Reports and Resources

By: 
PFM

 
What bills are being discussed?
 
In May 2015, a bipartisan group of members of the House Ways and Means and Energy and Commerce Committees introduced four bills designed to support and strengthen the Medicare Advantage (MA) program.
 
H.R.2505: “Medicare Advantage Transparency Act of 2015”
 
H.R.2505 would mandate the Centers for Medicare and Medicaid Services (CMS) to submit annual enrollment data for both MA and Medicare Advantage Prescription Drug (MA- PD) plans, by zip code, congressional district, and state to the House Ways and Means and Energy and Commerce Committees. Annual reports would ensure that policymakers have current and accurate Medicare Advantage enrollment information.
 
H.R.2507: “Increasing Regulatory Fairness Act of 2015”
 
H.R.2507 would expand the regulatory and rulemaking schedule that sets annual Medicare Advantage payment rates, also known as the “comment” or “rate setting” period, beginning in Calendar Year (CY) 2017. Every year, CMS provides a preliminary and final notice of MA payment rates to Medicare Advantage Organizations, which include any methodological changes since the previous year’s final notice.  H.R.2507 extends the “comment period” from at least 45 days to at least 60 days before the final notice.
 
H.R.2570: “Value Based Insurance Design for Better Care Act of 2015”
 
H.R.2570 would establish a three-year demonstration program to test value-based insurance design (V-BID) methodologies in MA plans. V-BID is used to lower cost-sharing, such as copayments and coinsurance, for high-value medications and clinical services to increase patients’ access to critical treatments.  Evidence shows that reducing cost-sharing for high-value medications and services increases their utilization, improves health outcomes and lowers health care costs. H.R.2570 would allow MA plans with 4 stars or higher to participate in the demonstration program.
 
H.R.2582: “Seniors’ Health Care Plan Protection Act of 2015”
 
H.R.2582 would revise CMS’ risk adjustment model to take into account the number of chronic conditions with which a beneficiary has been diagnosed. Risk adjustment is a payment methodology used to adjust payment to MA plans based on enrollees’ demographic and health characteristics.  Comorbidity prevalence on a per beneficiary basis, however, is not included in the current methodology. H.R.2582 would ensure that CMS’ risk adjustment model properly account for these factors.
In addition, H.R.2582 would revise the Star Rating System that evaluates MA plans.  The current system gives MA plans a quality score on a 5-star scale based on their performance, access, and process; it does not consider the socioeconomic status of enrollees. Traditionally, MAO contracts may be terminated if the MA plans they offer receive low star ratings. H.R.2582 would prevent CMS from terminating a contract solely due to an MA plan’s low star rating and would urge the agency to consider enrollees’ socioeconomic status in the Star Rating System.
 

What is the current status of these bills?
 
On June 17, 2015, all four bills passed the House of Representatives.  They will now be considered by the Senate. 
 
What is the significance of these bills?
 
The introduction of these bills demonstrates the increasing, bipartisan support for MA in Congress. As MA enrollment increases – over 17 million Medicare beneficiaries are currently enrolled in MA plans – it is likely Congress will continue to look for ways to improve and support the program for beneficiaries, plans and providers.    
 
 
View PFM's full fact sheet here
 


[i] https://www.congress.gov/bill/114th-congress/house-bill/2505/text

[ii] https://www.congress.gov/bill/114th-congress/house-bill/2507/text

[iii] https://www.congress.gov/bill/114th-congress/house-bill/2570/text

[iv] http://vbidcenter.org/wp-content/uploads/2014/10/V-BID-Brief-Medicare-Ad...

[v] https://www.congress.gov/bill/114th-congress/house-bill/2570/text

[vi] https://www.congress.gov/bill/114th-congress/house-bill/2582/text

[vii] http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk...

[viii] http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugC...

[ix] http://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or...

[x] https://www.congress.gov/bill/114th-congress/house-bill/2582/text

 

Date: 
Wednesday, June 24, 2015