42 U.S.C. § 1395w-21
Subject to the provisions of this section, each Medicare+Choice eligible individual (as defined in paragraph (3)) is entitled to elect to receive benefits (other than qualified prescription drug benefits) under this subchapter-
and may elect qualified prescription drug coverage in accordance with section 1395w-101 of this title.
A Medicare+Choice plan may be any of the following types of plans of health insurance:
Coordinated care plans which provide health care services, including but not limited to health maintenance organization plans (with or without point of service options), plans offered by provider-sponsored organizations (as defined in section 1395w-25(d) of this title), and regional or local preferred provider organization plans (including MA regional plans).
Specialized MA plans for special needs individuals (as defined in section 1395w-28(b)(6) of this title) may be any type of coordinated care plan.
An MSA plan, as defined in section 1395w-28(b)(3) of this title, and a contribution into a Medicare+Choice medical savings account (MSA).
A Medicare+Choice private fee-for-service plan, as defined in section 1395w-28(b)(2) of this title.
In this subchapter, the term "Medicare+Choice eligible individual" means an individual who is entitled to benefits under part A and enrolled under part B.
Except as the Secretary may otherwise provide and except as provided in subparagraph (C), an individual is eligible to elect a Medicare+Choice plan offered by a Medicare+Choice organization only if the plan serves the geographic area in which the individual resides.
Pursuant to rules specified by the Secretary, the Secretary shall provide that an MA local plan may offer to all individuals residing in a geographic area the option to continue enrollment in the plan, notwithstanding that the individual no longer resides in the service area of the plan, so long as the plan provides that individuals exercising this option have, as part of the benefits under the original medicare fee-for-service program option, reasonable access within that geographic area to the full range of basic benefits, subject to reasonable cost sharing liability in obtaining such benefits.
Notwithstanding subparagraph (A) and in addition to subparagraph (B), if a Medicare+Choice organization eliminates from its service area a Medicare+Choice payment area that was previously within its service area, the organization may elect to offer individuals residing in all or portions of the affected area who would otherwise be ineligible to continue enrollment the option to continue enrollment in an MA local plan it offers so long as-
An individual who is enrolled in a health benefit plan under chapter 89 of title 5 is not eligible to enroll in an MSA plan until such time as the Director of the Office of Management and Budget certifies to the Secretary that the Office of Personnel Management has adopted policies which will ensure that the enrollment of such individuals in such plans will not result in increased expenditures for the Federal Government for health benefit plans under such chapter.
The Secretary may apply rules similar to the rules described in subparagraph (A) in the case of individuals who are eligible for health care benefits under chapter 55 of title 10 or under chapter 17 of title 38.
An individual who is a qualified medicare beneficiary (as defined in section 1396d(p)(1) of this title), a qualified disabled and working individual (described in section 1396d(s) of this title), an individual described in section 1396a(a)(10)(E)(iii) of this title, or otherwise entitled to medicare cost-sharing under a State plan under subchapter XIX is not eligible to enroll in an MSA plan.
Under rules established by the Secretary, an individual is not eligible to enroll (or continue enrollment) in an MSA plan for a year unless the individual provides assurances satisfactory to the Secretary that the individual will reside in the United States for at least 183 days during the year.
The Secretary shall regularly evaluate the impact of permitting enrollment in MSA plans under this part on selection (including adverse selection), use of preventive care, access to care, and the financial status of the Trust Funds under this subchapter.
The Secretary shall submit to Congress periodic reports on the numbers of individuals enrolled in such plans and on the evaluation being conducted under subparagraph (B).
The Secretary shall establish a process through which elections described in subsection (a) are made and changed, including the form and manner in which such elections are made and changed. Subject to paragraph (4), such elections shall be made or changed only during coverage election periods specified under subsection (e) and shall become effective as provided in subsection (f).
Such process shall permit an individual who wishes to elect a Medicare+Choice plan offered by a Medicare+Choice organization to make such election through the filing of an appropriate election form with the organization.
Such process shall permit an individual, who has elected a Medicare+Choice plan offered by a Medicare+Choice organization and who wishes to terminate such election, to terminate such election through the filing of an appropriate election form with the organization.
Subject to clause (ii), an individual who fails to make an election during an initial election period under subsection (e)(1) is deemed to have chosen the original medicare fee-for-service program option.
The Secretary may establish procedures under which an individual who is enrolled in a health plan (other than Medicare+Choice plan) offered by a Medicare+Choice organization at the time of the initial election period and who fails to elect to receive coverage other than through the organization is deemed to have elected the Medicare+Choice plan offered by the organization (or, if the organization offers more than one such plan, such plan or plans as the Secretary identifies under such procedures).
An individual who has made (or is deemed to have made) an election under this section is considered to have continued to make such election until such time as-
On the first day of the annual, coordinated election period under subsection (e)(3) for plan years beginning on or after January 1, 2017, an MA eligible individual described in clause (i) or (ii) of subparagraph (B) is deemed, unless the individual elects otherwise, to have elected to receive benefits under this subchapter through an applicable MA plan (and shall be enrolled in such plan) beginning with such plan year, if-
An MA eligible individual described in this clause, with respect to a plan year, is an MA eligible individual who is enrolled in a reasonable cost reimbursement contract under section 1395mm(h) of this title in the previous plan year and who is not, for such previous plan year, enrolled in a prescription drug plan under part D, including coverage under section 1395w-132 of this title.
An MA eligible individual described in this clause, with respect to a plan year, is an MA eligible individual who is enrolled in a reasonable cost reimbursement contract under section 1395mm(h) of this title in the previous plan year and who, for such previous plan year, is enrolled in a prescription drug plan under part D-
In this paragraph, the term "applicable MA plan" means, in the case of an individual described in-
Not later than 45 days before the first day of the annual, coordinated election period under subsection (e)(3) for plan years beginning on or after January 1, 2017, the Secretary shall identify and notify the individuals who will be subject to deemed elections under subparagraph (A) on the first day of such period.
The Secretary shall provide for activities under this subsection to broadly disseminate information to medicare beneficiaries (and prospective medicare beneficiaries) on the coverage options provided under this section in order to promote an active, informed selection among such options.
At least 15 days before the beginning of each annual, coordinated election period (as defined in subsection (e)(3)(B)), the Secretary shall mail to each Medicare+Choice eligible individual residing in an area the following:
The general information described in paragraph (3).
A list identifying the Medicare+Choice plans that are (or will be) available to residents of the area and information described in paragraph (4) concerning such plans. Such information shall be presented in a comparative form.
Any other information that the Secretary determines will assist the individual in making the election under this section.
The mailing of such information shall be coordinated, to the extent practicable, with the mailing of any annual notice under section 1395b-2 of this title.
To the extent practicable, the Secretary shall, not later than 30 days before the beginning of the initial Medicare+Choice enrollment period for an individual described in subsection (e)(1), mail to the individual the information described in subparagraph (A).
