IB 
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 Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction 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 Com-
mittee 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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A BILL 
To amend title XVIII of the Social Security Act to improve 
the risk adjustment under the Medicare Advantage pro-
gram, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Securing Care for Sen-
iors Act of 2015’’. 
SEC. 2. 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 CONDITIONS 
AND OTHER FACTORS FOR THE PURPOSE OF 
MAKING
THE
RISK
ADJUSTMENT
SYSTEM 
MORE ACCURATE, TRANSPARENT, AND REG-
ULARLY UPDATED.— 
‘‘(I) REVISION BASED ON NUMBER 
OF
CHRONIC
CONDITIONS.—The Sec-
retary shall revise for 2017 and peri-
odically thereafter, the risk adjustment 
system under this subparagraph so 
that a risk score under such system, 
with respect to an individual, takes 
into account the number of chronic 
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conditions with which the individual 
has been diagnosed. 
‘‘(II) EVALUATION OF DIFFERENT 
RISK ADJUSTMENT MODELS.—The Sec-
retary shall evaluate the impact of in-
cluding two years of data to compare 
the models used to determine risk 
scores for 2013 and 2014 under such 
system. 
‘‘(III) EVALUATION AND ANALYSIS 
ON
CHRONIC
KIDNEY
DISEASE
(CKD) 
CODES.—The Secretary shall evaluate 
the impact of removing the diagnosis 
codes related to chronic kidney disease 
in the 2014 risk adjustment model and 
conduct an analysis of best practices of 
MA plans to slow disease progression 
related to chronic kidney disease. 
‘‘(IV) 
EVALUATION
AND
REC-
OMMENDATIONS ON USE OF ENCOUN-
TER DATA.—The Secretary shall evalu-
ate the impact of including 10 percent 
of encounter data in computing pay-
ment for 2016 and the readiness of the 
Centers for Medicare & Medicaid Serv-
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ices to incorporate encounter data in 
risk scores. In conducting such evalua-
tion, the Secretary shall use data col-
lected as encounter data on or after 
January 1, 2012, shall analyze such 
data for accuracy and completeness 
and issue recommendations for im-
proving such accuracy and complete-
ness, and shall not increase the per-
centage of such encounter data used 
unless the Secretary releases the data 
publicly, indicates how such data will 
be weighted in computing the risk 
scores, and ensures that the data re-
flects the degree and cost of care coordi-
nation under MA plans. 
‘‘(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 Medi-
care & Medicaid Services about the 
reasonableness of the methods, assump-
tions, and conclusions of such evalua-
tions and analyses. The Secretary shall 
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consult with the Medicare 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 com-
plete such evaluations 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 REVI-
SIONS BASED ON EVALUATIONS.—If the 
Secretary determines, based on such an 
evaluation or analysis, that revisions 
to the risk adjustment system to ad-
dress the matters described in any of 
subclauses (II) through (IV) would 
make the risk adjustment system under 
this subparagraph better reflect and 
appropriately weight for the popu-
lation that is served by the plan, the 
Secretary shall, beginning with 2017, 
and periodically thereafter, make such 
revisions. 
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‘‘(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 evalua-
tions conducted under subclauses (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 Sec-
retary shall ensure that the changes do not 
prevent Medicare Advantage organizations 
from performing or undertaking activities 
that are consistent with national health pol-
icy goals, including activities to promote 
early detection and better care coordination, 
the use of health risk assessments, care 
plans, and programs to slow the progression 
of chronic diseases. 
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‘‘(vi) OPPORTUNITY FOR REVIEW AND 
PUBLIC COMMENT REGARDING CHANGES TO 
ADJUSTMENT FACTORS.—For changes to ad-
justment factors effective for 2017 and sub-
sequent years, in addition to providing no-
tice of such changes in the announcement 
under subsection (b)(2), the Secretary shall 
provide an opportunity for review of pro-
posed changes of not less than 60 days and 
a public comment period of not less than 30 
days before implementing such changes.’’. 
SEC. 3. SENSE OF CONGRESS. 
It is the sense of Congress that— 
(1) the Centers for Medicare & Medicaid Services 
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 Advantage 
plans that lacks proper accounting for the socio-
economic status of enrollees in such plans and the ex-
tent 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-
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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). 
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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 
improve the risk adjustment under the Medicare 
Advantage program, and for other purposes. 
JUNE 16, 2015 
Reported from the Committee on Ways and Means with 
an amendment 
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 
VerDate Sep 11 2014 
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