Title: To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes.
Policy area: Health

Summary:
This bill requires the Centers for Medicare & Medicaid Services to establish a risk corridor program for Medicare Advantage (MA) plans during the public health emergency declared on January 31, 2020, relating to COVID-19 (i.e., coronavirus disease 2019), in which MA payments are based on the ratio of the plan's allowable costs to its aggregate premiums.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6583 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 6583

  To amend title XVIII of the Social Security Act to establish a risk 
   corridor program for Medicare Advantage plans during the COVID-19 
                   emergency, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 21, 2020

Ms. Houlahan (for herself and Mr. Larson of Connecticut) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
 and in addition to the Committee on Energy and Commerce, for a period 
    to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to establish a risk 
   corridor program for Medicare Advantage plans during the COVID-19 
                   emergency, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. ESTABLISHING A RISK CORRIDOR PROGRAM FOR MEDICARE ADVANTAGE 
              PLANS DURING THE COVID-19 EMERGENCY.

    (a) In General.--Section 1853 of the Social Security Act (42 U.S.C. 
1395w-23) is amended by adding at the end the following new subsection:
    ``(p) Risk Corridor Program During the COVID-19 Emergency.--
            ``(1) In general.--The Secretary shall establish and 
        administer a program of risk corridors for each plan year, any 
        portion of which occurs during the emergency period defined in 
        section 1135(g)(1)(B), under which the Secretary shall make 
        payments to MA organizations offering a Medicare Advantage plan 
        based on the ratio of the allowable costs of the plan to the 
        aggregate premiums of the plan.
            ``(2) Payment methodology.--The Secretary shall provide 
        under the program established under paragraph (1) that if the 
        allowable costs for a Medicare Advantage plan for any plan year 
        are more than 105 percent of the target amount, the Secretary 
        shall pay to the plan an amount equal to 75 percent of the 
        allowable costs in excess of 105 percent of the target amount.
            ``(3) Timing.--
                    ``(A) Submission of information by plans.--With 
                respect to a plan year for which the program described 
                in paragraph (1) is established and administered, not 
                later than July 1 of the succeeding plan year each MA 
                organization offering a Medicare Advantage plan shall 
                submit to the Secretary such information as the 
                Secretary may require for purposes of carrying out such 
                program.
                    ``(B) Payment.--The Secretary shall pay to an MA 
                organization offering a Medicare Advantage plan 
                eligible to receive a payment under the program with 
                respect to a plan year the amount provided under 
                paragraph (2) for such plan year not later than 60 days 
                after such organization submits information with 
                respect to such plan and plan year under subparagraph 
                (A).
            ``(4) Definitions.--
                    ``(A) Allowable costs.--The term `allowable costs' 
                means, with respect to an MA organization offering a 
                Medicare Advantage plan for a plan year, an amount 
                equal to the total costs (other than administrative 
                costs) of such plan in providing benefits covered by 
                such plan, but only to the extent that such costs are 
                incurred with respect to such benefits for items and 
                services that are benefits under the original medicare 
                fee-for-service program option.
                    ``(B) Target amount.--The term `target amount' 
                means, with respect to an MA organization offering a 
                Medicare Advantage plan for a plan year, the total 
                amount of payments paid to the MA organization for the 
                plan for benefits under the original medicare fee-for-
                service program option for the plan year, taking into 
                account amounts paid by the Secretary and enrollees, 
                based upon the bid amount submitted under section 1854, 
                reduced by the total amount of administrative expenses 
                for the year assumed in such bid.
            ``(5) Funding.--There are appropriated to the Centers for 
        Medicare & Medicaid Services Program Management Account, out of 
        any monies in the Treasury not otherwise obligated, such sums 
        as may be necessary for purposes of carrying out this 
        subsection.''.
    (b) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the amendments 
made by this section by program instruction or otherwise.
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