Securing Care for Seniors Act of 2013 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act to terminate after 2013 the permission to disenroll, between January 1 and March 15 of each year, only from a MedicareAdvantage (MA) plan to elect enrollment in the original Medicare fee-for-service program.
Restores the option under previous law to elect to change from an MA plan to the original Medicare fee-for-service plan, or from the original Medicare fee-for-service to an MA plan, once a year during the first three months.
Permits an MA organization to offer individuals enrolled in one of its MA plans one or more incentive programs designed to improve their health care.
Permits an MA plan, through mechanisms such as value based insurance design (VBID) practices, to vary cost sharing for the purpose of encouraging enrollees to use providers that the MA organization has identified as performing well on quality metrics.
Directs the Secretary of Health and Human Services (HHS) to evaluate and, as appropriate, revise for 2017 and periodically thereafter the risk adjustment system so that a risk score, with respect to an individual, takes into account the number of chronic conditions with which the individual has been diagnosed, and, to the extent available, at least two years of diagnostic data including data obtained during the individual's health risk assessments.
Requires the Secretary to take steps necessary to ensure that the MA 5-star rating system: (1) does not disadvantage a plan that enrolls a disproportionately high proportion of enrollees who are full-benefit dual eligible individuals, subsidy eligible individuals, or other individuals with complex health care needs such as individuals with multiple conditions; and (2) allows adjustments to account for differences in socioeconomic and demographic characteristics of enrollees and geographic variation in health outcomes.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2753 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 2753
To amend title XVIII of the Social Security Act to improve Medicare
Advantage, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 19, 2013
Mrs. Black introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve Medicare
Advantage, and for other purposes.
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 ``Securing Care for Seniors Act of
2013''.
SEC. 2. REINSTATEMENT OF 3-MONTH OPEN ENROLLMENT AND DISENROLLMENT
PERIOD FOR MEDICARE ADVANTAGE.
Section 1851(e)(2) of the Social Security Act (42 U.S.C. 1395w-
1(e)(2)) is amended--
(1) in subparagraph (C), by inserting ``and ending with
2013'' after ``(beginning with 2011''; and
(2) by adding at the end the following new subparagraph:
``(F) Continuous open enrollment and disenrollment
for first 3 months in subsequent years.--
``(i) In general.--Subject to subparagraph
(D), at any time during the first 3 months of a
year (beginning with 2014), or, if the
individual first becomes a Medicare Advantage
eligible individual during a year after 2014,
during the first 3 months of such year in which
the individual is a Medicare Advantage eligible
individual, a Medicare Advantage eligible
individual may change the election under
subsection (a)(1).
``(ii) Limitation of one change during open
enrollment period each year.--An individual may
exercise the right under clause (i) only once
during the applicable 3-month period described
in such clause in each year. The limitation
under this clause shall not apply to changes in
elections effected during an annual,
coordinated election period under paragraph (3)
or during a special election period under
paragraph (4).
``(iii) Application to part d for
individuals changing enrollment from ma to fee-
for-service.--The previous provisions of this
subparagraph shall only apply with respect to
changes in enrollment in a prescription drug
plan under part D in the case of an individual
who, previous to such change in enrollment, is
enrolled in a Medicare Advantage plan.''.
SEC. 3. PERMITTING INCENTIVES FOR PARTICIPATION IN HEALTH CARE
IMPROVEMENT PROGRAMS.
(a) In General.--Section 1859 of the Social Security Act (42 U.S.C.
1395w-28) is amended by adding at the end the following new subsection:
``(h) Permitting MA Organizations To Provide Incentives for
Participation in Health Care Improvement Programs.--
``(1) In general.--An MA organization may offer to
individuals enrolled in an MA plan offered by such organization
one or more incentive programs that are designed to improve the
health care of such individuals by providing one or more
incentives, such as the reducing or waiving of copayment
amounts, that reward individuals for participation in such a
program, if--
``(A) the incentive program meets the requirements
described in paragraph (2); and
``(B) the MA organization provides to the Secretary
such information on participation and performance in
the incentive program as the Secretary may specify.
``(2) Requirements.--The requirements described in this
paragraph, with respect to an incentive program offered by an
MA organization to individuals enrolled in an MA plan offered
by such organization, are as follows:
``(A) Incentive only upon completion of program.--
In the case of a program that consists of multiple
sessions or other multiple activities, any incentive
offered under the program is offered only upon
completion of all such sessions or activities.
