[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2197 Introduced in Senate (IS)]

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114th CONGRESS
  1st Session
                                S. 2197

  To amend title XVIII of the Social Security Act to improve the risk 
    adjustment under the Medicare Advantage program, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 22, 2015

  Mr. Crapo (for himself, Mr. Bennet, and Mr. Isakson) 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 improve the risk 
    adjustment under the Medicare Advantage program, 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. SHORT TITLE.

    This Act may be cited as the ``Securing Care for Seniors Act of 
2015''.

SEC. 2. 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 two 
                                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 conduct statistical 
                                analyses on 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 
                                results of the analyses 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 
                                subclauses (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. 3. 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.
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