US Laws - Affordable Health Care Act (HR3950F)
TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle D--Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans

SEC. 3315. IMMEDIATE REDUCTION IN COVERAGE GAP IN 2010. (5502)(1-click HTML)

Section 1860D-2(b) of the Social Security Act (42 U.S.C. 1395w-102(b)) is amended-- (5503)

(1) in paragraph (3)(A), by striking "paragraph (4)" and inserting "paragraphs (4) and (7)"; and (5504)

(2) by adding at the end the following new paragraph: (5505)

"(7) INCREASE IN INITIAL COVERAGE LIMIT IN 2010- (5506)

"(A) IN GENERAL- For the plan year beginning on January 1, 2010, the initial coverage limit described in paragraph (3)(B) otherwise applicable shall be increased by $500. (5507)

"(B) APPLICATION- In applying subparagraph (A)-- (5508)

"(i) except as otherwise provided in this subparagraph, there shall be no change in the premiums, bids, or any other parameters under this part or part C; (5509)

"(ii) costs that would be treated as incurred costs for purposes of applying paragraph (4) but for the application of subparagraph (A) shall continue to be treated as incurred costs; (5510)

"(iii) the Secretary shall establish procedures, which may include a reconciliation process, to fully reimburse PDP sponsors with respect to prescription drug plans and MA organizations with respect to MA-PD plans for the reduction in beneficiary cost sharing associated with the application of subparagraph (A); (5511)

"(iv) the Secretary shall develop an estimate of the additional increased costs attributable to the application of this paragraph for increased drug utilization and financing and administrative costs and shall use such estimate to adjust payments to PDP sponsors with respect to prescription drug plans under this part and MA organizations with respect to MA-PD plans under part C; and (5512)

"(v) the Secretary shall establish procedures for retroactive reimbursement of part D eligible individuals who are covered under such a plan for costs which are incurred before the date of initial implementation of subparagraph (A) and which would be reimbursed under such a plan if such implementation occurred as of January 1, 2010. (5513)

"(C) NO EFFECT ON SUBSEQUENT YEARS- The increase under subparagraph (A) shall only apply with respect to the plan year beginning on January 1, 2010, and the initial coverage limit for plan years beginning on or after January 1, 2011, shall be determined as if subparagraph (A) had never applied.". (5514)

  

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