42 U.S.C. § 1395w–23

Editorial Notes

References in Text

section 1395w–28(b)(6)(B)(iii) of this titleSubsection (b)(6)(B)(iii), referred to in subsec. (a)(1)(C)(iii)(II), probably means . This section does not contain a subsec. (b)(6)(B)(iii).

Section 1395w–24(b)(1)(C)(iv) of this titlesection 1395w–24(b)(1)(C)(v) of this titlePub. L. 111–148, title III, § 3202(b)(1)(B)Mar. 23, 2010124 Stat. 454 section 1395w–24(b)(1)(C)(viii) of this titlePub. L. 111–152, title I, § 1102(d)(2)Mar. 30, 2010124 Stat. 1045 , referred to in subsec. (a)(1)(E), was redesignated by , , , and subsequently redesignated by , , .

section 2355 of Pub. L. 98–369July 18, 198498 Stat. 1103 section 13567(b) of Pub. L. 103–66Aug. 10, 1993107 Stat. 608 Section 2355 of the Deficit Reduction Act of 1984, as amended by section 13567(b) of the Omnibus Budget Reconciliation Act of 1993, referred to in subsec. (a)(1)(H), is , div. B, title III, , , as amended by , title XIII, , , which is not classified to the Code.

Section 1395w–29 of this titlePub. L. 111–152, title I, § 1102(f)Mar. 30, 2010124 Stat. 1046 , referred to in subsecs. (b)(1)(B)(iii) and (j)(1)(A), was repealed by , , .

The Internal Revenue Code of 1986, referred to in subsec. (e)(2)(A), is classified generally to Title 26, Internal Revenue Code.

section 1395ww(d)(1)(B) of this titlesection 1395ww(d)(1)(B) of this titlePub. L. 114–255, div. C, title XV, § 15008(a)(2)(B)Dec. 13, 2016130 Stat. 1321 The matter following clause (v) of , referred to in subsec. (g), now follows cl. (vi) of following the redesignation of subcl. (II) of cl. (iv) of subsec. (d)(1)(B) as cl. (vi) by , , .

Amendments

oPub. L. 115–123, § 531122018—Subsec. ()(4)(D). , added subpar. (D).

oPub. L. 115–123, § 50311(d)Subsec. ()(6), (7). , added pars. (6) and (7).

Pub. L. 114–255, § 17006(f)(1)(A)2016—Subsec. (a)(1)(C)(i). , which directed substitution of “Subject to subparagraph (I), the Secretary” for “The Secretary”, was executed by making the substitution in the first sentence to reflect the probable intent of Congress.

Pub. L. 114–255, § 17006(f)(1)(B)Subsec. (a)(1)(I). , added subpar. (I).

Pub. L. 114–255, § 17006(b)(1)(A)(i)Subsec. (k)(1). , substituted “paragraphs (2), (4), and (5)” for “paragraphs (2) and (4)” in introductory provisions.

Pub. L. 114–255, § 17006(b)(1)(A)(ii)Subsec. (k)(1)(B)(i). , substituted “paragraphs (2), (4), and (5)” for “paragraphs (2) and (4)”.

Pub. L. 114–255, § 17006(b)(1)(B)Subsec. (k)(5). , added par. (5).

Pub. L. 114–255, § 17006(b)(2)(A)Subsec. (n)(2)(A)(i). , inserted before semicolon at end “and, for 2021 and subsequent years, the exclusion of payments for organ acquisitions for kidney transplants from the capitation rate as described in subsection (k)(5)”.

Pub. L. 114–255, § 17006(b)(2)(B)Subsec. (n)(2)(E). , substituted “subparagraphs (F) and (G)” for “subparagraph (F)” in introductory provisions.

Pub. L. 114–255, § 17006(b)(2)(C)Subsec. (n)(2)(G). , added subpar. (G).

Pub. L. 114–1062015—Subsec. (b)(2). inserted “(or, in 2017 and each subsequent year, at least 60 days)” after “45 days” and “(in 2017 and each subsequent year, of no less than 30 days)” after “opportunity”.