The Secretary shall require a Medicare Advantage organization that is offering a Medicare Advantage plan that has been converted from a reasonable cost reimbursement contract pursuant to section 1395mm(h)(5)(C)(iv) of this title to mail, not later than 30 days prior to the first day of the annual, coordinated election period under subsection (e)(3) of a year, to any individual enrolled under such contract and identified by the Secretary under subsection (c)(4)(D) for such year-
The information disseminated under this paragraph shall be written and formatted using language that is easily understandable by medicare beneficiaries.
The information described in subparagraph (A) shall be updated on at least an annual basis to reflect changes in the availability of Medicare+Choice plans and the benefits and Medicare+Choice monthly basic and supplemental beneficiary premiums for such plans.
General information under this paragraph, with respect to coverage under this part during a year, shall include the following:
A general description of the benefits covered under the original medicare fee-for-service program under parts A and B, including-
Information and instructions on how to exercise election options under this section.
A general description of procedural rights (including grievance and appeals procedures) of beneficiaries under the original medicare fee-for-service program and the Medicare+Choice program and the right to be protected against discrimination based on health status-related factors under section 1395w-22(b) of this title.
A general description of the benefits, enrollment rights, and other requirements applicable to medicare supplemental policies under section 1395ss of this title and provisions relating to medicare select policies described in section 1395ss(t) of this title.
The fact that a Medicare+Choice organization may terminate its contract, refuse to renew its contract, or reduce the service area included in its contract, under this part, and the effect of such a termination, nonrenewal, or service area reduction may have on individuals enrolled with the Medicare+Choice plan under this part.
In the case of an MA regional plan, a description of the catastrophic coverage and single deductible applicable under the plan.
Information under this paragraph, with respect to a Medicare+Choice plan for a year, shall include the following:
The benefits covered under the plan, including the following:
The monthly amount of the premium charged to an individual.
The reduction in part B premiums, if any.
The service area of the plan.
To the extent available, plan quality and performance indicators for the benefits under the plan (and how they compare to such indicators under the original medicare fee-for-service program under parts A and B in the area involved), including-
Supplemental health care benefits, including any reductions in cost-sharing under section 1395w-22(a)(3) of this title and the terms and conditions (including premiums) for such benefits.
The Secretary shall maintain a toll-free number for inquiries regarding Medicare+Choice options and the operation of this part in all areas in which Medicare+Choice plans are offered and an Internet site through which individuals may electronically obtain information on such options and Medicare+Choice plans.
The Secretary may enter into contracts with non-Federal entities to carry out activities under this subsection.
A Medicare+Choice organization shall provide the Secretary with such information on the organization and each Medicare+Choice plan it offers as may be required for the preparation of the information referred to in paragraph (2)(A).
If, at the time an individual first becomes entitled to benefits under part A and enrolled under part B, there is one or more Medicare+Choice plans offered in the area in which the individual resides, the individual shall make the election under this section during a period specified by the Secretary such that if the individual elects a Medicare+Choice plan during the period, coverage under the plan becomes effective as of the first date on which the individual may receive such coverage. If any portion of an individual's initial enrollment period under part B occurs after the end of the annual, coordinated election period described in paragraph (3)(B)(iii), the initial enrollment period under this part shall further extend through the end of the individual's initial enrollment period under part B.
Subject to paragraph (5)-
At any time during the period beginning January 1, 1998, and ending on December 31, 2005, a Medicare+Choice eligible individual may change the election under subsection (a)(1).
Subject to clause (ii), subparagraph (C)(iii),1 and subparagraph (D), at any time during the first 6 months of 2006, or, if the individual first becomes a Medicare+Choice eligible individual during 2006, during the first 6 months during 2006 in which the individual is a Medicare+Choice eligible individual, a Medicare+Choice eligible individual may change the election under subsection (a)(1).
An individual may exercise the right under clause (i) only once. The limitation under this clause shall not apply to changes in elections effected during an annual, coordinated election period under paragraph (3) or during a special enrollment period under the first sentence of paragraph (4).
Subject to subparagraph (D), at any time during the first 45 days of a year (beginning with 2011 and ending with 2018), an individual who is enrolled in a Medicare Advantage plan may change the election under subsection (a)(1), but only with respect to coverage under the original medicare fee-for-service program under parts A and B, and may elect qualified prescription drug coverage in accordance with section 1395w-101 of this title.
At any time after 2005 in the case of a Medicare+Choice eligible individual who is institutionalized (as defined by the Secretary), the individual may elect under subsection (a)(1)-
On any date during the period beginning on January 1, 2007, and ending on July 31, 2007, on which a Medicare Advantage eligible individual is an unenrolled fee-for-service individual (as defined in clause (ii)), the individual may elect under subsection (a)(1) to enroll in a Medicare Advantage plan that is not an MA-PD plan.
In this subparagraph, the term "unenrolled fee-for-service individual" means, with respect to a date, a Medicare Advantage eligible individual who-
An individual may exercise the right under clause (i) only once during the period described in such clause.
Nothing in this subparagraph shall be construed as permitting an individual exercising the right under clause (i)-
At any time during the period beginning after the last day of the annual, coordinated election period under paragraph (3) in which an individual is deemed to have elected to enroll in an MA plan or MA-PD plan under subsection (c)(4) and ending on the last day of February of the first plan year for which the individual is enrolled in such plan, such individual may change the election under subsection (a)(1) (including changing the MA plan or MA-PD plan in which the individual is enrolled).
An individual may exercise the right under clause (i) only once during the applicable period described in such clause. The limitation under this clause shall not apply to changes in elections effected during an annual, coordinated election period under paragraph (3) or during a special enrollment period under paragraph (4).
Subject to clause (ii) and subparagraph (D)-
such MA eligible individual may change the election under subsection (a)(1).
An individual may change the election pursuant to clause (i) only once during the applicable 3-month period described in such clause in each year. The limitation under this clause shall not apply to changes in elections effected during an annual, coordinated election period under paragraph (3) or during a special enrollment period under paragraph (4).
Clauses (i) and (ii) of this subparagraph shall only apply with respect to changes in enrollment in a prescription drug plan under part D in the case of an individual who, previous to such change in enrollment, is enrolled in a Medicare Advantage plan.
Pursuant to subsection (j), no unsolicited marketing or marketing materials may be sent to an individual described in clause (i) during the continuous open enrollment and disenrollment period established for the individual under such clause, notwithstanding marketing guidelines established by the Centers for Medicare & Medicaid Services.
Subject to paragraph (5), each individual who is eligible to make an election under this section may change such election during an annual, coordinated election period.
For purposes of this section, the term "annual, coordinated election period" means-
During the fall season of each year (beginning with 1999) and during the period described in subparagraph (B)(iii), in conjunction with the annual coordinated election period defined in subparagraph (B), the Secretary shall provide for a nationally coordinated educational and publicity campaign to inform Medicare+Choice eligible individuals about Medicare+Choice plans and the election process provided under this section.
During November 1998 the Secretary shall provide for an educational and publicity campaign to inform Medicare+Choice eligible individuals about the availability of Medicare+Choice plans, and eligible organizations with risk-sharing contracts under section 1395mm of this title, offered in different areas and the election process provided under this section. During the period described in subparagraph (B)(iii), the Secretary shall provide for an educational and publicity campaign to inform MA eligible individuals about the availability of MA plans (including MA-PD plans) offered in different areas and the election process provided under this section.
