Reps. Black, Blumenauer Praise House Passage of Legislation to Strengthen Medicare Advantage

Press Release

Today Congressman Diane Black (R-TN-06) and Congressman Earl Blumenauer (D-OR-03) responded to the House passage of H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act. This bipartisan legislation, authored by Black and Blumenauer, directs the Centers for Medicare and Medicaid Services (CMS) to establish a regional demonstration program for Medicare Advantage (MA) plans that allows the use of Value Based Insurance Design (VBID) to reduce the copayments or coinsurance for beneficiaries with specific chronic conditions.

H.R. 2570 additionally includes the language of Rep. Black's Electronic Health Fairness Act of 2015, which offers ambulatory surgical centers (ASCs) relief from penalties under the Obama Administration's electronic health records (EHRs) "meaningful use" standard.

Following passage of H.R .2570, the House also passed H.R. 2582, the Seniors' Health Care Plan Protection Act, which includes the provisions of Rep. Black and Blumenauer's Securing Care for Seniors Act. This legislation protects the Medicare Advantage program for future retirees by requiring CMS to reconsider potentially harmful changes made to the risk adjustment model. It further calls upon the agency to adopt a more transparent process for any future changes to the program with opportunities for feedback from beneficiaries

Black and Blumenauer released the following statements:

"One third of Medicare beneficiaries in Tennessee are enrolled in a Medicare Advantage (MA) plan. Seniors in my district consistently tell me that they enjoy the flexibility and choice of MA. I'm proud that the House acted today to strengthen this important program both for current beneficiaries and future retirees -- and we did it in a bipartisan way that puts patients and their doctors first," said Congressman Diane Black. "Our seniors deserve access to health coverage specifically tailored to their needs and dedicated to their unique health and well-being. With the passage of these bills, we have taken an important step forward in achieving that goal."

"The passage of the Strengthening Medicare Advantage Through Innovation and Transparency for Seniors Act and the Seniors' Health Care Plan Protection Act demonstrates that Congress can come together and pass bipartisan, commonsense legislation that improves care for seniors while strengthening Medicare," said Congressman Earl Blumenauer. "These two pieces of legislation will not only improve the accuracy and integrity of Medicare Advantage, but will also allow plans to innovate and pass savings along to beneficiaries. I'm proud we were able to get this important legislation across the finish line in the House, and I look forward to passage in the Senate."

Background on VBID:

The VBID method was first conceptualized by Dr. Mark Fendrick and a multidisciplinary team of faculty at the University of Michigan. This approach is based on the notion that, by lowering a consumer's cost sharing for essential, high-value clinical services, the consumer will then be motivated to continue their medication and take an active role in maintaining their health. For example, a typical VBID plan might lower or eliminate diabetic enrollees' out-of-pocket costs for test strips and insulin. This removes burdens on patients and encourages them to adhere to medication and treatment, which, in turn, helps to avoid expensive services due to complications in the future.

Background on CMS Changes to Medicare Risk Adjustment Model:

Recently, CMS enacted changes to the program's risk adjustment model -- its system for paying for benefits based on an enrollee's predicted health costs -- that could leave America's most vulnerable citizens at risk by discouraging plans to detect and care for chronic conditions in their early stages. These changes were made with little to no input from Congress and, most importantly, Medicare Advantage beneficiaries. H.R. 2582 directs the agency to reevaluate and, if necessary, make changes to its MA risk adjustment model to ensure that the metrics are accurate, evidence-based, and transparent so that seniors pay a fair, reasonable cost for their health care plans and the MA program remains sustainable in the long term.

Background on EHR Meaningful Use Standard:

The EHR meaningful use program requires physicians to conduct at least 50 percent of all Medicare patient encounters in a setting with a certified EHR technology or face harsh penalties. There are currently no certified EHRs in an ASC setting due to the unique nature of ASCs, so providers that serve the majority of Medicare patients in these settings can be penalized because they will not be able to meet the encounter threshold. A number of specialists provide vital services to most of their patients in ASCs, including ophthalmologists, gastroenterologists, and orthopedists, as well as many other specialists. HR 2570 would simply exempt any patient encounters that take place in an ASC from counting toward the EHR meaningful use threshold. This bipartisan legislation corrects the EHR penalty and protects physicians from the odd structure of the current program.

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