[Congressional Record (Bound Edition), Volume 161 (2015), Part 7]
[House]
[Pages 9850-9852]
[From the U.S. 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 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.


[[Page 9851]]


  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 thoughtful 
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.
  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

[[Page 9852]]

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.

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