I 
113TH CONGRESS 
1ST SESSION H. R. 2753 
To amend title XVIII of the Social Security Act to improve Medicare 
Advantage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 19, 2013 
Mrs. BLACK 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 
Medicare Advantage, 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 2013’’. 
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SEC. 2. REINSTATEMENT OF 3-MONTH OPEN ENROLLMENT 
AND DISENROLLMENT PERIOD FOR MEDI-
CARE ADVANTAGE. 
Section 1851(e)(2) of the Social Security Act (42 
U.S.C. 1395w–1(e)(2)) is amended— 
(1) in subparagraph (C), by inserting ‘‘and end-
ing with 2013’’ after ‘‘(beginning with 2011’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) CONTINUOUS
OPEN
ENROLLMENT 
AND DISENROLLMENT FOR FIRST 3 MONTHS IN 
SUBSEQUENT YEARS.— 
‘‘(i) IN
GENERAL.—Subject to sub-
paragraph (D), at any time during the 
first 3 months of a year (beginning with 
2014), or, if the individual first becomes a 
Medicare Advantage eligible individual dur-
ing a year after 2014, during the first 3 
months of such year in which the indi-
vidual is a Medicare Advantage eligible in-
dividual, a Medicare Advantage eligible in-
dividual may change the election under 
subsection (a)(1). 
‘‘(ii) LIMITATION
OF
ONE
CHANGE 
DURING OPEN ENROLLMENT PERIOD EACH 
YEAR.—An individual may exercise the 
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right under clause (i) only once during the 
applicable 3-month period described in 
such clause in each year. The limitation 
under this clause shall not apply to 
changes in elections effected during an an-
nual, coordinated election period under 
paragraph (3) or during a special election 
period under paragraph (4). 
‘‘(iii) APPLICATION TO PART D FOR 
INDIVIDUALS
CHANGING
ENROLLMENT 
FROM MA TO FEE-FOR-SERVICE.—The pre-
vious provisions of this subparagraph shall 
only apply with respect to changes in en-
rollment in a prescription drug plan under 
part D in the case of an individual who, 
previous to such change in enrollment, is 
enrolled in a Medicare Advantage plan.’’. 
SEC. 3. PERMITTING INCENTIVES FOR PARTICIPATION IN 
HEALTH CARE IMPROVEMENT PROGRAMS. 
(a) IN GENERAL.—Section 1859 of the Social Secu-
rity Act (42 U.S.C. 1395w–28) is amended by adding at 
the end the following new subsection: 
‘‘(h) PERMITTING MA ORGANIZATIONS TO PROVIDE 
INCENTIVES FOR PARTICIPATION IN HEALTH CARE IM-
PROVEMENT PROGRAMS.— 
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‘‘(1) IN GENERAL.—An MA organization may 
offer to individuals enrolled in an MA plan offered 
by such organization one or more incentive programs 
that are designed to improve the health care of such 
individuals by providing one or more incentives, such 
as the reducing or waiving of copayment amounts, 
that reward individuals for participation in such a 
program, if— 
‘‘(A) the incentive program meets the re-
quirements described in paragraph (2); and 
‘‘(B) the MA organization provides to the 
Secretary such information on participation and 
performance in the incentive program as the 
Secretary may specify. 
‘‘(2) REQUIREMENTS.—The requirements de-
scribed in this paragraph, with respect to an incen-
tive program offered by an MA organization to indi-
viduals enrolled in an MA plan offered by such orga-
nization, are as follows: 
‘‘(A) INCENTIVE ONLY UPON COMPLETION 
OF PROGRAM.—In the case of a program that 
consists of multiple sessions or other multiple 
activities, any incentive offered under the pro-
gram is offered only upon completion of all such 
sessions or activities. 
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‘‘(B) NONDISCRIMINATION.—Participation 
in the program is offered to all such individuals. 
‘‘(C) NO
CASH
OR
MONETARY
INCEN-
TIVE.— 
‘‘(i) 
IN
GENERAL.—No 
incentive 
under the program is in the form of cash 
or any other monetary rebate. 
‘‘(ii) 
CONSTRUCTION.—Nothing 
in 
clause (i) may be construed as preventing 
the offering of an incentive in the form of 
a reduction or waiver of copayment 
amounts or deductibles. 
‘‘(3) WAIVER AUTHORITY.—The Secretary may 
waive such requirements of this title and title XI, 
except for sections 1128A, 1128B(b), and 1877, as 
may be necessary to carry out the purposes of the 
program established under this subsection. 
‘‘(4) PROGRAM NOT TAKEN INTO ACCOUNT FOR 
BID AMOUNT.—The program may not be taken into 
account for purposes of the monthly bid amount 
submitted 
by 
the 
organization 
under 
section 
1854(a)(6) and provisions relating to the monthly 
bid amount. 
