House Ways & Means Committee Issues Report on Improving Seniors Access to Quality Benefits Act
Excerpts of the report follow:
I. SUMMARY AND BACKGROUND
A. Purpose and Summary
The bill, H.R. 4952, the "Improving Seniors Access to Quality Benefits Act," as ordered reported by the
B. Background and Need for Legislation
The MA program relies on private insurance companies to deliver Medicare benefits. Under MA plans, beneficiaries may receive supplemental services that are not provided under FFS.
MA plans are reimbursed at a capitated payment rate, one payment per month per beneficiary to encompass all of a patient's care, as opposed to Medicare Parts A and B (also referred to as fee-for-service), which rely on a variety of mechanisms for payment depending on the type and site of service. MA capitated payments are based on a county benchmark. The benchmark is the maximum the federal government will pay an MA plan for providing Part A and B services in a particular county. As required under the Affordable Care Act (ACA), the benchmark is set by taking the average per county fee-for- service spending for all fee-for-service beneficiaries enrolled in either Part A or Part B, or both. The ACA also increases the benchmark based on plan quality, with higher increases for qualifying areas.
MA plans submit a bid reflecting the plan's estimated costs of offering Medicare beneficiaries' Part A and Part B benefits. The bid is presented as the total cost to Medicare to cover an average or standard beneficiary. The bid includes plan administrative cost and profit.
The Secretary of the
Plans with higher quality ratings receive bonus amounts, commonly referred to as quality bonus payments. The ACA subjects these bonus payments to the benchmark, effectively capping the amount of bonus payments high performing plans are able to receive in certain counties. The
C. Legislative History
Background
H.R. 4952 was introduced on
Committee hearings
On
On
On
Committee action
II. EXPLANATION OF THE BILL
A. The "Improving Seniors Access to Quality Benefits Act"
PRESENT LAW
Under the Affordable Care Act (ACA), the
REASONS FOR CHANGE
Since quality bonus payments are counted under the benchmark, high performing plans in certain counties often have diminished quality bonus payments. This leads to less flexibility to offer additional services or lower cost sharing.
EXPLANATION OF PROVISIONS
Section 1:
Section 2: Determination of Blended Benchmark Amount Study.
Sense of
Study and Report: Not later than one year after the date of enactment, the Secretary of
EFFECTIVE DATE
Section 2: Not later than one year after the date of enactment.
III. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the Rules of the
The bill, H.R. 4952, was ordered favorably reported as amended by voice vote (with a quorum being present).
The vote on the amendment offered by
(TABLE OMITTED)
IV. BUDGET EFFECTS OF THE BILL
A. Committee Estimate of Budgetary Effects
In compliance with clause 3(d) of rule XIII of the Rules of the
B.
In compliance with clause 3(c)(2) of rule XIII of the Rules of the
C. Cost Estimate Prepared by the
In compliance with clause 3(c)(3) of rule XIII of the Rules of the
U.S.
Hon.
Dear Mr. Chairman: The
If you wish further details on this estimate, we will be pleased to provide them. The CBO staff contact is
Sincerely,
(For
Enclosure.
H.R. 4952--Improving Seniors Access to Quality Benefits Act
H.R. 4952 would direct the Secretary of
CBO estimates that the cost of this study would be less than
H.R. 4952 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.
The CEO staff contact for this estimate is
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
A. Committee Oversight Findings and Recommendations
With respect to clause 3(c)(1) of rule XIII of the Rules of the
B. Statement of General Performance Goals and Objectives
With respect to clause 3(c)(4) of rule XIII of the Rules of the
C. Information Relating to Unfunded Mandates
This information is provided in accordance with section 423 of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104- 4).
The Committee has determined the bill does not contain Federal mandates on the private sector. The Committee has determined the bill does not impose a Federal intergovernmental mandate on State, local, or tribal governments.
D. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
With respect to clause 9 of rule XXI of the Rules of the
E. Duplication of Federal Programs
In compliance with Sec. 3(g)(2) of
VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
In compliance with clause 3(e)(1)(B) of rule XIII of the Rules of the
The full text of the report is found at: https://www.congress.gov/congressional-report/115th-congress/house-report/832/1?r=22
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