Effective as of January 1, 2006, an individual may discontinue an election of a Medicare+Choice plan offered by a Medicare+Choice organization other than during an annual, coordinated election period and make a new election under this section if-
Effective as of January 1, 2006, an individual who, upon first becoming eligible for benefits under part A at age 65, enrolls in a Medicare+Choice plan under this part, the individual may discontinue the election of such plan, and elect coverage under the original fee-for-service plan, at any time during the 12-month period beginning on the effective date of such enrollment.
Notwithstanding the preceding provisions of this subsection, an individual-
Subject to paragraph (5), a Medicare+Choice organization-
An election of coverage made during the initial coverage election period under subsection (e)(1) shall take effect upon the date the individual becomes entitled to benefits under part A and enrolled under part B, except as the Secretary may provide (consistent with section 1395q of this title) in order to prevent retroactive coverage.
An election or change of coverage made under subsection (e)(2) shall take effect with the first day of the first calendar month following the date on which the election or change is made.
An election or change of coverage made during an annual, coordinated election period (as defined in subsection (e)(3)(B), other than the period described in clause (iii) of such subsection) in a year shall take effect as of the first day of the following year.
An election or change of coverage made during any other period under subsection (e)(4) shall take effect in such manner as the Secretary provides in a manner consistent (to the extent practicable) with protecting continuity of health benefit coverage.
Except as provided in this subsection, a Medicare+Choice organization shall provide that at any time during which elections are accepted under this section with respect to a Medicare+Choice plan offered by the organization, the organization will accept without restrictions individuals who are eligible to make such election.
If the Secretary determines that a Medicare+Choice organization, in relation to a Medicare+Choice plan it offers, has a capacity limit and the number of Medicare+Choice eligible individuals who elect the plan under this section exceeds the capacity limit, the organization may limit the election of individuals of the plan under this section but only if priority in election is provided-
The preceding sentence shall not apply if it would result in the enrollment of enrollees substantially nonrepresentative, as determined in accordance with regulations of the Secretary, of the medicare population in the service area of the plan.
Subject to subparagraph (B), a Medicare+Choice organization may not for any reason terminate the election of any individual under this section for a Medicare+Choice plan it offers.
A Medicare+Choice organization may terminate an individual's election under this section with respect to a Medicare+Choice plan it offers if-
Any individual whose election is terminated under clause (i) or (ii) of subparagraph (B) is deemed to have elected the original medicare fee-for-service program option described in subsection (a)(1)(A).
Any individual whose election is terminated under subparagraph (B)(iii) shall have a special election period under subsection (e)(4)(A) in which to change coverage to coverage under another Medicare+Choice plan. Such an individual who fails to make an election during such period is deemed to have chosen to change coverage to the original medicare fee-for-service program option described in subsection (a)(1)(A).
Pursuant to a contract under section 1395w-27 of this title, each Medicare+Choice organization receiving an election form under subsection (c)(2) shall transmit to the Secretary (at such time and in such manner as the Secretary may specify) a copy of such form or such other information respecting the election as the Secretary may specify.
No marketing material or application form may be distributed by a Medicare+Choice organization to (or for the use of) Medicare+Choice eligible individuals unless-
The standards established under section 1395w-26 of this title shall include guidelines for the review of any material or form submitted and under such guidelines the Secretary shall disapprove (or later require the correction of) such material or form if the material or form is materially inaccurate or misleading or otherwise makes a material misrepresentation.
In the case of material or form that is submitted under paragraph (1)(A) to the Secretary or a regional office of the Department of Health and Human Services and the Secretary or the office has not disapproved the distribution of marketing material or form under paragraph (1)(B) with respect to a Medicare+Choice plan in an area, the Secretary is deemed not to have disapproved such distribution in all other areas covered by the plan and organization except with regard to that portion of such material or form that is specific only to an area involved.
Each Medicare+Choice organization shall conform to fair marketing standards, in relation to Medicare+Choice plans offered under this part, included in the standards established under section 1395w-26 of this title. Such standards-
In the case of marketing material of an organization that uses, without modification, proposed model language specified by the Secretary, the period specified in paragraph (1)(A) shall be reduced from 45 days to 10 days.
For plan years beginning on or after January 1, 2010, a Medicare Advantage organization must ensure that the name of each Medicare Advantage plan offered by the Medicare Advantage organization includes the plan type of the plan (using standard terminology developed by the Secretary).
Each Medicare Advantage organization shall-
Each Medicare Advantage organization shall comply in a timely manner with any request by a State for information regarding the performance of a licensed agent, broker, or other third party representing the Medicare Advantage organization as part of an investigation by the State into the conduct of the agent, broker, or other third party.
Subject to sections 1395w-22(a)(5), 1395w-23(a)(4), 1395w-23(g), 1395w-23(h), 1395ww(d)(11), 1395ww(h)(3)(D), and 1395w-23(m) of this title, payments under a contract with a Medicare+Choice organization under section 1395w-23(a) of this title with respect to an individual electing a Medicare+Choice plan offered by the organization shall be instead of the amounts which (in the absence of the contract) would otherwise be payable under parts A and B for items and services furnished to the individual.
Subject to sections 1395w-23(a)(4), 1395w-23(e), 1395w-23(g), 1395w-23(h), 1395w-27(f)(2), 1395w-27a(h), 1395ww(d)(11), and 1395ww(h)(3)(D) of this title, only the Medicare+Choice organization shall be entitled to receive payments from the Secretary under this subchapter for services furnished to the individual.
Paragraphs (1) and (2) shall not apply with respect to expenses for organ acquisitions for kidney transplants described in section 1395w-22(a)(1)(B)(i) of this title.
The following prohibited activities are described in this paragraph:
Any unsolicited means of direct contact of prospective enrollees, including soliciting door-to-door or any outbound telemarketing without the prospective enrollee initiating contact.
The sale of other non-health related products (such as annuities and life insurance) during any sales or marketing activity or presentation conducted with respect to a Medicare Advantage plan.
The provision of meals of any sort, regardless of value, to prospective enrollees at promotional and sales activities.
Sales and marketing activities for the enrollment of individuals in Medicare Advantage plans that are conducted-
The Secretary shall establish limitations with respect to at least the following:
The scope of any appointment with respect to the marketing of a Medicare Advantage plan. Such limitation shall require advance agreement with a prospective enrollee on the scope of the marketing appointment and documentation of such agreement by the Medicare Advantage organization. In the case where the marketing appointment is in person, such documentation shall be in writing.
The use of the name or logo of a co-branded network provider on Medicare Advantage plan membership and marketing materials.
The offering of gifts and other promotional items other than those that are of nominal value (as determined by the Secretary) to prospective enrollees at promotional activities.
The use of compensation other than as provided under guidelines established by the Secretary. Such guidelines shall ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs.
The use by a Medicare Advantage organization of any individual as an agent, broker, or other third party representing the organization that has not completed an initial training and testing program and does not complete an annual retraining and testing program.
1See References in Text note below.
