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US Laws | Affordable Health Care Act (HR3950F)
TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle C--Provisions Relating to Part C

"(IV) PUBLICATION OF EVALUATION AND REVISIONS- The Secretary shall publish, as part of an announcement under subsection (b), a description of any evaluation conducted under subclause (III) during the preceding year and any revisions made under such subclause as a result of such evaluation.". (5189)

(g) Technical Correction- Section 1859(f)(5) of the Social Security Act (42 U.S.C. 1395w-28(f)(5)) is amended, in the matter preceding subparagraph (A), by striking "described in subsection (b)(6)(B)(i)". (5190)

SEC. 3206. EXTENSION OF REASONABLE COST CONTRACTS. (5191)(Text)

Section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)) is amended, in the matter preceding subclause (I), by striking "January 1, 2010" and inserting "January 1, 2013". (5192)

SEC. 3207. TECHNICAL CORRECTION TO MA PRIVATE FEE-FOR-SERVICE PLANS. (5193)(Text)

For plan year 2011 and subsequent plan years, to the extent that the Secretary of Health and Human Services is applying the 2008 service area extension waiver policy (as modified in the April 11, 2008, Centers for Medicare & Medicaid Services" memorandum with the subject "2009 Employer Group Waiver-Modification of the 2008 Service Area Extension Waiver Granted to Certain MA Local Coordinated Care Plans") to Medicare Advantage coordinated care plans, the Secretary shall extend the application of such waiver policy to employers who contract directly with the Secretary as a Medicare Advantage private fee-for-service plan under section 1857(i)(2) of the Social Security Act (42 U.S.C. 1395w-27(i)(2)) and that had enrollment as of October 1, 2009. (5194)

SEC. 3208. MAKING SENIOR HOUSING FACILITY DEMONSTRATION PERMANENT. (5195)(Text)

(a) In General- Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the following new subsection: (5196)

"(g) Special Rules for Senior Housing Facility Plans- (5197)

"(1) IN GENERAL- In the case of a Medicare Advantage senior housing facility plan described in paragraph (2), notwithstanding any other provision of this part to the contrary and in accordance with regulations of the Secretary, the service area of such plan may be limited to a senior housing facility in a geographic area. (5198)

"(2) MEDICARE ADVANTAGE SENIOR HOUSING FACILITY PLAN DESCRIBED- For purposes of this subsection, a Medicare Advantage senior housing facility plan is a Medicare Advantage plan that-- (5199)

"(A) restricts enrollment of individuals under this part to individuals who reside in a continuing care retirement community (as defined in section 1852(l)(4)(B)); (5200)

"(B) provides primary care services onsite and has a ratio of accessible physicians to beneficiaries that the Secretary determines is adequate; (5201)

"(C) provides transportation services for beneficiaries to specialty providers outside of the facility; and (5202)

"(D) has participated (as of December 31, 2009) in a demonstration project established by the Secretary under which such a plan was offered for not less than 1 year.". (5203)

(b) Effective Date- The amendment made by this section shall take effect on January 1, 2010, and shall apply to plan years beginning on or after such date. (5204)

SEC. 3209. AUTHORITY TO DENY PLAN BIDS. (5205)(Text)

(a) In General- Section 1854(a)(5) of the Social Security Act (42 U.S.C. 1395w-24(a)(5)) is amended by adding at the end the following new subparagraph: (5206)

"(C) REJECTION OF BIDS- (5207)

"(i) IN GENERAL- Nothing in this section shall be construed as requiring the Secretary to accept any or every bid submitted by an MA organization under this subsection. (5208)

"(ii) AUTHORITY TO DENY BIDS THAT PROPOSE SIGNIFICANT INCREASES IN COST SHARING OR DECREASES IN BENEFITS- The Secretary may deny a bid submitted by an MA organization for an MA plan if it proposes significant increases in cost sharing or decreases in benefits offered under the plan.". (5209)

(b) Application Under Part D- Section 1860D-11(d) of such Act (42 U.S.C. 1395w-111(d)) is amended by adding at the end the following new paragraph: (5210)

"(3) REJECTION OF BIDS- Paragraph (5)(C) of section 1854(a) shall apply with respect to bids submitted by a PDP sponsor under subsection (b) in the same manner as such paragraph applies to bids submitted by an MA organization under such section 1854(a).". (5211)

(c) Effective Date- The amendments made by this section shall apply to bids submitted for contract years beginning on or after January 1, 2011. (5212)

SEC. 3210. DEVELOPMENT OF NEW STANDARDS FOR CERTAIN MEDIGAP PLANS. (5213)(Text)

(a) In General- Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is amended by adding at the end the following new subsection: (5214)

"(y) Development of New Standards for Certain Medicare Supplemental Policies- (5215)

"(1) IN GENERAL- The Secretary shall request the National Association of Insurance Commissioners to review and revise the standards for benefit packages described in paragraph (2) under subsection (p)(1), to otherwise update standards to include requirements for nominal cost sharing to encourage the use of appropriate physicians" services under part B. Such revisions shall be based on evidence published in peer-reviewed journals or current examples used by integrated delivery systems and made consistent with the rules applicable under subsection (p)(1)(E) with the reference to the "1991 NAIC Model Regulation" deemed a reference to the NAIC Model Regulation as published in the Federal Register on December 4, 1998, and as subsequently updated by the National Association of Insurance Commissioners to reflect previous changes in law and the reference to "date of enactment of this subsection" deemed a reference to the date of enactment of the Patient Protection and Affordable Care Act. To the extent practicable, such revision shall provide for the implementation of revised standards for benefit packages as of January 1, 2015. (5216)

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