Pub. L. 114–113Subsec. (m)(2), (4)(A). substituted “1395ww(n)(6)(B)” for “1395ww(n)(6)(A)”.

oPub. L. 114–10Subsec. ()(4)(C). added subpar. (C).

Pub. L. 112–2402013—Subsec. (a)(1)(C)(ii)(III). substituted “1.5 percentage points” for “1.3 percentage points” and “5.9 percent” for “5.7 percent”.

Pub. L. 111–148, § 3201(f)(1)(B)Pub. L. 111–152, § 1102(a)2010—Subsec. (a)(1)(B)(i), (ii). , which directed amendment of subpar. (B) by inserting “and any performance bonus under subsection (n)” before period at end of cl. (i) and substituting “(G), plus the amount (if any) of any performance bonus under subsection (n)” for “(G)” in cl. (ii), was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3205(b)Subsec. (a)(1)(B)(iv). , added cl. (iv).

Pub. L. 111–152, § 1102(e)(2)Subsec. (a)(1)(C)(ii). , substituted “and each subsequent year” for “through 2010” in introductory provisions.

Pub. L. 111–152, § 1102(e)(1), which directed the substitution of “of coding adjustment” for “during phaseout of budget neutrality factor” in heading, was executed by making the substitution for “during phase-out of budget neutrality factor” to reflect the probable intent of Congress.

Pub. L. 111–152, § 1102(e)(3)(A)Subsec. (a)(1)(C)(ii)(II). –(C), inserted “annually” before “conduct an analysis” and “on a timely basis” after “are incorporated”, substituted “for 2008 and subsequent years” for “only for 2008, 2009, and 2010”, and inserted “and updated as appropriate” after “as available”.

Pub. L. 111–152, § 1102(e)(3)(D)Subsec. (a)(1)(C)(ii)(III), (IV). , which directed amendment “in subclause (II)” of subsec. (a)(1)(C)(ii) by adding subcls. (III) and (IV) at the end, was executed by adding subcls. (III) and (IV) after subcl. (II), to reflect the probable intent of Congress.

Pub. L. 111–148, § 3205(f)Subsec. (a)(1)(C)(iii). , added cl. (iii).

Pub. L. 111–148, § 3203Pub. L. 111–152, § 1102(a), which directed amendment of subpar. (C) by adding cl. (iii) relating to application of coding intensity adjustment for 2011 and subsequent years, was repealed by . As enacted, text read as follows:

Requirement to apply in 2011 through 2013“(I) .—In order to ensure payment accuracy, the Secretary shall conduct an analysis of the differences described in clause (ii)(I). The Secretary shall ensure that the results of such analysis are incorporated into the risk scores for 2011, 2012, and 2013.

Authority to apply in 2014 and subsequent years“(II) .—The Secretary may, as appropriate, incorporate the results of such analysis into the risk scores for 2014 and subsequent years.”

See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(e)(2)(A)(ii)Pub. L. 111–152, § 1102(a)Subsec. (b)(1)(B)(i). , which directed amendment of cl. (i) by substituting “MA local area (as defined in subsection (d)(2))” for “MA payment area” in introductory provisions and “MA local area (as so defined)” for “MA payment area” in subcl. (I), was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(e)(2)(A)(iii)Pub. L. 111–152, § 1102(a)Subsec. (b)(4). , which directed substitution of “MA local area (as so defined)” for “Medicare Advantage payment area”, was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(e)(2)(A)(iv)Pub. L. 111–152, § 1102(a)Subsec. (c)(1). , which directed amendment of par. (1) by striking “a Medicare Advantage payment area that is” in introductory provisions and substituting “MA local area (as defined in subsection (d)(2))” for “MA payment area” in subpar. (D)(i), was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(b)Pub. L. 111–152, § 1102(a)Subsec. (c)(6). , which directed amendment of par. (6) by substituting “for 2003 through 2010” for “for a year after 2002” in cl. (vi) and adding cl. (vii), which read “for 2011, 3 percentage points; and”, and cl. (viii), which read “for a year after 2011, 0 percentage points.”, was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(e)(1)(A)Pub. L. 111–152, § 1102(a)Subsec. (d). , which directed substitution of “MA region; MA local plan service area” for “MA region” in heading, was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(e)(1)(B)Subsec. (d)(1)(A). , which directed substitution of “with respect to an MA local plan—

