IIB 

114TH CONGRESS 

1ST SESSION H. R. 2582 

IN THE SENATE OF THE UNITED STATES 

JUNE 18, 2015 

Received; read twice and referred to the Committee on Finance 

AN ACT 

To amend title XVIII of the Social Security Act to delay 

the authority to terminate Medicare Advantage contracts 

for MA plans failing to achieve minimum quality ratings, 

to make improvements to the Medicare Adjustment risk 

adjustment system, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Seniors’ Health Care 

3 Plan Protection Act of 2015’’. 

4 SEC. 2. DELAY IN AUTHORITY TO TERMINATE CONTRACTS 

5 FOR MEDICARE ADVANTAGE PLANS FAILING 

6 TO ACHIEVE MINIMUM QUALITY RATINGS. 

7 (a) FINDINGS.—Consistent with the studies provided 

8 under the IMPACT Act of 2014 (Public Law 113–185), 

9 it is the intent of Congress— 

10 (1) to continue to study and request input on 

11 the effects of socioeconomic status and dual-eligible 

12 populations on the Medicare Advantage STARS rat13 ing system before reforming such system with the 

14 input of stakeholders; and 

15 (2) pending the results of such studies and 

16 input, to provide for a temporary delay in authority 

17 of the Centers for Medicare & Medicaid Services 

18 (CMS) to terminate Medicare Advantage plan con19 tracts solely on the basis of performance of plans 

20 under the STARS rating system. 

21 (b) DELAY IN MA CONTRACT TERMINATION AU22 THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM

23 QUALITY RATINGS.—Section 1857(h) of the Social Secu24 rity Act (42 U.S.C. 1395w–27(h)) is amended by adding 

25 at the end the following new paragraph: 


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

3 QUALITY RATING.—The Secretary may not termi4 nate a contract under this section with respect to 

5 the offering of an MA plan by a Medicare Advantage 

6 organization solely because the MA plan has failed 

7 to achieve a minimum quality rating under the 5- 

8 star rating system established under section 1853(o) 

9 during the period beginning on the date of the en10 actment of this paragraph and through the end of 

11 plan year 2018.’’. 

12 SEC. 3. IMPROVEMENTS TO MA RISK ADJUSTMENT SYSTEM. 

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

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

15 end the following new clauses: 

16 ‘‘(iv) EVALUATION AND SUBSEQUENT

17 REVISION OF THE RISK ADJUSTMENT SYS18 TEM TO ACCOUNT FOR CHRONIC CONDI19 TIONS AND OTHER FACTORS FOR THE

20 PURPOSE OF MAKING THE RISK ADJUST21 MENT SYSTEM MORE ACCURATE, TRANS22 PARENT, AND REGULARLY UPDATED.— 

23 ‘‘(I) REVISION BASED ON NUM24 BER OF CHRONIC CONDITIONS.—The 

25 Secretary shall revise for 2017 and 


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1 periodically thereafter, the risk adjust2 ment system under this subparagraph 

3 so that a risk score under such sys4 tem, with respect to an individual, 

5 takes into account the number of 

6 chronic conditions with which the in7 dividual has been diagnosed. 

8 ‘‘(II) EVALUATION OF DIF9 FERENT RISK ADJUSTMENT MOD10 ELS.—The Secretary shall evaluate 

11 the impact of including 2 years of 

12 data to compare the models used to 

13 determine risk scores for 2013 and 

14 2014 under such system. 

15 ‘‘(III) EVALUATION AND ANAL16 YSIS ON CHRONIC KIDNEY DISEASE

17 (CKD) CODES.—The Secretary shall 

18 evaluate the impact of removing the 

19 diagnosis codes related to chronic kid20 ney disease in the 2014 risk adjust21 ment model and conduct an analysis 

22 of best practices of MA plans to slow 

23 disease progression related to chronic 

24 kidney disease. 


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1 ‘‘(IV) EVALUATION AND REC2 OMMENDATIONS ON USE OF ENCOUN3 TER DATA.—The Secretary shall 

4 evaluate the impact of including 10 

5 percent of encounter data in com6 puting payment for 2016 and the 

7 readiness of the Centers for Medicare 

8 & Medicaid Services to incorporate en9 counter data in risk scores. In con10 ducting such evaluation, the Secretary 

11 shall use data collected as encounter 

12 data on or after January 1, 2012, 

13 shall analyze such data for accuracy 

14 and completeness and issue rec15 ommendations for improving such ac16 curacy and completeness, and shall 

17 not increase the percentage of such 

18 encounter data used unless the Sec19 retary releases the data publicly, indi20 cates how such data will be weighted 

21 in computing the risk scores, and en22 sures that the data reflects the degree 

23 and cost of care coordination under 

24 MA plans. 


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1 ‘‘(V) CONDUCT OF EVALUA2 TIONS.—Evaluations and analyses 

3 under subclause (II) through (IV) 

4 shall include an actuarial opinion 

5 from the Chief Actuary of the Centers 

6 for Medicare & Medicaid Services 

7 about the reasonableness of the meth8 ods, assumptions, and conclusions of 

9 such evaluations and analyses. The 

10 Secretary shall consult with the Medi11 care Payment Advisory Commission 

12 and accept and consider comments of 

13 stakeholders, such as managed care 

14 organizations and beneficiary groups, 

15 on such evaluation and analyses. The 

16 Secretary shall complete such evalua17 tions and analyses in a manner that 

18 permits the results to be applied for 

19 plan years beginning with the second 

20 plan year that begins after the date of 

21 the enactment of this clause. 