42 U.S.C. § 1395w-21
EDITORIAL NOTES
REFERENCES IN TEXTSubsec. (e)(2)(C), referred to in subsec. (e)(2)(B)(i), was amended generally by section 3204(a)(1) of Pub. L. 111-148 and, as so amended, no longer contains a cl. (iii).
AMENDMENTS2016-Subsec. (a)(3). Pub. L. 114-255, §17006(a)(1), struck out subpar. (A) designation and heading, substituted "In this subchapter," for "In this subchapter, subject to subparagraph (B),", and struck out subpar. (B), which provided a special rule for end-stage renal disease.Subsec. (e)(2)(C). Pub. L. 114-255, §17005(1), inserted "from 2011 through 2018" after "45-day period" in heading and "and ending with 2018" after "beginning with 2011" in text. Subsec. (e)(2)(G). Pub. L. 114-255, §17005(2), added subpar. (G).Subsec. (i)(3). Pub. L. 114-255, §17006(c)(2), added par. (3).2015-Subsec. (a)(3)(B). Pub. L. 114-10, §209(b)(3), inserted concluding provisions. Subsec. (c)(1). Pub. L. 114-10, §209(b)(1)(A), substituted "Subject to paragraph (4), such elections" for "Such elections". Subsec. (c)(4). Pub. L. 114-10, §209(b)(1)(B), added par. (4).Subsec. (d)(2)(B). Pub. L. 114-10, §209(c), designated existing provisions as cl. (i), inserted heading, and added cl. (ii). Pub. L. 114-10, §209(c)(1), which directed the substitution of "Notifications required" for "Notification to newly eligible medicare advantage eligible individuals" in heading, was executed by making the substitution for "Notification to newly eligible Medicare+Choice eligible individuals" to reflect the probable intent of Congress. Subsec. (e)(2)(F). Pub. L. 114-10, §209(b)(2)(A), added subpar. (F).Subsec. (e)(6)(A). Pub. L. 114-10, §209(b)(2)(B)(i), substituted "paragraph (1), during the period described in paragraph (2)(F)," for "paragraph (1),". 2010-Subsec. (b)(1)(C). Pub. L. 111-148, §3201(e)(2)(A)(i), which directed that subpar. (C) be struck out, was repealed by Pub. L. 111-152, §1102(a). See Effective Date of 2010 Amendment note below.Subsec. (e)(2)(C). Pub. L. 111-148, §3204(a)(1), amended subpar. (C) generally. Prior to amendment, subpar. (C) related to continuous open enrollment and disenrollment for first 3 months of a year after 2006.Subsec. (e)(3)(B)(iv). Pub. L. 111-148, §3204(b)(2)(A), substituted ",2008, 2009, and 2010" for "and succeeding years". Subsec. (e)(3)(B)(v). Pub. L. 111-148, §3204(b)(1), (2) (B), (3), added cl. (v). 2009-Subsec. (i)(1). Pub. L. 111-5 substituted "1395ww(h)(3)(D), and 1395w-23(m)" for "and 1395ww(h)(3)(D)". 2008-Subsec. (h)(4)(A). Pub. L. 110-275, §103(a)(1)(A)(i)(I)(aa), substituted ",subject to subsection (j)(2)(C), cash, gifts, prizes, or other monetary rebates" for "cash or other monetary rebates".Subsec. (h)(4)(C). Pub. L. 110-275, §103(a)(1)(A)(i)(I)(bb)-(III), added subpar. (C). Subsec. (h)(4)(D). Pub. L. 110-275, §103(b)(1)(A), added subpar. (D). Subsec. (h)(6). Pub. L. 110-275, §103(c)(1), added par. (6). Subsec. (h)(7). Pub. L. 110-275, §103(d)(1), added par. (7). Subsec. (j). Pub. L. 110-275, §103(a)(1)(A)(ii), added subsec. (j).Subsec. (j)(2). Pub. L. 110-275, §103(b)(1)(B), added par. (2). 2007-Subsec. (e)(2)(E)(i). Pub. L. 110-48, §2(1), substituted "the period beginning on January 1, 2007, and ending on July 31, 2007," for "2007 or 2008".Subsec. (e)(2)(E)(iii). Pub. L. 110-48, §2(2), substituted "the applicable period" for "year" in heading and "the period described in such clause" for "the year" in text. 2006-Subsec. (e)(2)(E). Pub. L. 109-432 added subpar. (E).2003-Subsec. (a)(1). Pub. L. 108-173, §102(c)(1)(A), (C), inserted "(other than qualified prescription drug benefits)" after "benefits" in introductory provisions and inserted concluding provisions.Subsec. (a)(1)(B). Pub. L. 108-173, §102(c)(1)(B), substituted comma for period at end. Subsec. (a)(2)(A). Pub. L. 108-173, §221(a)(1), substituted "Coordinated care plans (including regional plans)" for "Coordinated care plans" in heading, inserted cl. (i) designation and heading before "Coordinated", and inserted "regional or local" before "preferred provider organization plans" and "(including MA regional plans)" before period at end.Subsec. (a)(2)(A)(ii). Pub. L. 108-173, §231(a), added cl. (ii).Subsec. (a)(3)(B)(ii). Pub. L. 108-173, §222(l)(3)(D), made technical amendment to reference in original act which appears in text as reference to subsection (e)(4)(A) of this section. Subsec. (b)(1)(B). Pub. L. 108-173, §222(l)(3)(A)(i), (ii), substituted "an MA local plan" for "a plan" and "benefits under the original medicare fee-for-service program option" for "basic benefits described in section 1395w-22(a)(1)(A) of this title".Subsec. (b)(1)(C). Pub. L. 108-173, §222(l)(3)(A)(iii), substituted "in an MA local plan" for "in a Medicare+Choice plan" in introductory provisions. Subsec. (b)(4). Pub. L. 108-173, §233(b)(1), struck out "on a demonstration basis" after "plans" in heading.Subsec. (b)(4)(A). Pub. L. 108-173, §233(b)(2), struck out first sentence which read as follows: "An individual is not eligible to enroll in an MSA plan under this part-"(i) on or after January 1, 2003, unless the enrollment is the continuation of such an enrollment in effect as of such date; or"(ii) as of any date if the number of such individuals so enrolled as of such date has reached 390,000."Subsec. (b)(4)(C). Pub. L. 108-173, §233(b)(3), struck out at end "The Secretary shall submit such a report, by not later than March 1, 2002, on whether the time limitation under subparagraph (A)(i) should be extended or removed and whether to change the numerical limitation under subparagraph (A)(ii)."Subsec. (d)(3)(F). Pub. L. 108-173, §222(l)(3)(B)(i), added subpar. (F).Subsec. (d)(4)(A)(ii). Pub. L. 108-173, §222(l)(3)(B)(ii), inserted ",including information on the single deductible (if applicable) under section 1395w-27a(b)(1) of this title" after "cost sharing". Subsec. (d)(4)(B)(i). Pub. L. 108-173, §222(l)(3)(B)(iii), substituted "monthly amount of the premium charged to an individual" for "Medicare+Choice monthly basic beneficiary premium and Medicare+Choice monthly supplemental beneficiary premium, if any, for the plan or, in the case of an MSA plan, the Medicare+Choice monthly MSA premium".Subsec. (d)(4)(E). Pub. L. 108-173, §222(l)(3)(B)(iv), reenacted heading without change and amended text generally. Prior to amendment, text read as follows: "Whether the organization offering the plan includes mandatory supplemental benefits in its base benefit package or offers optional supplemental benefits and the terms and conditions (including premiums) for such coverage." Subsec. (e)(1). Pub. L. 