,,ii #aadth ,,congress #ast ,session ,s4 #baig ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #bb1 #bjae,mr4 ,crapo 7for himself1 ,mr4 ,bennet1 and ,mr4 ,isakson7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to improve the risk adjustment under the ,medicare ,advantage program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,securing ,care for ,seniors ,act of #bjae4 #b4 ,improvements to ,,ma 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 ,evaluation and subsequent revision of the risk adjustment system to account for chronic conditions and other factors for the purpose of making the risk adjustment system more accurate1 transparent1 and regularly updated 7,i7 ,revision based on number of chronic conditions ,the ,secretary shall revise for #bjag and periodically thereafter1 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 diagnosed4 7,,ii7 ,evaluation of different risk adjustment models ,the ,secretary shall evaluate the impact of including two years of data to compare the models used to determine risk scores for #bjac and #bjad under such system4 7,,iii7 ,evaluation and analysis on chronic kidney disease 7,,ckd7 codes ,the ,secretary shall evaluate the impact of removing the diagnosis codes related to chronic kidney disease in the #bjad risk adjustment model and conduct an analysis of best practices of ,,ma plans to slow disease progression related to chronic kidney disease4 7,,iv7 ,evaluation and recommendations on use of encounter data ,the ,secretary shall evaluate the impact of including #aj percent of encounter data in computing payment for #bjaf and the readiness of the ,centers for ,medicare ,medicaid ,services to incorporate encounter data in risk scores4 ,in conducting such evaluation1 the ,secretary shall use data collected as encounter data on or after ,january #a1 #bjab1 shall conduct statistical analyses on such data for accuracy and completeness and issue recommendations for improving such accuracy and completeness1 and shall not increase the percentage of such encounter data used unless the ,secretary releases the results of the analyses publicly1 indicates how such data will be weighted in computing the risk scores1 and ensures that the data reflects the degree and cost of care coordination under ,,ma plans4 7,v7 ,conduct of evaluations ,evaluations and analyses under subclauses 7,,ii7 through 7,,iv7 shall include an actuarial opinion from the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services about the reasonableness of the methods1 assumptions1 and conclusions of such evaluations and analyses4 ,the ,secretary shall consult with the ,medicare ,payment ,advisory ,commission and accept and consider comments of stakeholders1 such as managed care organizations and beneficiary groups1 on such evaluation and analyses4 ,the ,secretary shall complete such evaluations and analyses in a manner that permits the results to be applied for plan years beginning with the second plan year that begins after the date of the enactment of this clause4 7,,vi7 ,implementation of revisions based on evaluations ,if the ,secretary determines1 based on such an evaluation or analysis1 that revisions to the risk adjustment system to address the matters described in any of subclauses 7,,ii7 through 7,,iv7 would make the risk adjustment system under this subparagraph better reflect and appropriately weight for the population that is served by the plan1 the ,secretary shall1 beginning with #bjag1 and periodically thereafter1 make such revisions4 7,,vii7 ,periodic reporting to ,congress ,with respect to plan years beginning with #bjag and every third year thereafter1 the ,secretary shall submit to ,congress a report on the most recent revisions 7if any7 made under this clause1 including the evaluations conducted under subclauses 7,,ii7 through 7,,iv74 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 ,medicare ,advantage 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 changes to adjustment factors effective for #bjag 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 of not less than #fj days and a public comment period of not less than #cj days before implementing such changes4 4 #c4 ,sense of congress relating to medicare advantage risk adjustment ,it is the sense of ,congress that-- 7#a7 the ,secretary of ,health and ,human ,services should periodically monitor and improve the ,medicare ,advantage risk adjustment model to ensure that it accurately accounts for beneficiary risk1 including for those individuals with complex chronic comorbid conditions2 7#b7 the ,secretary should closely examine the current ,medicare ,advantage risk adjustment methodology to ensure that plans enrolling beneficiaries with the greatest health care needs receive adequate reimbursement to deliver high-quality care and other services to help beneficiaries avoid costly complications and further progression of chronic conditions and to the extent data indicate this to be the case1 the ,secretary should make necessary adjustment to the risk adjustment methodology2 and 7#c7 the ,secretary should reconsider the implementation of changes in the ,medicare ,advantage risk adjustment methodology finalized for #bjaf and to use to the extent appropriate the methodology finalized in #bjae for one additional year4