,,ii  #aai? ,,congress  #a/ ,session    
,s4 #aaje  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #be1 #bjbe,mr4    
,cassidy 7= himself & ,mr4 ,m]kley7     
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve risk adju/m5t "u ,m$ic>e        
,advantage4  #a4 ,%ort title ,?is ,act  
may be cit$ z ! ,no ,unreasonable       
,paym5ts1 ,cod+1 ,or ,diagnoses = !     
,eld]ly ,act or ! ,no ,,upcode ,act4    
#b4 ,improv+ risk adju/m5t "u ,m$ic>e   
,advantage  7a7 ,use ( #b ye>s (        
diagno/ic data ,section                 
#ahec7;a77#c77;,c77iii7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7;a77#c77;,c77iii77 is am5d$--
 7#a7 by /rik+ me?odology4--,su* risk & 
ins]t+ 8me?odology4--  7,i7 ,9 g5]al    
,subject to subclause 7,,ii71 su* risk  
2 &  7#b7 by add+ at ! end ! foll[+ new 
subclauses3  7,,ii7 ,use ( heal? /atus  
data ,= #bjbf & ea* subsequ5t ye>1 !    

,secret>y %all use #b ye>s ( diagno/ic  
data 7:5 available7 "u su* risk adju/m5t
 me?odology4  4  7b7 ,exclusion (       
diagnoses collect$ f *>t reviews & heal?
 risk assessm5ts  7#a7 ,9 g5]al ,section
 #ahec7;a77#a77;,c7 ( su* ,act 7#db     
,u4,s4,c4 #aciew-#bc7;a77#a77;,c77 is   
am5d$ by add+ at ! end ! foll[+ new     
clause3  7iv7 ,exclusion ( diagnoses    
collect$ f *>t reviews & heal? risk     
assessm5ts  7,i7 ,9 g5]al ,= #bjbf & ea*
 subsequ5t ye>1 = purposes ( e/abli%+ ! 
paym5t adju/m5t factors & adju/+ paym5t 
bas$ on heal? /atus "u clause 7i71 !    
,secret>y %all n take into acc\nt a     
diagnosis collect$ f a *>t review or a  
heal? risk assessm5t4  7,,ii7           
,id5tification ( diagnoses collect$ f   
*>t reviews & heal? risk assessm5ts ,!  
,secret>y %all e/abli% proc$ures to     
provide = ! id5tification & v]ification 
( diagnoses collect$ f *>t reviews &    
heal? risk assessm5ts4  4  7c7          
,application ( cod+ adju/m5t ,section   
#ahec7;a77#a77;,c77ii7 ( su* ,act 7#db  

,u4,s4,c4 #aciew-#bc7;a77#a77;,c77ii77  
is am5d$-- 7#a7 9 subclause 7,,iii71 by 
/rik+ ,9 calculat+ & ins]t+ ,subject to 
subclause 7,v71 9 calculat+2 &  7#b7 by 
add+ at ! end ! foll[+ new subclause3   
7,v7 ,9 calculat+ su* adju/m5t = #bjbf &
 ea* subsequ5t ye>1 ! ,secret>y %all    
evaluate ! impact on risk scores =      
,m$ic>e ,advantage enrollees ( diff]5ces
 9 cod+ patt]ns betwe5 ,m$ic>e          
,advantage plans & provid]s "u p>ts ,a &
 ,b & publicly report ! results ( su*   
evaluation4 ,! ,secret>y %all ensure t  
su* adju/m5t1 :i* may include adju/m5t  
on a plan or contract level1 fully      
acc\nts = ! impact ( cod+ patt]n        
diff]5ces n o!rwise acc\nt$ = to ! ext5t
 t ! ,secret>y id5tifies su* diff]5ces  
?r\gh annual evaluation4  4