108-173, §102(a)(4), inserted at end "If any portion of an individual's initial enrollment period under part B occurs after the end of the annual, coordinated election period described in paragraph (3)(B)(iii), the initial enrollment period under this part shall further extend through the end of the individual's initial enrollment period under part B."Subsec. (e)(2). Pub. L. 108-173, §102(a)(1)(A), substituted "2005" and "2006" for "2004" and "2005", respectively, wherever appearing.Subsec. (e)(2)(B)(i). Pub. L. 108-173, §102(a)(6)(A), inserted ",subparagraph (C)(iii)," after "clause (ii)".Subsec. (e)(2)(C)(i). Pub. L. 108-173, §102(a)(6)(B), substituted "clauses (ii) and (iii)" for "clause (ii)".Subsec. (e)(2)(C)(iii). Pub. L. 108-173, §102(a)(6)(C), added cl. (iii).Subsec. (e)(3)(B). Pub. L. 108-173, §102(a)(2), reenacted heading without change and amended text generally. Prior to amendment, text read as follows: "For purposes of this section, the term 'annual, coordinated election period' means, with respect to a year before 2003 and after 2005, the month of November before such year and with respect to 2003, 2004, and 2005, the period beginning on November 15 and ending on December 31 of the year before such year."Subsec. (e)(3)(C). Pub. L. 108-173, §102(a)(3)(A), inserted "and during the period described in subparagraph (B)(iii)" after "(beginning with 1999)". Subsec. (e)(3)(D). Pub. L. 108-173, §102(a)(3)(B), in heading, substituted "campaigns" for "campaign in 1998" and, in text, inserted at end "During the period described in subparagraph (B)(iii), the Secretary shall provide for an educational and publicity campaign to inform MA eligible individuals about the availability of MA plans (including MA-PD plans) offered in different areas and the election process provided under this section."Subsec. (e)(4). Pub. L. 108-173, §102(a)(1)(B), substituted "2006" for "2005" in two places. Subsec. (e)(5)(A)(i). Pub. L. 108-173, §233(d)(1), inserted "or" at end. Subsec. (e)(5)(A)(ii). Pub. L. 108-173, §233(d)(2), substituted semicolon for ",or". Subsec. (e)(5)(A)(iii). Pub. L. 108-173, §233(d)(3), struck out cl. (iii) which read as follows: "the month of November 1998;". Subsec. (f)(1). Pub. L. 108-173, §222(l)(3)(E), substituted "subsection (e)(1)" for "subsection (e)(1)(A)".Subsec. (f)(3). Pub. L. 108-173, §102(a)(5), inserted ",other than the period described in clause (iii) of such subsection" after "subsection (e)(3)(B)".Subsec. (i)(1). Pub. L. 108-173, §237(b)(2)(A)(i), inserted "1395w-23(a)(4)," after "Subject to sections 1395w-22(a)(5),".Subsec. (i)(2). Pub. L. 108-173, §237(b)(2)(A)(ii), inserted "1395w-23(a)(4)," after "Subject to sections". Pub. L. 108-173, §221(d)(5), inserted "1395w-27a(h)," after "1395w-27(f)(2),". 2002-Subsec. (e)(2)(A). Pub. L. 107-188, §532(a)(1), substituted "through 2004" for "through 2001" in heading and "during the period beginning January 1, 1998, and ending on December 31, 2004" for "during 1998, 1999, 2000, and 2001" in text.Subsec. (e)(2)(B). Pub. L. 107-188, §532(a)(2), substituted "during 2005" for "during 2002" in heading.Subsec. (e)(2)(B)(i), (C)(i). Pub. L. 107-188, §532(a)(3), substituted "2005" for "2002" wherever appearing. Subsec. (e)(2)(D). Pub. L. 107-188, §532(a)(4), substituted "2004" for "2001".Subsec. (e)(3)(B). Pub. L. 107-188, §532(c)(1)(A), substituted "means, with respect to a year before 2003 and after 2005, the month of November before such year and with respect to 2003, 2004, and 2005, the period beginning on November 15 and ending on December 31 of the year before such year" for "means, with respect to a calendar year (beginning with 2000), the month of November before such year". Subsec. (e)(4). Pub. L. 107-188, §532(a)(5), substituted "2005" for "2002" in introductory and concluding provisions.Subsec. (e)(6)(A). Pub. L. 107-188, §532(c)(1)(B), substituted "during the annual, coordinated election period under paragraph (3) for each subsequent year" for "each subsequent year (as provided in paragraph (3))". 2000-Subsec. (a)(3)(B). Pub. L. 106-554, §1(a)(6) [title VI, §620(a)], substituted "except that-" and cls. (i) and (ii) for "except that an individual who develops end-stage renal disease while enrolled in a Medicare+Choice plan may continue to be enrolled in that plan." Subsec. (d)(4)(B). Pub. L. 106-554, §1(a)(6) [title VI, §606(a)(2)(C)], designated existing provisions as cl. (i), inserted heading, and added cl. (ii).Subsec. (f)(2). Pub. L. 106-554, §1(a)(6) [title VI, §619(a)], struck out ",except that if such election or change is made after the 10th day of any calendar month, then the election or change shall not take effect until the first day of the second calendar month following the date on which the election or change is made" before period at end.Subsec. (h)(1)(A). Pub. L. 106-554, §1(a)(6) [title VI, §613(a)(1)], inserted "(or 10 days in the case described in paragraph (5))" after "45 days".Subsec. (h)(5). Pub. L. 106-554, §1(a)(6) [title VI, §613(a)(2)], added par. (5). 1999-Subsec. (b)(1)(A). Pub. L. 106-113, §1000(a)(6) [title V, §501(c)(1)], inserted "and except as provided in subparagraph (C)" after "may otherwise provide".Subsec. (b)(1)(C). Pub. L. 106-113, §1000(a)(6) [title V, §501(c)(2)], added subpar. (C). Subsec. (e)(2)(B)(i). Pub. L. 106-113, §1000(a)(6) [title V, §501(b)(1)], inserted "and subparagraph (D)" after "clause (ii)". Subsec. (e)(2)(C)(i). Pub. L. 106-113, §1000(a)(6) [title V, §501(b)(2)], inserted "and subparagraph (D)" after "clause (ii)". Subsec. (e)(2)(D). Pub. L. 106-113, §1000(a)(6) [title V, §501(b)(3)], added subpar. (D). Subsec. (e)(3)(C). Pub. L. 106-113, §1000(a)(6) [title V, §519(a)], substituted "During the fall season" for "In the month of November".Subsec. (e)(4)(A). Pub. L. 106-113, §1000(a)(6) [title V, §501(a)(1)], added subpar. (A) and struck out former subpar. (A) which read as follows: "the organization's or plan's certification under this part has been terminated or the organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides;".Subsec. (f)(2). Pub. L. 106-113, §1000(a)(6) [title V, §502(a)], inserted "or change" before "is made" and ",except that if such election or change is made after the 10th day of any calendar month, then the election or change shall not take effect until the first day of the second calendar month following the date on which the election or change is made" before the period at end.Subsec. (i)(2). Pub. L. 106-113, §1000(a)(6) [title III, §321(k)(6)(A)], struck out "and" after "1395w-27(f)(2),".
