Securing Senior's Health Care Act of 2015

Senior's Health Care Plan Protection Act of 2015

(Sec. 2) 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 Medicare Advantage (MA) plans before reforming it, and, pending study and input results, (2) delay Centers for Medicare & Medicaid (CMS) authority to terminate MA plan contracts solely on the basis of performance under the five-star rating system.

The Department of Health and Human Services (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.

(Sec. 3) This bill amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct HHS (in effect, 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 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.

(Sec. 4) 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); and
• Congress will work with CMS and stakeholders, including beneficiary groups and managed care organizations, to ensure that the five-star quality rating system for MA plans properly accounts for the socioeconomic status of plan enrollees and the extent to which plans serve them.

(Sec. 5) It is also the sense of Congress that HHS should:

• periodically monitor and improve the risk adjustment model for payments to MA organizations to ensure that it accurately accounts for beneficiary risk;
• closely examine and adjust as necessary the current MA 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
• reconsider the implementation of changes in the MA risk adjustment methodology finalized for 2016 and, to the extent appropriate, use the risk methodology finalized in 2015 for one additional year.

Written by the nonpartisan Congressional Research Service. All summary versions on Congress.gov