,i #aacth ,,congress #ast ,session ,h4 ,r4 #bgec ,,in ,,the ,,house ,,of ,,representatives ,july #ai1 #bjac ,mrs4 ,black introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to improve ,medicare ,advantage1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,securing ,care for ,seniors ,act of #bjac4 #b4 ,reinstatement of #c-month open enrollment and disenrollment period for ,medicare ,advantage ,section #ahea7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#a7;e77#b77 is amended-- 7#a7 in subparagraph 7,c71 by inserting and ending with #bjac after 7beginning with #bjaa2 and 7#b7 by adding at the end the following new subparagraph3 7,f7 ,continuous open enrollment and disenrollment for first #c months in subsequent years 7i7 ,in general ,subject to subparagraph 7,d71 at any time during the first #c months of a year 7beginning with #bjad71 or1 if the individual first becomes a ,medicare ,advantage eligible individual during a year after #bjad1 during the first #c months of such year in which the individual is a ,medicare ,advantage eligible individual1 a ,medicare ,advantage eligible individual may change the election under subsection 7a77#a74 7ii7 ,limitation of one change during open enrollment period each year ,an individual may exercise the right under clause 7i7 only once during the applicable #c-month period described in such clause in each year4 ,the limitation under this clause shall not apply to changes in elections effected during an annual1 coordinated election period under paragraph 7#c7 or during a special election period under paragraph 7#d74 7iii7 ,application to part ,d for individuals changing enrollment from ,,ma to fee-for-service ,the previous provisions of this subparagraph shall only apply with respect to changes in enrollment in a prescription drug plan under part ,d in the case of an individual who1 previous to such change in enrollment1 is enrolled in a ,medicare ,advantage plan4 4 #c4 ,permitting incentives for participation in health care improvement programs 7a7 ,in general ,section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is amended by adding at the end the following new subsection3 7h7 ,permitting ,,ma organizations ,to provide incentives for participation in health care improvement programs 7#a7 ,in general ,an ,,ma organization may offer to individuals enrolled in an ,,ma plan offered by such organization one or more incentive programs that are designed to improve the health care of such individuals by providing one or more incentives1 such as the reducing or waiving of copayment amounts1 that reward individuals for participation in such a program1 if-- 7,a7 the incentive program meets the requirements described in paragraph 7#b72 and 7,b7 the ,,ma organization provides to the ,secretary such information on participation and performance in the incentive program as the ,secretary may specify4 7#b7 ,requirements ,the requirements described in this paragraph1 with respect to an incentive program offered by an ,,ma organization to individuals enrolled in an ,,ma plan offered by such organization1 are as follows3 7,a7 ,incentive only upon completion of program ,in the case of a program that consists of multiple sessions or other multiple activities1 any incentive offered under the program is offered only upon completion of all such sessions or activities4 7,b7 ,nondiscrimination ,participation in the program is offered to all such individuals4 7,c7 ,no cash or monetary incentive 7i7 ,in general ,no incentive under the program is in the form of cash or any other monetary rebate4 7ii7 ,construction ,nothing in clause 7i7 may be construed as preventing the offering of an incentive in the form of a reduction or waiver of copayment amounts or deductibles4 7#c7 ,waiver authority ,the ,secretary may waive such requirements of this title and title ,,xi1 except for sections #aabh;,a1 #aabh;,b7b71 and #ahgg1 as may be necessary to carry out the purposes of the program established under this subsection4 7#d7 ,program not taken into account for bid amount ,the program may not be taken into account for purposes of the monthly bid amount submitted by the organization under section #ahed7;a77#f7 and provisions relating to the monthly bid amount4 7#e7 ,encouragement to participate in activities offered by certain persons or entities ,an ,,ma organization may1 as part of an incentive program offered by such organization to individuals under this subsection1 require or otherwise encourage such individuals to participate in activities designed to improve the health care of such individuals that are offered by persons or entities specified by such organization1 such as persons or entities