STATUTORY NOTES AND RELATED SUBSIDIARIES
EFFECTIVE DATE OF 2016 AMENDMENT Pub. L. 114-255, div. C, title XVII, §17006(a)(3), Dec. 13, 2016, 130 Stat. 1334, provided that: "The amendments made by this subsection [amending this section and sections 1395w-22 and 1395w-28 of this title] shall apply with respect to plan years beginning on or after January 1, 2021." Pub. L. 114-255, div. C, title XVII, §17006(c)(3), Dec. 13, 2016, 130 Stat. 1335, provided that: "The amendments made by this subsection [amending this section and section 1395w-22 of this title] shall apply with respect to plan years beginning on or after January 1, 2021."
EFFECTIVE DATE OF 2010 AMENDMENT Pub. L. 111-152, title I, §1102(a), Mar. 30, 2010, 124 Stat. 1040, provided that sections 3201 (amending this section and sections 1395w-23, 1395w-24, 1395w-27a, 1395w-29, and 1395eee of this title and enacting provisions set out as notes under this section and section 1395w-24 of this title) and 3203 (amending section 1395w-23 of this title) of Pub. L. 111-148 and the amendments made by such sections, were repealed, effective as if included in the enactment of Pub. L. 111-148. Pub. L. 111-148, title III, §3201(e)(2)(B), Mar. 23, 2010, 124 Stat. 447, which provided that amendments by section 3201(e)(2) of Pub. L. 111-148 (amending this section and sections 1395w-23 and 1395w-24 of this title) would take effect on Jan. 1, 2012, was repealed by Pub. L. 111-152, title I, §1102(a), Mar. 30, 2010, 124 Stat. 1040, effective as if included in the enactment of Pub. L. 111-148. Pub. L. 111-148, title III, §3204(a)(2), Mar. 23, 2010, 124 Stat. 456, provided that: "The amendment made by paragraph (1) [amending this section] shall apply with respect to 2011 and succeeding years."
EFFECTIVE DATE OF 2008 AMENDMENT Pub. L. 110-275, title I, §103(a)(3), July 15, 2008, 122 Stat. 2499, provided that: "The amendments made by this subsection [amending this section and section 1395w-104 of this title] shall apply to plan years beginning on or after January 1, 2009." Pub. L. 110-275, title I, §103(b)(3), July 15, 2008, 122 Stat. 2500, provided that: "The amendments made by this subsection [amending this section and section 1395w-104 of this title] shall take effect on a date specified by the Secretary (but in no case later than November 15, 2008)." Pub. L. 110-275, title I, §103(d)(3), July 15, 2008, 122 Stat. 2501, provided that: "The amendments made by this subsection [amending this section and section 1395w-104 of this title] shall apply to plan years beginning on or after January 1, 2009."
EFFECTIVE DATE OF 2003 AMENDMENT Pub. L. 108-173, title I, §102(c)(2), Dec. 8, 2003, 117 Stat. 2154, provided that: "The amendments made by this subsection [amending this section] shall apply on and after January 1, 2006." Pub. L. 108-173, title II, §223(a), Dec. 8, 2003, 117 Stat. 2207, provided that: "The amendments made by this subtitle [subtitle C (§§221-223) of title II of Pub. L. 108-173 enacting section 1395w-27a of this title and amending this section and sections 1395r, 1395s, 1395w, 1395w-22 to 1395w-24, 1395w-27, and 1395w-28 of this title] shall apply with respect to plan years beginning on or after January 1, 2006." Pub. L. 108-173, title II, §231(f)(1), Dec. 8, 2003, 117 Stat. 2208, provided that: "The amendments made by subsections (a), (b), and (c) [amending this section and section 1395w-28 of this title] shall take effect upon the date of the enactment of this Act [Dec. 8, 2003]." Amendment by section 237(b)(2)(A) of Pub. L. 108-173 applicable to services provided on or after Jan. 1, 2006, and contract years beginning on or after such date, see section 237(e) of Pub. L. 108-173 set out as a note under section 1320a-7b of this title.
EFFECTIVE DATE OF 2002 AMENDMENT Pub. L. 107-188, title V, §532(c)(2), June 12, 2002, 116 Stat. 696, provided that: "The amendment made by paragraph (1) [amending this section] shall apply to the annual, coordinated election period for years beginning with 2003."
EFFECTIVE DATE OF 2000 AMENDMENT Amendment by section 1(a)(6) [title VI, §606(a)(2)(C)] of Pub. L. 106-554 applicable to years beginning with 2003, see section 1(a)(6) [title VI, §606(b)] of Pub. L. 106-554 set out as a note under section 1395r of this title. Pub. L. 106-554, §1(a)(6) [title VI, §613(b)], Dec. 21, 2000, 114 Stat. 2763, 2763A-560, provided that: "The amendments made by subsection (a) [amending this section] shall apply to marketing material submitted on or after January 1, 2001." Pub. L. 106-554, §1(a)(6) [title VI, §619(b)], Dec. 21, 2000, 114 Stat. 2763, 2763A-563, provided that: "The amendment made by this section [amending this section] shall apply to elections and changes of coverage made on or after June 1, 2001." Pub. L. 106-554, §1(a)(6) [title VI, §620(b)], Dec. 21, 2000, 114 Stat. 2763, 2763A-564, provided that:"(1) IN GENERAL.-The amendment made by subsection (a) [amending this section] shall apply to terminations and discontinuations occurring on or after the date of the enactment of this Act [Dec. 21, 2000]."(2) APPLICATION TO PRIOR PLAN TERMINATIONS.-Clause (ii) of section 1851(a)(3)(B) of the Social Security Act [42 U.S.C. 1395w-21(a)(3)(B)(ii)] (as inserted by subsection (a)) shall also apply to individuals whose enrollment in a Medicare+Choice plan was terminated or discontinued after December 31, 1998, and before the date of the enactment of this Act. In applying this paragraph, such an individual shall be treated, for purposes of part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.], as having discontinued enrollment in such a plan as of the date of the enactment of this Act."
