Bills
| 3.23.22

Reassessing Medicare Advantage’s Risk-Adjustment Model (H.R. 2579)

Do you support or oppose this bill?

What is H.R. 2579?

(Updated July 21, 2017)

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.

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.

Argument opposed

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

Impact

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

Cost of H.R. 2579

A CBO cost estimate is unavailable.

Additional Info

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)