‘‘(5) ENCOURAGEMENT TO PARTICIPATE IN AC-
TIVITIES OFFERED BY CERTAIN PERSONS OR ENTI-
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TIES.—An MA organization may, as part of an in-
centive program offered by such organization to indi-
viduals under this subsection, require or otherwise 
encourage such individuals to participate in activities 
designed to improve the health care of such individ-
uals that are offered by persons or entities specified 
by such organization, such as persons or entities 
that the organization has identified as performing 
well on quality metrics identified by the organiza-
tion.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect for plan years beginning 
on or after the date of the enactment of this Act. 
SEC. 4. COST SHARING VARIATION PERMITTED TO EN-
COURAGE 
USE 
OF 
HIGH 
QUALITY 
PRO-
VIDERS. 
Section 1852 of the Social Security Act (42 U.S.C. 
1395w–22) is amended— 
(1) in subsection (a)(1)(B)— 
(A) in clause (i), by striking ‘‘clause (iii)’’ 
and inserting ‘‘clauses (iii) and (vi)’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(vi) COST SHARING VARIATION PER-
MITTED
TO
ENCOURAGE
USE
OF
HIGH 
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QUALITY
PROVIDERS.—Notwithstanding 
subsection (b), an MA plan offered by an 
MA organization may, through mecha-
nisms such as value based insurance design 
(VBID) practices, vary cost-sharing for the 
purpose of encouraging enrollees to use 
providers that such organization has iden-
tified as performing well on quality metrics 
identified by the organization. Any such 
variation on cost-sharing by an MA organi-
zation must occur on an annual basis. An 
MA organization may not vary cost-sharing 
pursuant to this paragraph during a plan 
year.’’; and 
(2) in subsection (b)(2), by striking ‘‘A 
Medicare+Choice’’ and inserting ‘‘Subject to sub-
section (a)(1)(B)(vi), a Medicare Advantage’’. 
SEC. 5. IMPROVEMENTS TO 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) REVISION OF RISK ADJUSTMENT 
SYSTEM TO ACCOUNT FOR CHRONIC CONDI-
TIONS
AND
TWO
YEARS
OF
DIAGNOSTIC 
DATA.— 
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‘‘(I) IN
GENERAL.—The Sec-
retary shall evaluate and, as the Sec-
retary determines appropriate, revise 
for 2017 and periodically 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 conditions with 
which the individual has been diag-
nosed, and at least two years of diag-
nostic data including such data ob-
tained during health risk assessments 
regarding the individual, to the extent 
that two years of such data are avail-
able. 
‘‘(II) PERIODIC
REPORTING
TO 
CONGRESS.—With respect to plan 
years beginning in 2017 and every 
third year thereafter, the Secretary 
shall submit to Congress a report on 
the most recent revisions (if any) 
made under subclause (I). 
‘‘(v) NO
CHANGES
TO
ADJUSTMENT 
FACTORS THAT PREVENT ACTIVITIES CON-
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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 MA organizations from per-
forming or undertaking activities that are 
consistent with national health policy 
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. 
‘‘(vi) OPPORTUNITY FOR REVIEW AND 
PUBLIC
COMMENT
REGARDING
CHANGES 
TO
ADJUSTMENT
FACTORS.—For 
any 
changes to adjustment factors effective for 
2015 and subsequent years, in addition to 
providing 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.’’. 
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SEC. 6. IMPROVEMENTS TO MA 5-STAR QUALITY RATING 
SYSTEM. 
Section 1853(o)(4) of the Social Security Act (42 
U.S.C. 1395w–23(o)(4)) is amended by adding at the end 
the following new subparagraph: 
‘‘(C) PLANS
WITH
DISPROPORTIONATELY 
HIGH
ENROLLMENT
OF
INDIVIDUALS
WITH 
COMPLEX HEALTH CARE NEEDS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall take such steps as are necessary to 
ensure that the 5-star rating system de-
scribed in subparagraph (A)— 
‘‘(I) does not disadvantage a plan 
that enrolls a disproportionately high 
proportion of enrollees who are full- 
benefit dual eligible individuals (as de-
fined in section 1935(c)(6)), subsidy 
eligible individuals (as defined in sec-
tion 1860D–14(a)(3)), or other indi-
viduals with complex health care 
needs such as individuals with mul-
tiple conditions; and 
‘‘(II) allows adjustments to ac-
count for differences in socioeconomic 
and demographic characteristics of en-
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rollees and geographic variation in 
health outcomes. 
‘‘(D) ANNOUNCEMENT OF CHANGES TWO 
YEARS PRIOR TO END OF PERFORMANCE PE-
RIOD.—The Secretary may not implement any 
change in the 5-star rating system described in 
subparagraph (A) with respect to any perform-
ance period used as part of such system unless 
the Secretary announces such change at least 
one year prior to the beginning of any such pe-
riod.’’. 
Æ 
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