22 ‘‘(VI) IMPLEMENTATION OF RE23 VISIONS BASED ON EVALUATIONS.—If 

24 the Secretary determines, based on 

25 such an evaluation or analysis, that 


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1 revisions to the risk adjustment sys2 tem to address the matters described 

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

4 would make the risk adjustment sys5 tem under this subparagraph better 

6 reflect and appropriately weight for 

7 the population that is served by the 

8 plan, the Secretary shall, beginning 

9 with 2017, and periodically thereafter, 

10 make such revisions. 

11 ‘‘(VII) PERIODIC REPORTING TO

12 CONGRESS.—With respect to plan 

13 years beginning with 2017 and every 

14 third year thereafter, the Secretary 

15 shall submit to Congress a report on 

16 the most recent revisions (if any) 

17 made under this clause, including the 

18 evaluations conducted under sub19 clauses (II) through (IV). 

20 ‘‘(v) NO CHANGES TO ADJUSTMENT

21 FACTORS THAT PREVENT ACTIVITIES CON22 SISTENT WITH NATIONAL HEALTH POLICY

23 GOALS.—In making any changes to the ad24 justment factors, including adjustment for 

25 health status under paragraph (3), the 


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1 Secretary shall ensure that the changes do 

2 not prevent Medicare Advantage organiza3 tions from performing or undertaking ac4 tivities that are consistent with national 

5 health policy goals, including activities to 

6 promote early detection and better care co7 ordination, the use of health risk assess8 ments, care plans, and programs to slow 

9 the progression of chronic diseases. 

10 ‘‘(vi) OPPORTUNITY FOR REVIEW AND

11 PUBLIC COMMENT REGARDING CHANGES

12 TO ADJUSTMENT FACTORS.—For changes 

13 to adjustment factors effective for 2017 

14 and subsequent years, in addition to pro15 viding notice of such changes in the an16 nouncement under subsection (b)(2), the 

17 Secretary shall provide an opportunity for 

18 review of proposed changes of not less than 

19 60 days and a public comment period of 

20 not less than 30 days before implementing 

21 such changes.’’. 

22 SEC. 4. SENSE OF CONGRESS RELATING TO MEDICARE AD23 VANTAGE STAR RATING SYSTEM. 

24 It is the sense of Congress that— 


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1 (1) the Centers for Medicare & Medicaid Serv2 ices has inadvertently created a star rating system 

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

4 (42 U.S.C. 1395w–23(o)(4)) for Medicare Advan5 tage plans that lacks proper accounting for the so6 cioeconomic status of enrollees in such plans and the 

7 extent to which such plans serve individuals who are 

8 also eligible for medical assistance under title XIX 

9 of such Act; and 

10 (2) Congress will work with the Centers for 

11 Medicare & Medicaid Services and stakeholders, in12 cluding beneficiary groups and managed care organi13 zations, to ensure that such rating system properly 

14 accounts for the socioeconomic status of enrollees in 

15 such plans and the extent to which such plans serve 

16 such individuals described in paragraph (1). 

17 SEC. 5. SENSE OF CONGRESS RELATING TO MEDICARE AD18 VANTAGE RISK ADJUSTMENT. 

19 It is the sense of Congress that— 

20 (1) the Secretary of Health and Human Serv21 ices should periodically monitor and improve the 

22 Medicare Advantage risk adjustment model to en23 sure that it accurately accounts for beneficiary risk, 

24 including for those individuals with complex chronic 

25 comorbid conditions; 


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1 (2) the Secretary should closely examine the 

2 current Medicare Advantage risk adjustment meth3 odology to ensure that plans enrolling beneficiaries 

4 with the greatest health care needs receive adequate 

5 reimbursement to deliver high-quality care and other 

6 services to help beneficiaries avoid costly complica7 tions and further progression of chronic conditions 

8 and to the extent data indicate this to be the case, 

9 the Secretary should make necessary adjustment to 

10 the risk adjustment methodology; and 

11 (3) the Secretary should reconsider the imple12 mentation of changes in the Medicare Advantage 

13 risk adjustment methodology finalized for 2016 and 

14 to use to the extent appropriate the methodology fi15 nalized in 2015 for one additional year. 

Passed the House of Representatives June 17, 2015. 

Attest: KAREN L. HAAS, 

Clerk. 


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