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 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 
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. 
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’’. 
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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
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 
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 two years of 
data to compare the models used to 
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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. 
‘‘(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 
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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. 
‘‘(V) 
CONDUCT
OF
EVALUA-
TIONS.—Evaluations 
and 
analyses 
under subclauses (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, 
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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 
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 
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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 
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-
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viding notice of such changes in the an-
nouncement under subsection (b)(2), the 
Secretary shall provide an opportunity for 
review of proposed changes and a public 
comment period of not less than 60 days 
before implementing such changes.’’. 
SEC. 3. SENSE OF CONGRESS. 
It is the sense of Congress that— 
(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). 
Æ 
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