Bills
| 3.23.22

Re-evaluating Changes to the Medicare Advantage Risk-Adjustment Model (H.R. 2582)

Do you support or oppose this bill?

What is H.R. 2582?

(Updated December 13, 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.

The Dept. of Health and Human Services would report to Congress every three years after 2017 with revisions (if any) related to this legislation.

This bill is almost an identical copy of the "Securing Care for Seniors Act." The biggest difference is this bill delays the ability of CMS to terminate Medicare Advantage plan contracts when people fail to comply with performance standards under the STARS rating system. The delay would extend until the end of plan year 2018.

Argument in favor

Affordable Care Act changes to Medicare Advantage’s risk-adjustment have made it unsustainable. Re-evaluating how data is collected how the program is shaped will put it on a better track for serving seniors and retirees.

Argument opposed

There’s no guarantee that there will be any real changes once these studies and evaluations are completed. Congress shouldn’t leave such an important decision in the hands of bureaucrats — it needs to take action once the data has been analyzed.

Impact

Seniors who are enrolled in Medicare Advantage, companies involved with Medicare Advantage plans, the Centers for Medicare and Medicaid Services (CMS).

Cost of H.R. 2582

A CBO cost estimate is unavailable.

Additional Info

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 Army Medicine)