that the organization has identified as performing well on quality metrics identified by the organization4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect for plan years beginning on or after the date of the enactment of this ,act4 #d4 ,cost sharing variation permitted to encourage use of high quality providers ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended-- 7#a7 in subsection 7a77#a77;,b7-- 7,a7 in clause 7i71 by striking clause 7iii7 and inserting clauses 7iii7 and 7vi72 and 7,b7 by adding at the end the following new clause3 7vi7 ,cost sharing variation permitted to encourage use of high quality providers ,notwithstanding subsection 7b71 an ,,ma plan offered by an ,,ma organization may1 through mechanisms such as value based insurance design 7,,vbid7 practices1 vary cost-sharing for the purpose of encouraging enrollees to use providers that such organization has identified as performing well on quality metrics identified by the organization4 ,any such variation on cost-sharing by an ,,ma organization must occur on an annual basis4 ,an ,,ma organization may not vary cost-sharing pursuant to this paragraph during a plan year4 2 and 7#b7 in subsection 7b77#b71 by striking ,a ,medicare,choice and inserting ,subject to subsection 7a77#a77;,b77vi71 a ,medicare ,advantage4 #e4 ,improvements to risk adjustment system ,section #ahec7;a77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#a77;,c77 is amended by adding at the end the following new clauses3 7iv7 ,revision of risk adjustment system to account for chronic conditions and two years of diagnostic data 7,i7 ,in general ,the ,secretary shall evaluate and1 as the ,secretary determines appropriate1 revise for #bjag and periodically thereafter the risk adjustment system under this subparagraph so that a risk score under such system1 with respect to an individual1 takes into account the number of chronic conditions with which the individual has been diagnosed1 and at least two years of diagnostic data including such data obtained during health risk assessments regarding the individual1 to the extent that two years of such data are available4 7,,ii7 ,periodic reporting to ,congress ,with respect to plan years beginning in #bjag and every third year thereafter1 the ,secretary shall submit to ,congress a report on the most recent revisions 7if any7 made under subclause 7,i74 7v7 ,no changes to adjustment factors that prevent activities consistent with national health policy goals ,in making any changes to the adjustment factors1 including adjustment for health status under paragraph 7#c71 the ,secretary shall ensure that the changes do not prevent ,,ma organizations from performing or undertaking activities that are consistent with national health policy goals1 including activities to promote early detection and better care coordination1 the use of health risk assessments1 care plans1 and programs to slow the progression of chronic diseases4 7vi7 ,opportunity for review and public comment regarding changes to adjustment factors ,for any changes to adjustment factors effective for #bjae and subsequent years1 in addition to providing notice of such changes in the announcement under subsection 7b77#b71 the ,secretary shall provide an opportunity for review of proposed changes and a public comment period of not less than #fj days before implementing such changes4 4 #f4 ,improvements to ,,ma #e-star quality rating system ,section #ahec7o77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77#d77 is amended by adding at the end the following new subparagraph3 7,c7 ,plans with disproportionately high enrollment of individuals with complex health care needs 7i7 ,in general ,the ,secretary shall take such steps as are necessary to ensure that the #e-star rating system described in subparagraph 7,a7-- 7,i7 does not disadvantage a plan that enrolls a disproportionately high proportion of enrollees who are full-benefit dual eligible individuals 7as defined in section #aice7;c77#f771 subsidy eligible individuals 7as defined in section #ahfj;,d-#ad7;a77#c771 or other individuals with complex health care needs such as individuals with multiple conditions2 and 7,,ii7 allows adjustments to account for differences in socioeconomic and demographic characteristics of enrollees and geographic variation in health outcomes4 7,d7 ,announcement of changes two years prior to end of performance period ,the ,secretary may not implement any change in the #e-star rating system described in subparagraph 7,a7 with respect to any performance period used as part of such system unless the ,secretary announces such change at least one year prior to the beginning of any such period4 4