,,ii #aaith ,,congress #b;d ,session ,s4 #chdh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #aa1 #bjbf ,mr4 ,scott of ,south ,carolina 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 require the ,secretary of ,health and ,human ,services to publish information on expenditures under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,apples to ,apples ,comparison ,act of #bjbf4 #b4 ,requiring the ,secretary of ,health and ,human ,services to publish information on expenditures under the ,medicare program ,section #ahgd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7 is amended-- 7#a7 in subsection 7g7-- 7,a7 in paragraph 7#a7-- 7i7 in the matter preceding subparagraph 7,a71 by inserting 7and1 beginning with #bjbg1 publish on the public website of the ,centers for ,medicare ,medicaid ,services in machine-readable files information on7 after a report on2 7ii7 in subparagraph 7,a71 by inserting 7and1 beginning with #bjbg1 by county and ,metropolitan ,statistical ,area7 after ,state2 and 7iii7 in subparagraph 7,b7-- 7,i7 in clause 7ii71 by striking and at the end2 7,,ii7 in clause 7iii71 by striking the period and inserting 2 and2 and 7,,iii7 by adding at the end the following new clause3 7iv7 beginning with #bjbg1 each category of individuals described in subsection 7h77#a74 2 and 7,b7 by adding at the end the following new paragraph3 7#c7 ,special rule for #bjbg report and publication of information ,as part of the report and publication of information required under paragraph 7#a7 for #bjbg1 the ,secretary shall include enrollment information submitted under this subsection for each preceding year 7beginning with #bjae71 broken down by county and ,metropolitan ,statistical ,area and provided for each category of individuals described in subsection 7h77#a74 2 and 7#b7 by adding at the end the following new subsection3 7h7 ,information on expenditures 7#a7 ,in general ,not later than #cj days after the last day of each year 7beginning with #bjbg71 the ,secretary shall1 for each county and each ,metropolitan ,statistical ,area1 publish on the public website of the ,centers for ,medicare ,medicaid ,services in machine-readable files the total and average expenditures under this title for items and services furnished to individuals entitled to benefits under part ,a or enrolled under part ,b residing in such county or ,metropolitan ,statistical ,area for each month occurring in the specified historical period and for each month occurring in the specified projected period with respect to such year1 broken down by the following categories of individuals3 7,a7 ,individuals entitled to benefits under part ,a and not enrolled under part ,b4 7,b7 ,individuals who are-- 7i7 not entitled to benefits under part ,a2 7ii7 enrolled under part ,b2 and 7iii7 not enrolled under a ,medicare ,advantage plan under part ,c4 7,c7 ,individuals who are-- 7i7 entitled to benefits under part ,a and enrolled under part ,b2 and 7ii7 not enrolled under a ,medicare ,advantage plan under part ,c4 7,d7 ,individuals described in subparagraph 7,a7 who are enrolled in a prescription drug plan under part ,d4 7,e7 ,individuals described in subparagraph 7,b7 who are enrolled in a prescription drug plan under part ,d4 7,f7 ,individuals described in subparagraph 7,c7 who are enrolled in a prescription drug plan under part ,d4 7,g7 ,individuals described in subparagraph 7,a7 who are not enrolled in a prescription drug plan under part ,d4 7,h7 ,individuals described in subparagraph 7,b7 who are not enrolled in a prescription drug plan under part ,d4 7,i7 ,individuals described in subparagraph 7,c7 who are not enrolled in a prescription drug plan under part ,d4 7,j7 ,individuals described in subparagraph 7,a7 who are enrolled in a ,federal health care program 7as defined in section #aabh;,b7 or a health plan under chapter #hi of title #e1 ,united ,states ,code4 7,k7 ,individuals described in subparagraph 7,b7 who are enrolled in such a program or plan4 7,l7 ,individuals described in subparagraph 7,c7 who are enrolled in such a program or plan4 7,m7 ,individuals described in subparagraph 7,a7 who are not enrolled in such a program or plan4 7,n7 ,individuals described in subparagraph 7,b7 who are not enrolled in such a program or plan4 7,o7 ,individuals described in subparagraph 7,c7 who are not enrolled in such a program or plan4 7,p7 ,individuals described in subparagraph 7,a7 who are enrolled in a group health plan 7as defined in section #bgia of the ,public ,health ,service ,act7 or a medicare supplemental policy under section #ahhb4 7,q7 ,individuals described in subparagraph 7,b7 who are enrolled in such a plan or policy4 7,r7 ,individuals described in subparagraph 7,c7 who are enrolled in such a plan or policy4 7,s7 ,individuals described in subparagraph 7,a7 who are not enrolled in such a plan or policy4 7,t7 ,individuals described in subparagraph 7,b7 who are not enrolled in such a plan or policy4 7,u7 ,individuals described in subparagraph 7,c7 who are not enrolled in such a plan or policy4 7,v7 ,individuals enrolled in a specialized ,,ma plan for special needs individuals1 broken down by each type of plan4 7,w7 ,individuals enrolled in an ,,ma plan other than a plan described in subparagraph 7,v74 7,x7 ,individuals enrolled in an ,,ma plan4 7,y7 ,individuals described in subparagraph 7,x7 who are enrolled in a ,federal health care program 7as defined in section #aabh;,b7 or a health plan under chapter #hi of title #e1 ,united ,states ,code4 7,z7 ,individuals described in subparagraph 7,x7 who are not enrolled in such a program or plan4 7,,aa7 ,individuals