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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Seniors’ Health Care 
Plan Protection Act of 2015’’. 
SEC. 2. DELAY IN AUTHORITY TO TERMINATE CONTRACTS 
FOR MEDICARE ADVANTAGE PLANS FAILING 
TO ACHIEVE MINIMUM QUALITY RATINGS. 
(a) FINDINGS.—Consistent with the studies provided 
under the IMPACT Act of 2014 (Public Law 113–185), 
it is the intent of Congress— 
(1) to continue to study and request input on 
the effects of socioeconomic status and dual-eligible 
populations on the Medicare Advantage STARS rat-
ing system before reforming such system with the 
input of stakeholders; and 
(2) pending the results of such studies and 
input, to provide for a temporary delay in authority 
of the Centers for Medicare & Medicaid Services 
(CMS) to terminate Medicare Advantage plan con-
tracts solely on the basis of performance of plans 
under the STARS rating system. 
(b) DELAY IN MA CONTRACT TERMINATION AU-
THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM 
QUALITY RATINGS.—Section 1857(h) of the Social Secu-
rity Act (42 U.S.C. 1395w–27(h)) is amended by adding 
at the end the following new paragraph: 
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‘‘(3) DELAY IN CONTRACT TERMINATION AU-
THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM 
QUALITY RATING.—The Secretary may not termi-
nate a contract under this section with respect to 
the offering of an MA plan by a Medicare Advantage 
organization solely because the MA plan has failed 
to achieve a minimum quality rating under the 5- 
star rating system established under section 1853(o) 
during the period beginning on the date of the en-
actment of this paragraph and through the end of 
plan year 2018.’’. 
SEC. 3. IMPROVEMENTS TO MA RISK ADJUSTMENT SYSTEM. 
Section 1853(a)(1)(C) of the Social Security Act (42 
U.S.C. 1395w–23(a)(1)(C)) is amended by adding at the 
end the following new clauses: 
‘‘(iv) EVALUATION AND SUBSEQUENT 
REVISION OF THE RISK ADJUSTMENT SYS-
TEM
TO
ACCOUNT
FOR
CHRONIC
CONDI-
TIONS
AND
OTHER
FACTORS
FOR
THE 
PURPOSE OF MAKING THE RISK ADJUST-
MENT
SYSTEM
MORE
ACCURATE, TRANS-
PARENT, AND REGULARLY UPDATED.— 
‘‘(I) REVISION BASED ON NUM-
BER OF CHRONIC CONDITIONS.—The 
Secretary shall revise for 2017 and 
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periodically thereafter, the risk adjust-
ment system under this subparagraph 
so that a risk score under such sys-
tem, with respect to an individual, 
takes into account the number of 
chronic conditions with which the in-
dividual has been diagnosed. 
‘‘(II) 
EVALUATION
OF
DIF-
FERENT
RISK
ADJUSTMENT
MOD-
ELS.—The Secretary shall evaluate 
the impact of including 2 years of 
data to compare the models used to 
determine risk scores for 2013 and 
2014 under such system. 
‘‘(III) EVALUATION
AND
ANAL-
YSIS
ON
CHRONIC
KIDNEY
DISEASE 
(CKD)
CODES.—The Secretary shall 
evaluate the impact of removing the 
diagnosis codes related to chronic kid-
ney disease in the 2014 risk adjust-
ment model and conduct an analysis 
of best practices of MA plans to slow 
disease progression related to chronic 
kidney disease. 
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‘‘(IV) EVALUATION
AND
REC-
OMMENDATIONS ON USE OF ENCOUN-
TER
DATA.—The 
Secretary 
shall 
evaluate the impact of including 10 
percent of encounter data in com-
puting payment for 2016 and the 
readiness of the Centers for Medicare 
& Medicaid Services to incorporate en-
counter data in risk scores. In con-
ducting such evaluation, the Secretary 
shall use data collected as encounter 
data on or after January 1, 2012, 
shall analyze such data for accuracy 
and completeness and issue rec-
ommendations for improving such ac-
curacy and completeness, and shall 
not increase the percentage of such 
encounter data used unless the Sec-
retary releases the data publicly, indi-
cates how such data will be weighted 
in computing the risk scores, and en-
sures that the data reflects the degree 
and cost of care coordination under 
MA plans. 
