[Congressional Record Volume 161, Number 97 (Wednesday, June 17, 2015)]
[House]
[Pages H4485-H4487]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SENIORS' HEALTH CARE PLAN PROTECTION ACT OF 2015
Mr. BRADY of Texas. Mr. Speaker, I move to suspend the rules and pass
the bill (H.R. 2582) to amend title XVIII of the Social Security Act to
improve the risk adjustment under the Medicare Advantage program, to
delay the authority to terminate Medicare Advantage contracts for MA
plans failing to achieve minimum quality ratings, and for other
purposes, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 2582
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 ``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 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 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
[[Page H4486]]
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.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Texas (Mr. Brady) and the gentleman from New York (Mr. Rangel) each
will control 20 minutes.
The Chair recognizes the gentleman from Texas.
General Leave
Mr. BRADY of Texas. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days in which to revise and extend their
remarks and include extraneous material on H.R. 2582, currently under
consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I stand in strong support of H.R. 2582, the Securing
Seniors' Health Care Act of 2015.
When Medicare began implementing the STARS ratings measurement
system, they did so using the typical Washington approach of one size
fits all. The STARS program uses the same measures to evaluate plans
with different benefit designs and different coverage mixes. Congress
needs to work with stakeholders and Medicare to reform this system to
make it work for all.
CMS should continue to study issues like the effect that
socioeconomic conditions have on health care and the effect that
coverage of duals has on various rating systems and thus properly serve
their populations.
This legislation is common sense. Let's not restrict seniors from
plans they have chosen and like just because they aren't performing
well under CMS's poorly managed STARS standards.
Until we truly understand the effects of duals and low-income
beneficiaries on the plan's STARS ratings, we shouldn't be terminating
them. A 3-year delay will do just that: give CMS and Congress the time
to address the STARS rating system and allow all seniors access to the
plans they choose and that they like.
CMS has made some poor policy decisions in recent years through the
regulatory process in Medicare Advantage and part D of the prescription
drug plan, and this years's call letter and rate notice is no
exception.
The changes to the risk adjustment system include masking coding
intensity adjustments, while in press releases CMS touts not exceeding
statutory levels of coding intensity adjustments.
In plain English, Medicare Advantage plans are managed care plans,
and the changes in the recent regulations handcuff plans from properly
managing some of our frailest seniors suffering from, for example,
blood and kidney diseases.
This bill requires that CMS review the changes made in their most
recent regulatory cycle and reverse those that negatively affect risk
adjustments.
{time} 1800
This bill has CMS reviewing the use of encounter date as well. CMS
has told Congress, the Government Accountability Office, and MedPAC
that the data is not ready yet to show us; yet it is being used for
risk adjustment in Medicare Advantage? That doesn't make sense. We need
to see a stronger commitment by CMS to be transparent about their
policies and their data in Medicare Advantage.
The changes made this year to MA just don't make sense, and I look
forward to working with all my colleagues to reverse some of these
changes and make continued improvements to the system as a whole.
I want to thank Mr. Buchanan, Mr. Rangel, Mrs. Blackburn of
Tennessee, Mr. Guthrie, and Mr. Loebsack for their hard work in getting
this policy moving forward.
I want to, again, reiterate my thanks to Mrs. Black and Mr.
Blumenauer on our committee for their leadership regarding these
issues.
Mr. Speaker, I reserve the balance of my time.
Mr. RANGEL. Mr. Speaker, I yield myself such time as I may consume.
I want to thank the gentleman from Texas for bringing up this bill
and also my colleague, Mr. Buchanan of Florida.
There was some comment that CMS was making some mistakes that have
not been transparent. It has been my understanding that they have had
problems wrestling with this so-called star system themselves and have
not enforced the law, that we are now saying that they will not enforce
the law until after they study the complexities and report back to the
Congress in an additional 3 years.
In short, they have this star system and, as most people should
recognize, that when you are dealing with old, fragile, sick, poor
people, there are more complexities to performance than in ordinary
programs that compete with Medicare Advantage.
We have this population, and they have penalized some of the
providers because they have had just more problems to deal with than
just medical problems, and they haven't been able to resolve them. They
haven't enforced this provision.
Under this bill, which Mr. Buchanan and the other sponsors have
agreed, it tells the CMS to go back and to find out a way that you can
treat these recipients of health care in a fairer way. It also tells
CMS to take into consideration that the problems that Medicare
Advantage has still to come are far more severe and far more complex
than in other areas.
This is particularly true with our citizens in Puerto Rico that don't
really have an option to anything except Medicare Advantage. Of course,
as we all know, the economic conditions and the poverty that prevails
there is extreme.
I don't have any other requests for time, but I do want to thank my
colleagues on the other side of the aisle for assisting to make certain
that the Affordable Care program and other programs like it become more
effective.
