRESS.—With respect to plan 

24 years beginning with 2017 and every 

25 third year thereafter, the Secretary 


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1 shall submit to Congress a report on 

2 the most recent revisions (if any) 

3 made under this clause, including the 

4 evaluations conducted under sub5 clauses (II) through (IV). 

6 ‘‘(v) NO CHANGES TO ADJUSTMENT

7 FACTORS THAT PREVENT ACTIVITIES CON8 SISTENT WITH NATIONAL HEALTH POLICY

9 GOALS.—In making any changes to the ad10 justment factors, including adjustment for 

11 health status under paragraph (3), the 

12 Secretary shall ensure that the changes do 

13 not prevent Medicare Advantage organiza14 tions from performing or undertaking ac15 tivities that are consistent with national 

16 health policy goals, including activities to 

17 promote early detection and better care co18 ordination, the use of health risk assess19 ments, care plans, and programs to slow 

20 the progression of chronic diseases. 

21 ‘‘(vi) OPPORTUNITY FOR REVIEW AND

22 PUBLIC COMMENT REGARDING CHANGES

23 TO ADJUSTMENT FACTORS.—For changes 

24 to adjustment factors effective for 2017 

25 and subsequent years, in addition to proVerDate Sep 11 2014 00:47 May 30, 2015 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2579.IH H2579

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1 viding notice of such changes in the an2 nouncement under subsection (b)(2), the 

3 Secretary shall provide an opportunity for 

4 review of proposed changes and a public 

5 comment period of not less than 60 days 

6 before implementing such changes.’’. 

7 SEC. 3. SENSE OF CONGRESS. 

8 It is the sense of Congress that— 

9 (1) the Centers for Medicare & Medicaid Serv10 ices has inadvertently created a star rating system 

11 under section 1853(o)(4) of the Social Security Act 

12 (42 U.S.C. 1395w–23(o)(4)) for Medicare Advan13 tage plans that lacks proper accounting for the so14 cioeconomic status of enrollees in such plans and the 

15 extent to which such plans serve individuals who are 

16 also eligible for medical assistance under title XIX 

17 of such Act; and 

18 (2) Congress will work with the Centers for 

19 Medicare & Medicaid Services and stakeholders, in20 cluding beneficiary groups and managed care organi21 zations, to ensure that such rating system properly 

22 accounts for the socioeconomic status of enrollees in 

23 such plans and the extent to which such plans serve 

24 such individuals described in paragraph (1). 

Æ 


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