I 112th CONGRESS 2d Session H. R. 4254 IN THE HOUSE OF REPRESENTATIVES March 22, 2012 Mr. Stark 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 enhance Medicare Advantage program integrity.

1.

Short title

This Act may be cited as the Medicare Advantage Program Integrity Act of 2012.

2.

Medicare Advantage coding intensity adjustment

Section 1853(a)(1)(C)(ii)(III) of the Social Security Act (42 U.S.C. 1395w–23(a)(1)(C)(ii)(III)) is amended to read as follows: (III)In calculating each year’s adjustment, the adjustment factor shall be for 2014, not less than the adjustment factor applied for 2010, plus 1.3 percentage points; for each of years 2015 through 2018, not less than the adjustment factor applied for the previous year, plus 0.6 percentage point; and for 2019 and each subsequent year, not less than 7.1 percent. .

3.

Implementation of Office of Inspector General recommendation to delay certain Medicare plan prepayments

(a)

Medicare Advantage payments

Section 1853(a)(1) of the Social Security Act (42 U.S.C. 1395w–23(a)(1)) is amended— (1)in subparagraph (A), in the matter preceding clause (i)— (A)by striking subsections (e), (g), (i), and (l) and inserting subparagraph (I), subsections (e), (g), (i), and (l),; and (B)by inserting (or, for months beginning with January 2013, on the date specified in subparagraph (I)) after in advance; and (2)by adding at the end the following new subparagraph: (I)

Timing of payments

(i)

In general

With respect to monthly payments under this section for months beginning with January 2013, subject to clause (ii), the date specified in this subparagraph with respect to a payment for— (I)January is January 2nd; (II)February is February 15th; (III)March is March 30th; and (IV)April or any succeeding month in a year is the 15th day of the 2nd succeeding month. (ii)

Holidays, weekends, etc

If the date otherwise specified in clause (i) is a holiday or weekend, the date specified in this subparagraph shall be the first weekday before such date. . (b)

Application under part D

Section 1860D–15(d)(1) of the Social Security Act (42 U.S.C. 1395w–115(d)(1)) is amended by inserting and shall be made consistent with the timing of monthly payments to MA organizations under section 1853(a)(1)(I) after as the Secretary determines.