text: 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 2 
                                  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.
  
              Passed the House of Representatives June 17, 2015.
  
              Attest:
  
                                                   KAREN L. HAAS,
  
                                                                   Clerk.
target: 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 &amp; 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. 
feat_title: Seniors' Health Care Plan Protection Act of 2015