Page:United States Statutes at Large Volume 113 Part 2.djvu/899

 PUBLIC LAW 106-113—APPENDIX F 113 STAT. 1501A-381 substantial changes in payment for small Medicare+Choice plans. (C) For medicare beneficiaries newly enrolled in Medicare+Choice plans in a given year, the correspondence between the average risk factor calculated from medicare fee-for-service data for those individuals from the period prior to their enrollment in a Medicare+Choice plan and the average risk factor calculated fc>r such individuals during their initial year of enrollment in a Medicare+Choice plan. (D) For medicare beneficiaries disenrolling from or switching among Medicare+Choice plans in a given year, the correspondence between the average risk factor calculated from data pertaining to the period prior to their disenrollment from a Medicare+Choice plan and the average risk factor calculated from data pertaining to the period after disenrollment. (E) An evaluation of the exclusion of "discretionary" hospitalizations from consideration in the risk adjustment methodology. (F) Suggestions for changes or improvements in the risk adjustment methodology. (3) REPORT. —Not later than December 1, 2000, the Commission shall submit a report to Congress on the study conducted under paragraph (1), together with any recommendations for legislation that the Commission determines to be appropriate as a result of such study. (c) STUDY AND REPORT REGARDING REPORTING OF ENCOUNTER DATA.— (1) STUDY.— The Secretary of Health and Human Services shall conduct a study on how to reduce the costs and burdens on Medicare+Choice organizations of their complying with reporting requirements for encounter data imposed by the Secretary in establishing and implementing a risk adjustment methodology used in making payments to such organizations under section 1853 of the Social Security Act (42 U.S.C. 1395w- 23). The Secretary shall consult with representatives of Medicare+Choice organizations in conducting the study. The study shall address the following issues: (A) Limiting the number and types of sites of services (that are in addition to inpatient sites) for which encounter data must be reported. (B) Establishing alternative risk adjustment methods that would require submission of less data. (C) The potential for Medicare+C^hoice organizations to misreport, overreport, or underreport prevalence of diagnoses in outpatient sites of care, the potential for increases in payments to Medicare+Choice organizations from changes in Medicare+Choice plan coding practices ' (commonly known as "coding creep") and proposed methods for detecting and adjusting for such variations in diagnosis coding as part of the risk adjustment methodology using encounter data from multiple sites of care. (D) The impact of such requirements on the willingness of insurers to offer Medicare+Choice MSA plans and options for modifying encounter data reporting requirements to accommodate such plans.

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