EFFECTIVE DATE OF 1999 AMENDMENT Amendment by section 1000(a)(6) [title III, §321(k)(6)(A)] of Pub. L. 106-113 effective as if included in the enactment of the Balanced Budget Act of 1997, Pub. L. 105-33 except as otherwise provided, see section 1000(a)(6) [title III, §321(m)] of Pub. L. 106-113 set out as a note under section 1395d of this title. Pub. L. 106-113, div. B, §1000(a)(6) [title V, §501(d)], Nov. 29, 1999, 113 Stat. 1536, 1501A-379, provided that: "(1) The amendments made by subsection (a) [amending this section and section 1395ss of this title] apply to notices of impending terminations or discontinuances made on or after the date of the enactment of this Act [Nov. 29, 1999]."(2) The amendments made by subsection (c) [amending this section] apply to elections made on or after the date of the enactment of this Act [Nov. 29, 1999] with respect to eliminations of Medicare+Choice payment areas from a service area that occur before, on, or after the date of the enactment of this Act." Pub. L. 106-113, div. B, §1000(a)(6) [title V, §502(b)], Nov. 29, 1999, 113 Stat. 1536, 1501A-380, provided that: "The amendments made by this section [amending this section] apply to elections and changes of coverage made on or after January 1, 2000." Pub. L. 106-113, div. B, §1000(a)(6) [title V, §519(b)], Nov. 29, 1999, 113 Stat. 1536, 1501A-385, provided that: "The amendment made by subsection (a) [amending this section] first applies to campaigns conducted beginning in 2000."
REGULATIONS Pub. L. 108-173, title II, §223(b), Dec. 8, 2003, 117 Stat. 2207, provided that: "The Secretary [of Health and Human Services] shall revise the regulations previously promulgated to carry out part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.] to carry out the provisions of this Act [see Tables for classification]."
CONSTRUCTION Pub. L. 108-173, title II, §221(b)(2), Dec. 8, 2003, 117 Stat. 2181, provided that: "Nothing in part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.] shall be construed as preventing an MSA plan or MA private fee-for-service plan from having a service area that covers one or more MA regions or the entire nation."
NO CUTS IN GUARANTEED BENEFITS Pub. L. 111-148, title III, §36023602,, 124 Stat. 538, provided that: "Nothing in this Act [see Short Title note set out under section 18001 of this title] shall result in the reduction or elimination of any benefits guaranteed by law to participants in Medicare Advantage plans."
IMPLEMENTATION OF MEDICARE ADVANTAGE PROGRAM Pub. L. 108-173, title II, §201, Dec. 8, 2003, 117 Stat. 2176, provided that:"(a) IN GENERAL.-There is hereby established the Medicare Advantage program. The Medicare Advantage program shall consist of the program under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.] (as amended by this Act [see Tables for classification])."(b) REFERENCES.-Subject to subsection (c), any reference to the program under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.] shall be deemed a reference to the Medicare Advantage program and, with respect to such part, any reference to 'Medicare+Choice' is deemed a reference to 'Medicare Advantage' and 'MA'."(c) TRANSITION.-In order to provide for an orderly transition and avoid beneficiary and provider confusion, the Secretary [of Health and Human Services] shall provide for an appropriate transition in the use of the terms 'Medicare+Choice' and 'Medicare Advantage' (or 'MA') in reference to the program under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.]. Such transition shall be fully completed for all materials for plan years beginning not later than January 1, 2006. Before the completion of such transition, any reference to 'Medicare Advantage' or 'MA' shall be deemed to include a reference to 'Medicare+Choice'."
REPORT ON IMPACT OF INCREASED FINANCIAL ASSISTANCE TO MEDICARE ADVANTAGE PLANS Pub. L. 108-173, title II, §211(g), Dec. 8, 2003, 117 Stat. 2178, directed the Secretary of Health and Human Services to submit to Congress, not later than July 1, 2006, a report that described the impact of additional financing provided under Pub. L. 108-173 and other Acts on the availability of Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans.
MEDPAC STUDY AND REPORT ON CLARIFICATION OF AUTHORITY REGARDING DISAPPROVAL OF UNREASONABLE BENEFICIARY COST-SHARING Pub. L. 108-173, title II, §211(h), Dec. 8, 2003, 117 Stat. 2179, directed the Medicare Payment Advisory Commission, in consultation with beneficiaries, consumer groups, employers, and organizations offering plans under this part, to conduct a study to determine the extent to which the cost-sharing structures under such plans affect access to covered services or select enrollees based on the health status of eligible individuals described in subsection (a)(3) of this section, and to submit a report to Congress on such study not later than Dec. 31, 2004.
MORATORIUM ON NEW LOCAL PREFERRED PROVIDER ORGANIZATION PLANS Pub. L. 108-173, title II, §221(a)(2), Dec. 8, 2003, 117 Stat. 2180, directed the Secretary of Health and Human Services not to permit the offering of a local preferred provider organization plan under this part during 2006 or 2007 in a service area unless such plan was offered under this part (including under a demonstration project under this part) in such area as of Dec. 31, 2005.
SPECIALIZED MA PLANS Pub. L. 110-275, title I, §164(b), July 15, 2008, 122 Stat. 2571, provided that: "During the period beginning on January 1, 2010, and ending on December 31, 2010, the Secretary of Health and Human Services may not exercise the authority provided under section 231(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 [Pub. L. 108-173] (42 U.S.C. 1395w-21 note) to designate other plans as specialized MA plans for special needs individuals." Pub. L. 110-173, title I, §108(b), Dec. 29, 2007, 121 Stat. 2496, provided that:"(1) AUTHORITY TO DESIGNATE OTHER PLANS AS SPECIALIZED MA PLANS.-During the period beginning on January 1, 2008, and ending on December 31, 2009, the Secretary of Health and Human Services shall not exercise the authority provided under section 231(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 [Pub. L. 108-173] (42 U.S.C. 1395w-21 note) to designate other plans as specialized MA plans for special needs individuals under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.]. The preceding sentence shall not apply to plans designated as specialized MA plans for special needs individuals under such authority prior to January 1, 2008. "(2) ENROLLMENT IN NEW PLANS.-During the period beginning on January 1, 2008, and ending on December 31, 2009, the Secretary of Health and Human Services shall not permit enrollment of any individual residing in an area in a specialized Medicare Advantage plan for special needs individuals under part C of title XVIII of the Social Security Act to take effect unless that specialized Medicare Advantage plan for special needs individuals was available for enrollment for individuals residing in that area on January 1, 2008." Pub. L. 108-173, title II, §231(d), Dec. 8, 2003, 117 Stat. 2208, provided that: "In promulgating regulations to carry out section 1851(a)(2)(A)(ii) of the Social Security Act [42 U.S.C. 1395w-21(a)(2)(A)(ii)] (as added by subsection (a)) and section 1859(b)(6) of such Act [42 U.S.C. 1395w-28(b)(6)] (as added by subsection (b)), the Secretary [of Health and Human Services] may provide (notwithstanding section 1859(b)(6)(A) of such Act) for the offering of specialized MA plans for special needs individuals by MA plans that disproportionately serve special needs individuals." Pub. L. 108-173, title II, §231(e), Dec. 8, 2003, 117 Stat. 2208, provided that: "Not later than December 31, 2007, the Secretary [of Health and Human Services] shall submit to Congress a report that assesses the impact of specialized MA plans for special needs individuals on the cost and quality of services provided to enrollees. Such report shall include an assessment of the costs and savings to the medicare program as a result of amendments made by subsections (a), (b), and (c) [amending this section and section 1395w-28 of this title]."
