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house Bill H.R. 2579

Reassessing Medicare Advantage’s Risk-Adjustment Model

Argument in favor

Especially after the changes made to Medicare Advantage’s risk-adjustment model by the ACA, re-evaluating the model is important to keep services thoughtfully tailored to the people they serve.

Burnetta's Opinion
···
06/01/2016
Bullshit. Once again you are trying to take away monies that were promised. You want change. Cut your own perks and benefits. Just my opinion
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Argument opposed

This bill doesn't offer any guarantees of tangible change. New evaluations don't necessarily mean that anything will change.

John's Opinion
···
03/08/2016
I say lets get government out of the healthcare business and stop all this lobbying by these insurance companies to change the laws to increase their bottom lines at the cost of America
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What is House Bill H.R. 2579?

This bill would require the Centers for Medicare and Medicaid Services (CMS) to re-evaluate and, if necessary, make changes to the Medicare Advantage (MA) risk adjustment model

The way that the risk adjustment model scores for the number of chronic conditions a person has been diagnosed with would be changed for 2017 — reforms aimed at ensuring that the metrics are accurate, evidence-based, and transparent. 

The re-evaluation would include a consideration of using data from two years — in this case 2013 and 2014 — to determine risk scores. Stakeholders like the Medicare Payment Advisory Commission, managed care organizations, and beneficiary groups would be consulted when creating the other elements of a new evaluation. CMS would also have to consider the socio-economic status of beneficiaries when evaluating changes in the program.

The Dept. of Health and Human Services would report to Congress every three years after 2017 and describe revisions (if any) that have been made that are related to this legislation.

Impact

Seniors who are enrolled in Medicare Advantage and other stakeholders, the Centers for Medicare and Medicaid Services (CMS).

Cost of House Bill H.R. 2579

A CBO cost estimate is unavailable.

More Information

In-Depth: When introducing this bill, Rep. Diane Black (R-TN) noted that more than one-third of all Medicare beneficiaries are enrolled in Medicare Advantage, and that her legislation: 

“Protects the Medicare Advantage program for future retirees by requiring CMS to reconsider potentially harmful changes made to the risk adjustment system. It further calls upon the agency to adopt a more transparent process for any future changes to the program with opportunities for feedback from beneficiaries.”

Adding a bipartisan flavor to this legislation, Rep. Earl Blumenauer (D-OR) signed on as a cosponsor, praising this bill for its effort to “shed light on the changes necessary to ensure the unique and specific needs of Medicare beneficiaries are met with high-quality care.”

This bill was passed unanimously by the House Ways and Means Committee through a voice vote.


Of Note: Medicare Advantage plans have undergone some of the most drastic changes under the Affordable Care Act (ACA). Advantage plans are offered private companies that contract with Medicare to provide Part A and Part B benefits. These plans usually offer prescription drug coverage, and most Medicare services are covered through these plans and aren’t paid for under Original Medicare.

According to the Kaiser Family Foundation, in 2014 there were about 15.7 million people enrolled in Medicare Advantage plans, and the program accounts for 30 percent of total Medicare spending.


Media:

Summary by Eric Revell
(Photo Credit: Flickr user Thirteen of Clubs)

AKA

Securing Care for Seniors Act of 2015

Official Title

To amend title XVIII of the Social Security Act to improve the risk adjustment under the Medicare Advantage program, and for other purposes.

bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
  • The house has not voted
      house Committees
      Committee on Energy and Commerce
      Health
      Committee on Ways and Means
      Health
    IntroducedMay 29th, 2015
    I say lets get government out of the healthcare business and stop all this lobbying by these insurance companies to change the laws to increase their bottom lines at the cost of America
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    No spending.
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    Looking at whats wrong is great but if you dont have a framework for how to fix it nothing happena. This is feel good legislation to say we are protecting seniors without doing anythibg. Sorry congress you must fo better
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    Stop wasting time on tinkering with this disastrous legislation. Start repealing every piece until you can gut the whole ACA.
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    Bullshit. Once again you are trying to take away monies that were promised. You want change. Cut your own perks and benefits. Just my opinion
    Like (1)
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    Another way to charge elderly more wake up people understand what GOP is trying to do against you and for the Insurance industry
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    This bill doesn't make sense. It gives an out to paying. Just leave our medicare alone.
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