[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2104 Introduced in Senate (IS)]

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114th CONGRESS
  1st Session
                                S. 2104

 To amend title XVIII of the Social Security Act to provide relief to 
 Medicare Advantage plans with a significant number of dually eligible 
 or low-income subsidy beneficiaries and to prevent the termination of 
                            two star plans.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 30, 2015

Mr. Portman (for himself and Mr. Casey) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to provide relief to 
 Medicare Advantage plans with a significant number of dually eligible 
 or low-income subsidy beneficiaries and to prevent the termination of 
                            two star plans.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preserving Medicare Advantage for 
all Medicare Beneficiaries Act of 2015''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) In the IMPACT Act of 2014 (Public Law 113-185), 
        Congress recognized the potential effects of socioeconomic 
        status and dual eligible populations on the Medicare Advantage 
        STARS rating system by requesting the Assistant Secretary of 
        Planning and Evaluation in the Department of Health and Human 
        Services undertake studies on this population and the Medicare 
        program.
            (2) Studies published in the past year have shown the need 
        for an interim policy until the comprehensive results of the 
        studies undertaken as part of the IMPACT Act of 2014 are 
        published. An adjustment for 2016 is necessary while Congress 
        continues to work to achieve an appropriate policy for a 
        temporary bridge until the results from the studies undertaken 
        by the Assistant Secretary of Planning and Evaluation in the 
        Department of Health and Human Services under such Act are 
        finalized.

SEC. 3. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR CERTAIN MEDICARE 
              ADVANTAGE 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 certain 
        plans failing to achieve minimum quality rating.--
                    ``(A) In general.--Subject to subparagraph (B), 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.
                    ``(B) Application only to plans receiving a quality 
                rating of at least 2 stars.--Subparagraph (A) shall 
                only apply with respect to a contract with respect to 
                the offering of an MA plan that has a quality rating 
                under section 1853(o)(4) of at least 2 stars for the 
                most recent plan year.''.

SEC. 4. DEMONSTRATION PROJECT TO DIRECT QUALITY IMPROVEMENT PROGRAMS TO 
              ADDRESS SOCIOECONOMIC STATUS DISPARITIES IN MEDICARE 
              ADVANTAGE PLANS.

    (a) Establishment.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        establish a demonstration project under this section to provide 
        funds to MA organizations offering one or more qualified MA 
        plans for use in developing or expanding programs or services 
        with respect to such plans that seek to improve health care 
        delivery and outcomes of care for enrollees with low 
        socioeconomic status.
            (2) Duration.--The demonstration project under this section 
        shall be conducted for a period of 1 year beginning in plan 
        year 2016.
    (b) Definitions.--In this section:
            (1) MA organization; ma plan.--The terms ``MA 
        organization'' and ``MA plan'' have the meaning given such 
        terms in subsections (a)(1) and (b)(1), respectively, of 
        section 1859 of the Social Security Act (42 U.S.C. 1395w-28).
            (2) Qualified ma plan.--
                    (A) The term ``qualified MA plan'' means an MA plan 
                described in subparagraph (B) or (C).
                    (B) An MA plan is described in this subparagraph if 
                the MA plan meets each of the following criteria:
                            (i) The plan has a quality rating under 
                        section 1853(o)(4) of the Social Security Act 
                        (42 U.S.C. 1395w-23(o)(4)) of at least 3.25 
                        stars but not more than 4 stars for the most 
                        recent plan year.
                            (ii) Not less than 45 percent of enrollees 
                        in the plan are one or both of the following:
                                    (I) Eligible for a low income 
                                subsidy under section 1860D-14 of such 
                                Act (42 U.S.C. 1395w-114).
                                    (II) Dually eligible for benefits 
                                under the Medicare program under title 
                                XVIII of such Act (42 U.S.C. 1395 et 
                                seq.) and the Medicaid program under 
                                title XIX of such Act (42 U.S.C. 1396 
                                et seq.).
                    (C) An MA plan is described in this subparagraph if 
                the MA plan meets each of the following criteria:
                            (i) The plan has a quality rating under 
                        section 1853(o)(4) of the Social Security Act 
                        (42 U.S.C. 1395w-23(o)(4)) of at least 3.0 
                        stars but not more than 4 stars for the most 
                        recent plan year.
                            (ii) Not less than 60 percent of enrollees 
                        in the plan are one or both of the following:
                                    (I) Eligible for a low income 
                                subsidy under section 1860D-14 of such 
                                Act (42 U.S.C. 1395w-114).
                                    (II) Dually eligible for benefits 
                                under the Medicare program under title 
                                XVIII of such Act (42 U.S.C. 1395 et 
                                seq.) and the Medicaid program under 
                                title XIX of such Act (42 U.S.C. 1396 
                                et seq.).
    (c) Use of Funds.--
            (1) In general.--Subject to paragraph (2), funds received 
        under the demonstration project by an MA organization with 
        respect to a qualified MA plan shall be used under the Quality 
        Improvement Program of the organization under section 1852(e) 
        of the Social Security Act (42 U.S.C. 1395w-22(e)) to target 
        improvement by the qualified MA plan with respect to two or 
        more triple-weighted measures under the 5-star rating system 
        under section 1853(o)(4) of such Act (42 U.S.C. 1395w-
        23(o)(4)).
            (2) Focus on outcome measure.--
                    (A) In general.--Except as provided in subparagraph 
                (B), at least one of the measures targeted under 
                paragraph (1) shall be an outcome measure.
                    (B) Exception.--An MA organization may apply to the 
                Secretary for an exception to subparagraph (A) in order 
                to focus on only process measures under this 
                subsection.
    (d) Inclusion in Annual Quality Improvement Program Report.--An MA 
organization receiving funds under the demonstration project shall 
include, as part of the annual report to the Secretary on the Quality 
Improvement Program of the organization under such section 1852(e) for 
each year of the demonstration project, with respect to each qualified 
MA plan offered by the organization, the results of the targeting of 
plan improvement on measures under subsection (c) during the preceding 
year.
    (e) Funding.--
            (1) In general.--For purposes of carrying out the 
        demonstration project under this section, subject to paragraph 
        (2), the Secretary shall provide for the transfer from the 
        Federal Hospital Insurance Trust Fund under section 1817 of the 
        Social Security Act (42 U.S.C. 1395i) and the Federal 
        Supplementary Medical Insurance Trust Fund under section 1841 
        of such Act (42 U.S.C. 1395t), in such proportion as the 
        Secretary determines appropriate, of an amount equal to the 
        amount the Secretary determines is equal to the estimated total 
        savings to the Medicare program as a result of the 
        implementation of the amendment made by section 2 to the 
        Centers for Medicare & Medicaid Services Program Management 
        Account.
            (2) Administration.--The Secretary may retain up to 10 
        percent of the funds transferred under paragraph (1) to 
        administer the demonstration project under this section and the 
        remainder of such funds shall be distributed in accordance with 
        this section to MA organizations offering qualified MA plans 
        based on the enrollment in such plans of individuals described 
        in each of subclauses (I) and (II) of subsections (b)(2)(B)(ii) 
        and (b)(2)(C)(ii).
            (3) Availability.--Amounts transferred under paragraph (1) 
        shall remain available until expended.
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