MEDPAC STUDY ON CONSUMER COALITIONS Pub. L. 106-554, §1(a)(6) [title I, §124], Dec. 21, 2000, 114 Stat. 2763, 2763A-478, directed the Medicare Payment Advisory Commission to conduct a study examining the use of consumer coalitions in the marketing of Medicare+Choice plans under the medicare program under this subchapter and to submit a report on the study to Congress no later than 1 year after Dec. 21, 2000.
REPORT ON ACCOUNTING FOR VA AND DOD EXPENDITURES FOR MEDICARE BENEFICIARIES Pub. L. 106-113, div. B, §1000(a)(6) [title V, §551], Nov. 29, 1999, 113 Stat. 1536, 1501A-392, directed the Secretary of Health and Human Services, jointly with the Secretaries of Defense and of Veterans Affairs, to submit to Congress, no later than Apr. 1, 2001, a report on the estimated use of health care services furnished by the Departments of Defense and of Veterans Affairs to medicare beneficiaries.
REPORT ON MEDICARE MSA (MEDICAL SAVINGS ACCOUNT) PLANS Pub. L. 106-113, div. B, §1000(a)(6) [title V, §552(b)], Nov. 29, 1999, 113 Stat. 1536, 1501A-393, directed the Medicare Payment Assessment Commission to submit to Congress, no later than 1 year after Nov. 29, 1999, a report on specific legislative changes that should be made to make MSA plans a viable option under the Medicare+Choice program.
GAO AUDIT AND REPORTS ON PROVISION OF MEDICARE+CHOICE HEALTH INFORMATION TO BENEFICIARIES Pub. L. 106-113, div. B, §1000(a)(6) [title V, §553(b)], Nov. 29, 1999, 113 Stat. 1536, 1501A-393, provided that:"(1) IN GENERAL.-Beginning in 2000, the Comptroller General shall conduct an annual audit of the expenditures by the Secretary of Health and Human Services during the preceding year in providing information regarding the Medicare+Choice program under part C of title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.) to eligible medicare beneficiaries."(3) [(2)] REPORTS.-Not later than March 31 of 2001, 2004, 2007, and 2010, the Comptroller General shall submit a report to Congress on the results of the audit of the expenditures of the preceding 3 years conducted pursuant to subsection (a) [enacting provisions set out as a note under section 1395ss of this title], together with an evaluation of the effectiveness of the means used by the Secretary of Health and Human Services in providing information regarding the Medicare+Choice program under part C of title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.) to eligible medicare beneficiaries."
ENROLLMENT TRANSITION RULE Pub. L. 105-33, title IV, §4002(c), Aug. 5, 1997, 111 Stat. 329, provided that: "An individual who is enrolled on December 31, 1998, with an eligible organization under section 1876 of the Social Security Act (42 U.S.C. 1395mm) shall be considered to be enrolled with that organization on January 1, 1999, under part C of title XVIII of such Act [42 U.S.C. 1395w-21 et seq.] if that organization has a contract under that part for providing services on January 1, 1999 (unless the individual has disenrolled effective on that date)."
SECRETARIAL SUBMISSION OF LEGISLATIVE PROPOSAL Pub. L. 105-33, title IV, §4002(f)(2), Aug. 5, 1997, 111 Stat. 330, directed the Secretary of Health and Human Services to submit to Congress, no later than 6 months after Aug. 5, 1997, proposed technical and conforming amendments in the law as required by the provisions of chapter 1 (§§4001-4006) of subtitle A of title IV of Pub. L. 105-33.
REPORT ON INTEGRATION AND TRANSITION Pub. L. 105-33, title IV, §4014(c), Aug. 5, 1997, 111 Stat. 337, directed the Secretary of Health and Human Services to submit to Congress, no later than Jan. 1, 1999, a plan which provided for the integration of health plans offered by social health maintenance organizations and similar plans as an option under the Medicare+Choice program under this part, for a transition for such organizations operating under demonstration project authority, and for appropriate payment levels for plans offered by such organizations.
MEDICARE ENROLLMENT DEMONSTRATION PROJECT Pub. L. 105-33, title IV, §40184018,, 111 Stat. 346, provided that:"(a) DEMONSTRATION PROJECT.- "(1) ESTABLISHMENT.-The Secretary shall implement a demonstration project (in this section referred to as the 'project') for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions, as described in part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.] (as added by section 4001 of this Act), in an area."(2) CONSULTATION.-Before implementing the project under this section, the Secretary shall consult with affected parties on-"(A) the design of the project;"(B) the selection criteria for the third-party contractor; and "(C) the establishment of performance standards, as described in paragraph (3)."(3) PERFORMANCE STANDARDS.- "(A) IN GENERAL.-The Secretary shall establish performance standards for the accuracy and timeliness of the Medicare+Choice plan enrollment and disenrollment functions performed by the third-party contractor. "(B) NONCOMPLIANCE.-In the event that the third-party contractor is not in substantial compliance with the performance standards established under subparagraph (A), such enrollment and disenrollment functions shall be performed by the Medicare+Choice plan until the Secretary appoints a new third-party contractor."(b) REPORT TO CONGRESS.-The Secretary shall periodically report to Congress on the progress of the project conducted pursuant to this section."(c) WAIVER AUTHORITY.-The Secretary shall waive compliance with the requirements of part C of title XVIII of the Social Security Act [42 U.S.C. 1395w-21 et seq.] (as amended by section 4001 of this Act) to such extent and for such period as the Secretary determines is necessary to conduct the project. "(d) DURATION.-A demonstration project under this section shall be conducted for a 3-year period."(e) SEPARATE FROM OTHER DEMONSTRATION PROJECTS.-A project implemented by the Secretary under this section shall not be conducted in conjunction with any other demonstration project."
- Secretary
- The term "Secretary" means the Secretary of Housing and Urban Development.1See References in Text note below.
- United States
- The term "United States" means (but only for purposes of subparagraphs (A) and (B) of this paragraph) the fifty States and the District of Columbia.
- person
- The term "person" means an individual, a trust or estate, a partnership, or a corporation.
- practices
- The term "practices" means design, financing, permitting, construction, commissioning, operation and maintenance, and other practices that contribute to achieving zero-net-energy buildings or facilities.
- project
- The terms "federally assisted housing" and "project" mean-(A) a public housing project (as such term is defined in section 3(b) of the United States Housing Act of 1937 [42 U.S.C. 1437a(b)] );(B) housing for which project-based assistance is provided under section 8 of the United States Housing Act of 1937 [42 U.S.C. 1437f] ;(C) housing that is assisted under section 1701q of title 12;(D) housing that is assisted under section 1701q of title 12, as such section existed before November 28, 1990;(E) housing financed by a loan or mortgage insured under section 1715l(d)(3) of title 12 that bears interest at a rate determined under the proviso of section 1715l(d)(5) of title 12;(F) housing insured, assisted, or held by the Secretary or a State or State agency under section 1715z-1 of title 12;(G) housing constructed or substantially rehabilitated pursuant to assistance provided under section 8(b)(2) of the United States Housing Act of 1937 [42 U.S.C. 1437f(b)(2)], as in effect before October 1, 1983, that is assisted under a contract for assistance under such section; and(H) housing that is assisted under section 80131 of this title.