#aad? ,,congress  #a/ ,session  ,h4 ,r4 
#behb  ,,an ,,act  ,to am5d title       
,,xviii ( ! ,social ,security ,act to   
delay ! au?ority to t]m9ate ,m$ic>e     
,advantage contracts = ,,ma plans fail+ 
to a*ieve m9imum quality rat+s1 to make 
improvem5ts to ! ,m$ic>e ,adju/m5t risk 
adju/m5t sy/em1 & = o!r purposes4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,s5iors' ,heal? ,c>e ,plan ,protection  
,act ( #bjae4  #b4 ,delay 9 au?ority ,to
 t]m9ate contracts = ,m$ic>e ,advantage 
plans fail+ ,to a*ieve m9imum quality   
rat+s  7a7 ,f9d+s ,consi/5t ) ! /udies  
provid$ "u ! ,,impact ,act ( #bjad      
7,public ,law #aac-ahe71 x is ! int5t ( 
,congress--  7#a7 to cont9ue to /udy &  
reque/ input on ! effects (             
socioeconomic /atus & dual-eligible     
populations on ! ,m$ic>e ,advantage     
,,/>s rat+ sy/em be=e re=m+ su* sy/em ) 
! input ( /akehold]s2 &  7#b7 p5d+ !    
results ( su* /udies & input1 to provide
 = a tempor>y delay 9 au?ority ( !      
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices     

7,,cms7 to t]m9ate ,m$ic>e ,advantage   
plan contracts solely on ! basis (      
p]=mance ( plans "u ! ,,/>s rat+ sy/em4 
7b7 ,delay 9 ,,ma contract t]m9ation    
au?ority = plans fail+ ,to a*ieve m9imum
 quality rat+s ,section #aheg7;h7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bg7;h77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#c7 ,delay 
9 contract t]m9ation au?ority = plans   
fail+ to a*ieve m9imum quality rat+ ,!  
,secret>y may n t]m9ate a contract "u   
?is section ) respect to ! (f]+ ( an    
,,ma plan by a ,m$ic>e ,advantage       
organization solely because ! ,,ma plan 
has fail$ to a*ieve a m9imum quality    
rat+ "u ! #e-/> rat+ sy/em e/abli%$ "u  
section #ahec7o7 dur+ ! p]iod beg9n+ on 
! date ( ! enactm5t ( ?is p>agraph &    
?r\gh ! end ( plan ye> #bjah4  4  #c4   
,improvem5ts to ,,ma risk adju/m5t sy/em
 ,section #ahec7;a77#a77;,c7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciew-#bc7;a77#a77;,c77 is am5d$ by    
add+ at ! end ! foll[+ new clauses3     

7iv7 ,evaluation & subsequ5t revision ( 
! risk adju/m5t sy/em to acc\nt = *ronic
 conditions & o!r factors = ! purpose ( 
mak+ ! risk adju/m5t sy/em m accurate1  
transp>5t1 & regul>ly updat$  7,i7      
,revision bas$ on numb] ( *ronic        
conditions ,! ,secret>y %all revise =   
#bjag & p]iodically !reaft]1 ! risk     
adju/m5t sy/em "u ?is subp>agraph s t a 
risk score "u su* sy/em1 ) respect to an
 individual1 takes into acc\nt ! numb] (
 *ronic conditions ) :i* ! individual   
has be5 diagnos$4  7,,ii7 ,evaluation ( 
diff]5t risk adju/m5t models ,!         
,secret>y %all evaluate ! impact (      
includ+ #b ye>s ( data to comp>e !      
models us$ to det]m9e risk scores =     
#bjac & #bjad "u su* sy/em4  7,,iii7    
,evaluation & analysis on *ronic kidney 
disease 7,,ckd7 codes ,! ,secret>y %all 
evaluate ! impact ( remov+ ! diagnosis  
codes relat$ to *ronic kidney disease 9 
! #bjad risk adju/m5t model & conduct an
 analysis ( be/ practices ( ,,ma plans  
to sl[ disease progression relat$ to    

*ronic kidney disease4  7,,iv7          
,evaluation & recomm5dations on use (   
enc\nt] data ,! ,secret>y %all evaluate 
! impact ( includ+ #aj p]c5t ( enc\nt]  
data 9 comput+ paym5t = #bjaf & !       
read9ess ( ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices to incorporate enc\nt] data 9  
risk scores4 ,9 conduct+ su* evaluation1
 ! ,secret>y %all use data collect$ z   
enc\nt] data on or aft] ,janu>y #a1     
#bjab1 %all analyze su* data = accuracy 
& complet5ess & issue recomm5dations =  
improv+ su* accuracy & complet5ess1 &   
%all n increase ! p]c5tage ( su* enc\nt]
 data us$ unless ! ,secret>y releases ! 
data publicly1 indicates h[ su* data w  
be weight$ 9 comput+ ! risk scores1 &   
ensures t ! data reflects ! degree & co/
 ( c>e coord9ation "u ,,ma plans4  7,v7 
,conduct ( evaluations ,evaluations &   
analyses "u subclause 7,,ii7 ?r\gh      
7,,iv7 %all include an actu>ial op9ion f
 ! ,*ief ,actu>y ( ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices ab\t ! reasonabl5ess (
 ! me?ods1 assumptions1 & conclusions ( 