described in subparagraph 7,x7 who are enrolled in a group health plan 7as defined in section #bgia of the ,public ,health ,service ,act7 or a medicare supplemental policy under section #ahhb4 7,,bb7 ,individuals described in subparagraph 7,x7 who are not enrolled in such a plan or policy4 7,,cc7 ,individuals described in subparagraph 7,x7 who are enrolled in a prescription drug plan under part ,d4 7,,dd7 ,individuals described in subparagraph 7,x7 who are not enrolled in such a plan4 7,,ee7 ,individuals described in subparagraph 7,x7 who are enrolled in an ,,ma-,,pd plan4 7,,ff7 ,individuals described in subparagraph 7,x7 who are not enrolled in such a plan4 7,,gg7 ,individuals described in subparagraph 7,,cc7 or 7,,ee7 who are enrolled in a ,federal health care program 7as defined in section #aabh;,b7 or a health plan under chapter #hi of title #e1 ,united ,states ,code4 7,,hh7 ,individuals described in subparagraph 7,,cc7 or 7,,ee7 who are not enrolled in such a program or plan4 7,,ii7 ,individuals enrolled in an employer group waiver plan4 7#b7 ,definitions ,for purposes of this subsection3 7,a7 ,specified historical period ,the term specified historical period means1 with respect to a year1 the #aj-year period ending on the last day of such year4 7,b7 ,specified projected period ,the term specified projected period means1 with respect to a year1 the period beginning on the first day of the subsequent year of a duration specified by the ,secretary 7but in no case to exceed a duration of #e years74 4 #c4 ,med,p,a,c analysis of ,medicare ,advantage and fee-for-service expenditures ,section #ahje7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#f7;b77 is amended by adding at the end the following new paragraph3 7#ab7 ,analysis of ,medicare ,advantage and fee-for-service expenditures 7,a7 ,in general ,the ,commission shall1 as part of the report described in paragraph 7#a77;,c7 submitted for each year 7beginning with #bjbg71 include a retrospective analysis of average expenditures under this title for individuals enrolled in a ,medicare ,advantage plan under part ,c compared to average expenditures under this title for individuals entitled to benefits under part ,a and enrolled under part ,b who are eligible to enroll under such a plan but who are not so enrolled4 7,b7 ,considerations ,in preparing each analysis described in subparagraph 7,a71 the ,commission shall-- 7i7 use data provided by the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services and the ,boards of ,trustees of the ,federal ,hospital ,insurance ,trust ,fund established under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust fund established under section #ahda and such other data as the ,commission determines appropriate2 7ii7 take into account-- 7,i7 differences in value provided under ,medicare ,advantage plans compared to the value provided under parts ,a and ,b1 such as the existence of out-of-pocket expenditure caps1 supplemental benefits available under such plans1 and the integration of benefits for covered part ,d drugs under certain such plans2 7,,ii7 demographic differences of individuals enrolled in ,medicare ,advantage plans compared to individuals entitled to benefits under part ,a and enrolled under part ,b who are not enrolled in such a plan2 and 7,,iii7 differences in ,,hcc risk scores2 and 7iii7 not take into account any favorable selection differences with respect to enrollment in such plans4 7,c7 ,publication requirements ,with respect to each analysis described in subparagraph 7,a71 the ,commission shall-- 7i7 make public all data used in preparing such analysis in a manner that-- 7,i7 allows replication of such analysis2 and 7,,ii7 protects the confidentiality of personal information of individuals entitled to benefits under part ,a and enrolled under part ,b2 7ii7 not later than #fj days prior to the submission of such analysis1 make public the methodology used to conduct such analysis and allow at least #cj days for public comment on such methodology2 and 7iii7 make public a response to each such comment received on the methodology prior to or concurrent with the submission of such analysis4 4 #d4 ,trustees report of expenditure information ,section #ahgd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk71 as amended by section #b1 is amended by adding at the end the following new subsection3 7i7 ,trustees' report of expenditure information 7#a7 ,in general ,the ,boards of ,trustees of the ,federal ,hospital ,insurance ,trust ,fund established under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund established under section #ahda shall jointly1 as part of the reports described in sections #ahag7;b77#b7 and #ahda7;b77#b7 submitted for a year 7beginning with #bjbg71 include information on aggregate and average expenditures under this title for the following categories of individuals and1 in the case of the category described in subparagraph 7,c71 broken down by expenditures under part ,a and expenditures under part ,b3 7,a7 ,individuals entitled to benefits under part ,a and not enrolled under part ,b4 7,b7 ,individuals enrolled under part ,b and not entitled to benefits under part ,a4 7,c7 ,individuals entitled to benefits under part ,a1 enrolled under part ,b1 and not enrolled in a ,medicare ,advantage plan under part ,c4 7#b7 ,provision of disaggregated information ,the ,boards of ,trustees described in paragraph 7#a7 shall1 as part of all expenditure data 7including data tables7 made public by such ,boards1 disaggregate such data1 to the extent practicable1 based on the categories of individuals described in paragraph 7#a74 4