WASHINGTON — Today, Ways and Means members Reps. Diane Black (R-TN) and Earl Blumenauer (D-OR) and Energy and Commerce members Rep. Brett Guthrie (R-KY) and Rep. Dave Loebsack (D-IA), introduced H.R. 2579, the Securing Care for Seniors Act of 2015. The bill would require the Centers for Medicare & Medicaid Services (CMS) to reevaluate and consider changes to Medicare Advantage’s risk adjustment model.
Upon introduction of H.R. 2579, Rep. Black issued the following statement:
“Today, more than a third of Medicare beneficiaries enjoy the flexibility of a Medicare Advantage plan, yet recent cuts imposed by Obamacare and changes to the risk-adjustment model threaten the sustainability of this important program in the long term. My 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.”
Rep. Blumenauer added:
“Requiring CMS to evaluate the Medicare Advantage program based on evidence-based data will not only improve the accuracy of the program, but its integrity. This legislation will shed light on the changes necessary to ensure the unique and specific needs of Medicare beneficiaries are met with high-quality care.”
Background: Medicare Advantage uses a risk-adjustment model to determine reimbursements to providers based on beneficiaries’ age, gender, health status, and complexity of care. All of CMS’s revisions to the model should be accurate, transparent, and based on evidence. So this bill requires CMS to evaluate and, if appropriate, incorporate minor changes to risk-adjustment model, such as using multiple years of data and adjusting for multiple chronic conditions. The legislation also includes a Sense of Congress regarding the Medicare Advantage STARS ratings system, citing work that the Congress plans to reform the system in conjunction with CMS and stakeholders.