su* evaluations & analyses4 ,! ,secret>y
 %all consult ) ! ,m$ic>e ,paym5t       
,advisory ,commission & accept & consid]
 comm5ts ( /akehold]s1 su* z manag$ c>e 
organizations & b5efici>y gr\ps1 on su* 
evaluation & analyses4 ,! ,secret>y %all
 complete su* evaluations & analyses 9 a
 mann] t p]mits ! results to be appli$ =
 plan ye>s beg9n+ ) ! second plan ye> t 
beg9s aft] ! date ( ! enactm5t ( ?is    
clause4  7,,vi7 ,implem5tation (        
revisions bas$ on evaluations ,if !     
,secret>y det]m9es1 bas$ on su* an      
evaluation or analysis1 t revisions to !
 risk adju/m5t sy/em to address ! matt]s
 describ$ 9 any ( subclauses 7,,ii7     
?r\gh 7,,iv7 w\ld make ! risk adju/m5t  
sy/em "u ?is subp>agraph bett] reflect &
 appropriately weight = ! population t  
is s]v$ by ! plan1 ! ,secret>y %all1    
beg9n+ ) #bjag1 & p]iodically !reaft]1  
make su* revisions4  7,,vii7 ,p]iodic   
report+ to ,congress ,) respect to plan 
ye>s beg9n+ ) #bjag & e ?ird ye>        
!reaft]1 ! ,secret>y %all submit to     

,congress a report on ! mo/ rec5t       
revisions 7if any7 made "u ?is clause1  
includ+ ! evaluations conduct$ "u       
subclauses 7,,ii7 ?r\gh 7,,iv74  7v7 ,no
 *anges to adju/m5t factors t prev5t    
activities consi/5t ) national heal?    
policy goals ,9 mak+ any *anges to !    
adju/m5t factors1 includ+ adju/m5t =    
heal? /atus "u p>agraph 7#c71 !         
,secret>y %all ensure t ! *anges d n    
prev5t ,m$ic>e ,advantage organizations 
f p]=m+ or und]tak+ activities t are    
consi/5t ) national heal? policy goals1 
includ+ activities to promote e>ly      
detection & bett] c>e coord9ation1 ! use
 ( heal? risk assessm5ts1 c>e plans1 &  
programs to sl[ ! progression ( *ronic  
diseases4  7vi7 ,opportunity = review & 
public comm5t reg>d+ *anges to adju/m5t 
factors ,= *anges to adju/m5t factors   
effective = #bjag & subsequ5t ye>s1 9   
addition to provid+ notice ( su* *anges 
9 ! ann\ncem5t "u subsection 7b77#b71 ! 
,secret>y %all provide an opportunity = 
review ( propos$ *anges ( n less ?an #fj

 days & a public comm5t p]iod ( n less  
?an #cj days be=e implem5t+ su* *anges4 
4  #d4 ,s5se ( ,congress relat+ to      
,m$ic>e ,advantage /> rat+ sy/em ,x is !
 s5se ( ,congress t-- 7#a7 ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices has          
inadv]t5tly creat$ a /> rat+ sy/em "u   
section #ahec7o77#d7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7o77#d77 = ,m$ic>e ,advantage 
plans t lacks prop] acc\nt+ = !         
socioeconomic /atus ( enrollees 9 su*   
plans & ! ext5t to :i* su* plans s]ve   
individuals :o are also eligible =      
m$ical assi/ance "u title ,,xix ( su*   
,act2 &  7#b7 ,congress w "w ) ! ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices &          
/akehold]s1 includ+ b5efici>y gr\ps &   
manag$ c>e organizations1 to ensure t   
su* rat+ sy/em prop]ly acc\nts = !      
socioeconomic /atus ( enrollees 9 su*   
plans & ! ext5t to :i* su* plans s]ve   
su* individuals describ$ 9 p>agraph     
7#a74  #e4 ,s5se ( ,congress relat+ to  
,m$ic>e ,advantage risk adju/m5t ,x is !

 s5se ( ,congress t--  7#a7 ! ,secret>y 
( ,heal? & ,human ,s]vices %\ld         
p]iodically monitor & improve ! ,m$ic>e 
,advantage risk adju/m5t model to ensure
 t x accurately acc\nts = b5efici>y     
risk1 includ+ = ^? individuals ) complex
 *ronic comorbid conditions2  7#b7 !    
,secret>y %\ld closely exam9e ! curr5t  
,m$ic>e ,advantage risk adju/m5t        
me?odology to ensure t plans enroll+    
b5efici>ies ) ! greate/ heal? c>e ne$s  
receive adequate reimbursem5t to deliv] 
high-quality c>e & o!r s]vices to help  
b5efici>ies avoid co/ly complications & 
fur!r progression ( *ronic conditions & 
to ! ext5t data indicate ?is to be !    
case1 ! ,secret>y %\ld make necess>y    
adju/m5t to ! risk adju/m5t me?odology2 
&  7#c7 ! ,secret>y %\ld reconsid] !    
implem5tation ( *anges 9 ! ,m$ic>e      
,advantage risk adju/m5t me?odology     
f9aliz$ = #bjaf & to use to ! ext5t     
appropriate ! me?odology f9aliz$ 9 #bjae
 = "o additional ye>4  ,pass$ ! ,h\se ( 
,repres5tatives ,june #ag1 #bjae4;,cl]k4