HR-2582 : Still Just a Bill

Securing Senior's Health Care Act of 2015

This bill amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct the Department of Health and Human Services (HHS) (in effect, the Centers for Medicare & Medicaid Services [CMS]) to revise for 2017, and periodically afterwards, the system for risk adjustments to payments to Medicare+Choice organizations so that an individual's risk score takes into account the number of chronic conditions with which the individual has been diagnosed.

HHS must, including an actuarial opinion of the CMS Chief Actuary, evaluate the impacts of:

• including two years of data to compare the models used to determine the risk scores for 2013 and 2014,
• removing the diagnosis codes related to chronic kidney disease in the 2014 risk adjustment model, and
• including 10% of encounter data in computing payment for 2016 and CMS readiness to incorporate encounter data in risk scores.

HHS shall also analyze the best practices of MedicareAdvantage (MA) plans to slow disease progression related to chronic kidney disease.

HHS shall then, if appropriate, make revisions to the risk adjustment system, based on such an evaluation or analysis, to better reflect and appropriately weight for the population served.

Congress declares that the five-star quality rating system for MA plans lacks proper accounting for the socioeconomic status of plan enrollees and the extent to which those plans serve individuals also eligible for medical assistance under SSAct title XIX (Medicaid).

It is the intent of Congress to: (1) continue to study and request input on the effects of socioeconomic status and dual-eligible populations on the five-star quality rating system for MA plans before reforming it, and, pending study and input results, (2) delay CMS authority to terminate MA plan contracts solely on the basis of performance under the five-star quality rating system.

HHS may not, through the end of plan year 2018, terminate a contract with respect to the offering of an MA plan by an MA organization solely because the plan has failed to achieve a minimum quality rating under the five-star rating system.