Seniors' Health Care Plan Protection Act of 2015

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 rating 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 contracts solely on the basis of performance of 
        plans under the STARS rating system.
    (b) Delay in MA Contract Termination Authority for Plans Failing To 
Achieve Minimum Quality Ratings.--Section 1857(h) of the Social 
Security Act (42 U.S.C. 1395w-27(h)) is amended by adding at the end 
the following new paragraph:
            ``(3) Delay in contract termination authority for plans 
        failing to achieve minimum quality rating.--The Secretary may 
        not terminate 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 
        enactment 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 system to account for 
                        chronic conditions and other factors for the 
                        purpose of making the risk adjustment system 
                        more accurate, transparent, and regularly 
                        updated.--
                                    ``(I) Revision based on number of 
                                chronic conditions.--The Secretary 
                                shall 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 
                                diagnosed.
                                    ``(II) Evaluation of different risk 
                                adjustment models.--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 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 
                                recommendations on use of encounter 
                                data.--The Secretary shall evaluate the 
                                impact of including 10 percent of 
                                encounter data in computing payment for 
                                2016 and the readiness of the Centers 
                                for Medicare & Medicaid Services to 
                                incorporate encounter data in risk 
                                scores. In conducting 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 
                                recommendations for improving such 
                                accuracy and completeness, and shall 
                                not increase the percentage 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 reflects the 
                                degree and cost of care coordination 
                                under MA plans.
                                    ``(V) Conduct of evaluations.--
                                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 methods, 
                                assumptions, and conclusions of such 
                                evaluations and analyses. The Secretary 
                                shall 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 
                                complete 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 revisions 
                                based on evaluations.--If the Secretary 
                                determines, based on such an evaluation 
                                or analysis, that revisions to the risk 
                                adjustment system to address 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 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 subclauses (II) through 
                                (IV).
                            ``(v) No changes to adjustment factors that 
                        prevent activities consistent with national 
                        health policy goals.--In making any changes to 
                        the adjustment factors, including adjustment 
                        for health status under paragraph (3), the 
                        Secretary shall ensure that the changes do not 
                        prevent Medicare Advantage organizations from 
                        performing 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 changes to adjustment factors 
                        effective for 2017 and subsequent years, in 
                        addition to providing notice of such changes in 
                        the announcement 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 ADVANTAGE STAR RATING 
              SYSTEM.

    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 socioeconomic 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, including beneficiary 
        groups and managed care organizations, 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 ADVANTAGE RISK 
              ADJUSTMENT.

    It is the sense of Congress that--
            (1) the Secretary of Health and Human Services should 
        periodically monitor and improve the Medicare Advantage risk 
        adjustment model to ensure that it accurately accounts for 
        beneficiary risk, including for those individuals with complex 
        chronic comorbid conditions;
            (2) the Secretary should closely examine the current 
        Medicare Advantage risk adjustment methodology 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 
        complications 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 implementation of 
        changes in the Medicare Advantage risk adjustment methodology 
        finalized for 2016 and to use to the extent appropriate the 
        methodology finalized in 2015 for one additional year.

            Passed the House of Representatives June 17, 2015.

            Attest:

                                                 KAREN L. HAAS,

                                                                 Clerk.

Summary: Senior's Health Care Plan Protection Act of 2015 (Sec. 2) It is the intent of Congress to: (1) continue to study and request input on the effects of socioeconomic status and dual-eligible populations on the five-star quality rating system for Medicare Advantage (MA) plans before reforming it, and, pending study and input results, (2) delay Centers for Medicare &amp; Medicaid (CMS) authority to terminate MA plan contracts solely on the basis of performance under the five-star rating system. The Department of Health and Human Services (HHS) may not, through the end of plan year 2018, terminate a contract with respect to the offering of an MA plan by an MA organization solely because the plan has failed to achieve a minimum quality rating under the five-star rating system. (Sec. 3) This bill amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct HHS (in effect, CMS) to revise for 2017, and periodically afterwards, the system for risk adjustments to payments to Medicare+Choice organizations so that an individual's risk score takes into account the number of chronic conditions with which the individual has been diagnosed. HHS must, including an actuarial opinion of the CMS Chief Actuary, evaluate the impacts of:  including two years of data to compare the models used to determine the risk scores for 2013 and 2014, removing the diagnosis codes related to chronic kidney disease in the 2014 risk adjustment model, and including 10% of encounter data in computing payment for 2016 and CMS readiness to incorporate encounter data in risk scores.   HHS shall also analyze the best practices of MA plans to slow disease progression related to chronic kidney disease. HHS shall then, if appropriate, make revisions to the risk adjustment system, based on such an evaluation or analysis, to better reflect and appropriately weight for the population served. (Sec. 4) Congress declares that:  the five-star quality rating system for MA plans lacks proper accounting for the socioeconomic status of plan enrollees and the extent to which those plans serve individuals also eligible for medical assistance under SSAct title XIX (Medicaid); and Congress will work with CMS and stakeholders, including beneficiary groups and managed care organizations, to ensure that the five-star quality rating system for MA plans properly accounts for the socioeconomic status of plan enrollees and the extent to which plans serve them.  (Sec. 5) It is also the sense of Congress that HHS should:  periodically monitor and improve the risk adjustment model for payments to MA organizations to ensure that it accurately accounts for beneficiary risk; closely examine and adjust as necessary the current MA risk adjustment methodology 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 complications and further progression of chronic conditions; and reconsider the implementation of changes in the MA risk adjustment methodology finalized for 2016 and, to the extent appropriate, use the risk methodology finalized in 2015 for one additional year.