Mr. Speaker, I reserve the balance of my time.
Mr. BRADY of Texas. Mr. Speaker, I am pleased to yield 2 minutes to
the gentlewoman from Tennessee (Mrs. Blackburn), one of the thought
leaders on health care on the Energy and Commerce Committee.
Mrs. BLACKBURN. Mr. Speaker, I do thank the gentleman from Texas for
his leadership and for, really, his commitment to working these issues
through. As you have heard him say, dealing with Medicare Advantage
issues are important, and it is important that we get them right.
That is why I appreciate the fact that we come to the floor with
these suspension bills to revisit these issues and say: Look, there are
some things that just are not working as they were intended.
[[Page H4487]]
As you have heard, there has been bipartisan agreement, that the
stars rating program needs a revisit, and CMS even agrees that the
rules are not working.
As the gentleman from New York said, this has a specific effect on
the frail, the low-income, those beneficiaries that are the most frail.
It also affects the dual eligibles, those that are both Medicare and
Medicaid eligible.
It is appropriate that we look at this rating program, that we back
up and pause and consider the negative impact that some of these
arbitrary ratings have on these programs when it may be the only
program that is available that will meet these needs.
This is common sense. It is the right thing to do. I thank my
colleagues that they are willing to say: CMS, it is not working; you
have to come to the table with us.
This delay, this pause, and a review of the system is appropriate.
I thank everyone involved for their leadership, and I do express
thanks to Mr. Buchanan and his team for the way they have worked with
us and the Energy and Commerce Committee on the issue.
Mr. RANGEL. Mr. Speaker, I have no further requests for time. I
reserve the balance of my time.
Mr. BRADY of Texas. Mr. Speaker, I yield 2 minutes to the gentlewoman
from Tennessee (Mrs. Black), again, one of our key healthcare leaders
on the Ways and Means Committee who is critical in the advancement of
this legislation.
Mrs. BLACK. Mr. Speaker, I rise today in support of H.R. 2582, the
Seniors' Health Care Plan Protection Act.
I am pleased that this legislation includes the language of my bill,
the Securing Care for Seniors Act; and I thank Congressman Buchanan for
his efforts to bring this important policy solution to the floor of the
House today.
Across the country, 16 million seniors enjoy the flexibility of the
Medicare Advantage plan. When we make changes to this program, seniors
are the ones impacted. It just makes sense that they would have a place
at the table when these changes are discussed.
Recently, CMS revised the Medicare Advantage risk adjustment model
under the shroud of secrecy with little input from Congress and, most
importantly, from Medicare beneficiaries.
Members of both parties have concerns that these modifications could
discourage plans to detect and care for the chronic conditions in their
early stages. That is why, today, we are calling for a timeout on CMS'
changes.
We are instructing the agency to reevaluate their risk adjustment
model and to move forward with metrics that are accurate, evidence-
based, and are transparent. This will ensure that seniors pay a fair
cost for their healthcare plans, and that the MA program remains
sustainable in the long term.
I urge a ``yes'' vote on H.R. 2582.
Mr. RANGEL. Mr. Speaker, I yield myself such time as I may consume.
I would just like to say that this has been one of the most exciting
recent legislative experiences I have had, where we are dealing with
Americans who are not Republican and Democrat, but they are sick
people; and, in this particular case, they are sick, and they are old,
and they are fragile, and the government is not serving them.
Both sides of the aisle have agreed that the administration has to do
something to make certain that they study how we can be fair to the
providers and, at the same time, provide the service to those people
that need it. They, themselves, agree that, for 3 years, they have not
been able to find an answer.
What we have said jointly is you find that answer in 3 years. Until
such time, don't you think about terminating these programs. It is with
this cooperation that we both have a common sense of our obligation as
legislators, and it has been really a legislative pleasure working with
my colleagues on these suspensions this evening.
Mr. Speaker, I yield back the balance of my time.
Mr. BRADY of Texas. Mr. Speaker, I yield myself such time as I may
consume.
I agree with the gentleman from New York that this is a bill that
brings, really, a team of Republicans and Democrats together with their
best ideas on how we can help improve Medicare for our seniors.
This bill is titled ``Securing Seniors' Health Care Act.'' It is
aptly titled.
I am hopeful that today is just one example of more common ground
between Republicans and Democrats, not just on the Ways and Means
Committee, but through the House as well. I urge strong support for
passage of this bill.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Texas (Mr. Brady) that the House suspend the rules and
pass the bill, H.R. 2582, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
The title of the bill was amended so as to read: ``A bill To amend
title XVIII of the Social Security Act to delay the authority to
terminate Medicare Advantage contracts for MA plans failing to achieve
minimum quality ratings, to make improvements to the Medicare
Adjustment risk adjustment system, and for other purposes.''.
A motion to reconsider was laid on the table.
____________________