Sec. 17006. Allowing end-stage renal disease beneficiaries to choose a Medicare Advantage plan

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Section 1851(a)(3) of the Social Security Act ( 42 U.S.C. 1395w–21(a)(3) ) is amended— by striking subparagraph (B); and by striking and all that follows through eligible individual In this title, subject to subparagraph (B), and inserting . eligible individual .—In this title, Section 1852(b)(1) of the Social Security Act ( 42 U.S.C. 1395w–22(b)(1) ) is amended— by striking subparagraph (B); and by striking and all that follows through Beneficiaries A Medicare+Choice organization and inserting .

Beneficiaries .—A Medicare Advantage organization Section 1859(b)(6) of the Social Security Act ( 42 U.S.C. 1395w–28(b)(6) ) is amended, in the last sentence, by striking may waive and all that follows through subparagraph and . The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2021. Section 1853 of the Social Security Act ( 42 U.S.C. 1395w–23 ) is amended— in subsection (k)— in paragraph (1)— in the matter preceding subparagraph (A), by striking paragraphs

(2)and

(4)and inserting paragraphs (2), (4), and

(5); and in subparagraph (B)(i), by striking paragraphs

(2)and

(4)and inserting paragraphs (2), (4), and

(5); and by adding at the end the following new paragraph: After determining the applicable amount for an area for a year under paragraph

(1)(beginning with 2021), the Secretary shall adjust such applicable amount to exclude from such applicable amount the Secretary’s estimate of the standardized costs for payments for organ acquisitions for kidney transplants covered under this title (including expenses covered under section 1881(d)) in the area for the year. ; and in subsection (n)(2)— in subparagraph (A)(i), by inserting and, for 2021 and subsequent years, the exclusion of payments for organ acquisitions for kidney transplants from the capitation rate as described in subsection (k)(5) before the semicolon at the end; in subparagraph (E), in the matter preceding clause (i), by striking subparagraph

(F)and inserting subparagraphs

(F)and

(G); and by adding at the end the following new subparagraph: The base payment amount specified in subparagraph

(E)for a year (beginning with 2021) shall be adjusted in the same manner under paragraph

(5)of subsection

(k)as the applicable amount is adjusted under such subsection. . Section 1852(a)(1)(B)(i) of the Social Security Act ( 42 U.S.C. 1395w–22(a)(1)(B)(i) ) is amended by inserting or coverage for organ acquisitions for kidney transplants, including as covered under section 1881(d) after hospice care . Section 1851(i) of the Social Security Act ( 42 U.S.C. 1395w–21(i) ) is amended by adding at the end the following new paragraph: Paragraphs