``(B) Nondiscrimination.--Participation in the
program is offered to all such individuals.
``(C) No cash or monetary incentive.--
``(i) In general.--No incentive under the
program is in the form of cash or any other
monetary rebate.
``(ii) Construction.--Nothing in clause (i)
may be construed as preventing the offering of
an incentive in the form of a reduction or
waiver of copayment amounts or deductibles.
``(3) Waiver authority.--The Secretary may waive such
requirements of this title and title XI, except for sections
1128A, 1128B(b), and 1877, as may be necessary to carry out the
purposes of the program established under this subsection.
``(4) Program not taken into account for bid amount.--The
program may not be taken into account for purposes of the
monthly bid amount submitted by the organization under section
1854(a)(6) and provisions relating to the monthly bid amount.
``(5) Encouragement to participate in activities offered by
certain persons or entities.--An MA organization may, as part
of an incentive program offered by such organization to
individuals under this subsection, require or otherwise
encourage such individuals to participate in activities
designed to improve the health care of such individuals that
are offered by persons or entities specified by such
organization, such as persons or entities that the organization
has identified as performing well on quality metrics identified
by the organization.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect for plan years beginning on or after the date of the
enactment of this Act.
SEC. 4. COST SHARING VARIATION PERMITTED TO ENCOURAGE USE OF HIGH
QUALITY PROVIDERS.
Section 1852 of the Social Security Act (42 U.S.C. 1395w-22) is
amended--
(1) in subsection (a)(1)(B)--
(A) in clause (i), by striking ``clause (iii)'' and
inserting ``clauses (iii) and (vi)''; and
(B) by adding at the end the following new clause:
``(vi) Cost sharing variation permitted to
encourage use of high quality providers.--
Notwithstanding subsection (b), an MA plan
offered by an MA organization may, through
mechanisms such as value based insurance design
(VBID) practices, vary cost-sharing for the
purpose of encouraging enrollees to use
providers that such organization has identified
as performing well on quality metrics
identified by the organization. Any such
variation on cost-sharing by an MA organization
must occur on an annual basis. An MA
organization may not vary cost-sharing pursuant
to this paragraph during a plan year.''; and
(2) in subsection (b)(2), by striking ``A Medicare+Choice''
and inserting ``Subject to subsection (a)(1)(B)(vi), a Medicare
Advantage''.
SEC. 5. IMPROVEMENTS TO 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) Revision of risk adjustment system
to account for chronic conditions and two years
of diagnostic data.--
``(I) In general.--The Secretary
shall evaluate and, as the Secretary
determines appropriate, 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, and
at least two years of diagnostic data
including such data obtained during
health risk assessments regarding the
individual, to the extent that two
years of such data are available.
``(II) Periodic reporting to
congress.--With respect to plan years
beginning in 2017 and every third year
thereafter, the Secretary shall submit
to Congress a report on the most recent
revisions (if any) made under subclause
(I).
``(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 MA 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 any changes to adjustment factors
effective for 2015 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 and a public comment
period of not less than 60 days before
implementing such changes.''.
SEC. 6. IMPROVEMENTS TO MA 5-STAR QUALITY RATING SYSTEM.
Section 1853(o)(4) of the Social Security Act (42 U.S.C. 1395w-
23(o)(4)) is amended by adding at the end the following new
subparagraph:
``(C) Plans with disproportionately high enrollment
of individuals with complex health care needs.--
``(i) In general.--The Secretary shall take
such steps as are necessary to ensure that the
5-star rating system described in subparagraph
(A)--
``(I) does not disadvantage a plan
that enrolls a disproportionately high
proportion of enrollees who are full-
benefit dual eligible individuals (as
defined in section 1935(c)(6)), subsidy
eligible individuals (as defined in
section 1860D-14(a)(3)), or other
individuals with complex health care
needs such as individuals with multiple
conditions; and
``(II) allows adjustments to
account for differences in
socioeconomic and demographic
characteristics of enrollees and
geographic variation in health
outcomes.
``(D) Announcement of changes two years prior to
end of performance period.--The Secretary may not
implement any change in the 5-star rating system
described in subparagraph (A) with respect to any
performance period used as part of such system unless
the Secretary announces such change at least one year
prior to the beginning of any such period.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line