Section 1 Short title
This Act may be cited as the “Medicare Advantage Quality Expansion Act of 2017”.
Medicare Advantage Quality Expansion Act of 2017
A BILL
To amend title XVIII of the Social Security Act to exclude MA quality rating bonuses for certain new entrant Medicare Advantage plans from benchmark cap.
Sec. 2 MA quality rating bonuses for certain new entrant plans excluded from benchmark cap
Section 1853 of the Social Security Act (42 U.S.C. 1395w–23) is amended—
in subsection (n) by amending paragraph (4) to read as follows:
“(4) Cap on benchmark amount
“(A) In general—In no case shall the blended benchmark amount for an area for a year (determined, subject to subparagraph (B), taking into account subsection (o)) be greater than the applicable amount that would (but for the application of this subsection) be determined under subsection (k)(1) for the area for the year.
“(B) Quality rating bonuses applicable to certain new entrant plans not considered in blended benchmark determination
“(i) In general—Subsection (o) shall not be taken into account in determining the blended benchmark for purposes of subparagraph (A) in the case of any increase under such subsection applicable to a Medicare Advantage plan that is a new entrant plan, with respect to an area, as described in clause (ii).
“(ii) New entrant plan—For purposes of clause (i), a Medicare Advantage plan is a new entrant plan, with respect to an area, if—
“(I) the plan is offered in such area beginning on or after January 1, 2018, by an organization or sponsor that did not offer a Medicare Advantage plan in such area during the 3-year period preceding January 1, 2018; and
“(II) as of the date the plan is first offered in such area, there was not any other Medicare Advantage plan being offered in the area that was a qualifying plan (as defined in paragraph (3)(A)).”
in subsection (o), by adding at the end the following new paragraph:
“(6) Increase in case of certain new entrant plans made without regard to benchmark cap—An increase under this subsection, with respect to a new entrant plan (as described in subsection (n)(4)(B)(ii)) for an area, shall be made to the applicable percentage determined under subsection (n)(2)(B) without regard to the limitation under subsection (n)(4)(A).”