(1)and

(2)shall not apply with respect to expenses for organ acquisitions for kidney transplants described in section 1852(a)(1)(B)(i). . The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2021. The Secretary of Health and Human Services (in this subsection referred to as the Secretary ) shall conduct an evaluation of whether the 5-star rating system based on the data collected under section 1852(e) of the Social Security Act ( 42 U.S.C. 1395w–22(e) ) should include a quality measure specifically related to care for enrollees in Medicare Advantage plans under part C of title XVIII of such Act determined to have end-stage renal disease. Not later than April 1, 2020, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services the results of the evaluation under paragraph (1). Not later than December 31, 2023, the Secretary of Health and Human Services (in this subsection referred to as the Secretary ) shall submit to Congress a report on the impact of the provisions of, and amendments made by, this section with respect to the following: Spending under— the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act; and the Medicare Advantage program under part C of such title. The number of enrollees determined to have end-stage renal disease— in the original Medicare fee-for-service program; and in the Medicare Advantage program. The sufficiency of the amount of data under the original Medicare fee-for-service program for individuals determined to have end-stage renal disease for purposes of determining payment rates for end-stage renal disease under the Medicare Advantage program. Section 1853(a)(1) of the Social Security Act ( 42 U.S.C. 1395w–23(a)(1) ) is amended— in subparagraph (C)(i), by striking The Secretary and inserting Subject to subparagraph (I), the Secretary ; and by adding at the end the following new subparagraph: In order to determine the appropriate adjustment for health status under subparagraph (C)(i), the following shall apply: The Secretary shall take into account the total number of diseases or conditions of an individual enrolled in an MA plan. The Secretary shall make an additional adjustment under such subparagraph as the number of diseases or conditions of an individual increases. The Secretary may use at least 2 years of diagnosis data. With respect to individuals who are dually eligible for benefits under this title and title XIX, the Secretary shall make separate adjustments for each of the following: Full-benefit dual eligible individuals (as defined in section 1935(c)(6)). Such individuals not described in item (aa). The Secretary shall evaluate the impact of including additional diagnosis codes related to mental health and substance use disorders in the risk adjustment model. The Secretary shall evaluate the impact of including the severity of chronic kidney disease in the risk adjustment model. The Secretary shall evaluate whether other factors (in addition to those described in subparagraph (H)) should be taken into consideration when computing payment rates under such subparagraph. The Secretary shall phase-in any changes to risk adjustment payment amounts under subparagraph (C)(i) under this subparagraph over a 3-year period, beginning with 2019, with such changes being fully implemented for 2022 and subsequent years. The Secretary shall provide an opportunity for review of the proposed changes to such risk adjustment payment amounts under this subparagraph and a public comment period of not less than 60 days before implementing such changes. . The Medicare Payment Advisory Commission shall conduct an evaluation of the impact of the provisions of, and amendments made by, this section on risk scores for enrollees in Medicare Advantage plans under part C of title XVIII of the Social Security Act and payments to Medicare Advantage plans under such part, including the impact of such provisions and amendments on the overall accuracy of risk scores under the Medicare Advantage program. Not later than July 1, 2020, the Medicare Payment Advisory Commission shall submit to Congress a report on the evaluation under subclause (I), together with recommendations for such legislation and administrative action as the Commission determines appropriate. Not later than December 31, 2018, and every 3 years thereafter, the Secretary of Health and Human Services shall submit to Congress a report on the risk adjustment model and the ESRD risk adjustment model under the Medicare Advantage program under part C of title XVIII of the Social Security Act, including any revisions to either such model since the previous report. Such report shall include information on how such revisions impact the predictive ratios under either such model for groups of enrollees in Medicare Advantage plans, including very high and very low cost enrollees, and groups defined by the number of chronic conditions of enrollees. The Comptroller General of the United States (in this subparagraph referred to as the Comptroller General ) shall conduct a study on how to most accurately measure the functional status of enrollees in Medicare Advantage plans and whether the use of such functional status would improve the accuracy of risk adjustment payments under the Medicare Advantage program under part C of title XVIII of the Social Security Act. Such study shall include an analysis of the challenges in collecting and reporting functional status information for Medicare Advantage plans under such part, providers of services and suppliers under the Medicare program, and the Centers for Medicare & Medicaid Services. Not later than June 30, 2018, the Comptroller General shall submit to Congress a report containing the results of the study under clause (i), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

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42 USC 1395w–21(a)(3)
42 USC 1395w–22(b)(1)
42 USC 1395w–28(b)(6)
42 USC 1395w–23
42 USC 1395w–22(a)(1)(B)(i)
42 USC 1395w–21(i)
42 USC 1395w–22(e)
42 USC 1395w–23(a)(1)

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Sec. 17006

Allowing end-stage renal disease beneficiaries to choose a Medicare Advantage plan

Cite42 USC 1395w–21(a)(3)

Cite42 USC 1395w–22(b)(1)

Cite42 USC 1395w–28(b)(6)

Cite42 USC 1395w–23

Cite42 USC 1395w–22(a)(1)(B)(i)

Cites 8 · showing 5Cited by 0 across 0 sources