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‘‘(V) 
CONDUCT
OF
EVALUA-
TIONS.—Evaluations 
and 
analyses 
under subclause (II) through (IV) 
shall include an actuarial opinion 
from the Chief Actuary of the Centers 
for Medicare & Medicaid Services 
about the reasonableness of the meth-
ods, assumptions, and conclusions of 
such evaluations and analyses. The 
Secretary shall consult with the Medi-
care Payment Advisory Commission 
and accept and consider comments of 
stakeholders, such as managed care 
organizations and beneficiary groups, 
on such evaluation and analyses. The 
Secretary shall complete such evalua-
tions and analyses in a manner that 
permits the results to be applied for 
plan years beginning with the second 
plan year that begins after the date of 
the enactment of this clause. 
‘‘(VI) IMPLEMENTATION OF RE-
VISIONS BASED ON EVALUATIONS.—If 
the Secretary determines, based on 
such an evaluation or analysis, that 
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revisions to the risk adjustment sys-
tem to address the matters described 
in any of subclauses (II) through (IV) 
would make the risk adjustment sys-
tem under this subparagraph better 
reflect and appropriately weight for 
the population that is served by the 
plan, the Secretary shall, beginning 
with 2017, and periodically thereafter, 
make such revisions. 
‘‘(VII) PERIODIC REPORTING TO 
CONGRESS.—With respect to plan 
years beginning with 2017 and every 
third year thereafter, the Secretary 
shall submit to Congress a report on 
the most recent revisions (if any) 
made under this clause, including the 
evaluations 
conducted 
under 
sub-
clauses (II) through (IV). 
‘‘(v) NO
CHANGES
TO
ADJUSTMENT 
FACTORS THAT PREVENT ACTIVITIES CON-
SISTENT WITH NATIONAL HEALTH POLICY 
GOALS.—In making any changes to the ad-
justment factors, including adjustment for 
health status under paragraph (3), the 
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Secretary shall ensure that the changes do 
not prevent Medicare Advantage organiza-
tions from performing or undertaking ac-
tivities that are consistent with national 
health policy goals, including activities to 
promote early detection and better care co-
ordination, the use of health risk assess-
ments, care plans, and programs to slow 
the progression of chronic diseases. 
‘‘(vi) OPPORTUNITY FOR REVIEW AND 
PUBLIC
COMMENT
REGARDING
CHANGES 
TO ADJUSTMENT FACTORS.—For changes 
to adjustment factors effective for 2017 
and subsequent years, in addition to pro-
viding notice of such changes in the an-
nouncement under subsection (b)(2), the 
Secretary shall provide an opportunity for 
review of proposed changes of not less than 
60 days and a public comment period of 
not less than 30 days before implementing 
such changes.’’. 
SEC. 4. SENSE OF CONGRESS RELATING TO MEDICARE AD-
VANTAGE STAR RATING SYSTEM. 
It is the sense of Congress that— 
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(1) the Centers for Medicare & Medicaid Serv-
ices has inadvertently created a star rating system 
under section 1853(o)(4) of the Social Security Act 
(42 U.S.C. 1395w–23(o)(4)) for Medicare Advan-
tage plans that lacks proper accounting for the so-
cioeconomic status of enrollees in such plans and the 
extent to which such plans serve individuals who are 
also eligible for medical assistance under title XIX 
of such Act; and 
(2) Congress will work with the Centers for 
Medicare & Medicaid Services and stakeholders, in-
cluding beneficiary groups and managed care organi-
zations, to ensure that such rating system properly 
accounts for the socioeconomic status of enrollees in 
such plans and the extent to which such plans serve 
such individuals described in paragraph (1). 
SEC. 5. SENSE OF CONGRESS RELATING TO MEDICARE AD-
VANTAGE RISK ADJUSTMENT. 
It is the sense of Congress that— 
(1) the Secretary of Health and Human Serv-
ices should periodically monitor and improve the 
Medicare Advantage risk adjustment model to en-
sure that it accurately accounts for beneficiary risk, 
including for those individuals with complex chronic 
comorbid conditions; 
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(2) the Secretary should closely examine the 
current Medicare Advantage risk adjustment meth-
odology to ensure that plans enrolling beneficiaries 
with the greatest health care needs receive adequate 
reimbursement to deliver high-quality care and other 
services to help beneficiaries avoid costly complica-
tions and further progression of chronic conditions 
and to the extent data indicate this to be the case, 
the Secretary should make necessary adjustment to 
the risk adjustment methodology; and 
(3) the Secretary should reconsider the imple-
mentation of changes in the Medicare Advantage 
risk adjustment methodology finalized for 2016 and 
to use to the extent appropriate the methodology fi-
nalized in 2015 for one additional year. 
Passed the House of Representatives June 17, 2015. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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