“(i) for years before 2012, an MA local area (as defined in paragraph (2)); and

“(ii) for 2012 and succeeding years, a service area that is an entire urban or rural area, as applicable (as described in paragraph (5)); and”

Pub. L. 111–152, § 1102(a)for “with respect to an MA local plan, an MA local area (as defined in paragraph (2)); and”, was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(e)(1)(C)Pub. L. 111–152, § 1102(a)Subsec. (d)(5). , which directed the addition of par. (5), was repealed by . As enacted, text read as follows: “For 2012 and succeeding years, the service area for an MA local plan shall be an entire urban or rural area in each State as follows:

Urban areas.—“(A)

In general“(i) .—Subject to clause (ii) and subparagraphs (C) and (D), the service area for an MA local plan in an urban area shall be the Core Based Statistical Area (in this paragraph referred to as a ‘CBSA’) or, if applicable, a conceptually similar alternative classification, as defined by the Director of the Office of Management and Budget.

CBSA covering more than one state“(ii) .—In the case of a CBSA (or alternative classification) that covers more than one State, the Secretary shall divide the CBSA (or alternative classification) into separate service areas with respect to each State covered by the CBSA (or alternative classification).

Rural areas“(B) .—Subject to subparagraphs (C) and (D), the service area for an MA local plan in a rural area shall be a county that does not qualify for inclusion in a CBSA (or alternative classification), as defined by the Director of the Office of Management and Budget.

Refinements to service areas“(C) .—For 2015 and succeeding years, in order to reflect actual patterns of health care service utilization, the Secretary may adjust the boundaries of service areas for MA local plans in urban areas and rural areas under subparagraphs (A) and (B), respectively, but may only do so based on recent analyses of actual patterns of care.

Additional authority to make limited exceptions to service area requirements for ma local plansMarch 23, 2010“(D) .—The Secretary may, in addition to any adjustments under subparagraph (C), make limited exceptions to service area requirements otherwise applicable under this part for MA local plans that have in effect (as of )—

“(i) agreements with another MA organization or MA plan that preclude the offering of benefits throughout an entire service area; or

“(ii) limitations in their structural capacity to support adequate networks throughout an entire service area as a result of the delivery system model of the MA local plan.”

See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(i)(2)Pub. L. 111–152, § 1102(a)section 1395eee of this titleSubsec. (d)(6). , which directed the addition of par. (6), was repealed by . As enacted, text read as follows: “For years beginning with 2012, in the case of a PACE program under , the MA payment area shall be the MA local area (as defined in paragraph (2)).” See Effective Date of 2010 Amendment note below.

Pub. L. 111–152, § 1102(c)(1)oSubsec. (j). , inserted “subject to subsection (),” after “For purposes of this part,” in introductory provisions.

Pub. L. 111–148, § 3201(a)(1)(A)Pub. L. 111–152, § 1102(a)–(C)(i), which directed the designation of existing provisions as par. (1), the insertion of par. (1) heading, the redesignation of former pars. (1) and (2) as subpars. (A) and (B), respectively, and former subpars. (A) and (B) of former par. (1) as cls. (i) and (ii) of subpar. (A), respectively, and the realignment of margins, was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–152, § 1102(b)(1)¹₁₂¹₁₂¹₁₂¹₁₂Subsec. (j)(1)(A). , substituted “for the area for the year (or, for 2007, 2008, 2009, and 2010, ⁄ of the applicable amount determined under subsection (k)(1) for the area for the year; for 2011, ⁄ of the applicable amount determined under subsection (k)(1) for the area for 2010; and, beginning with 2012, ⁄ of the blended benchmark amount determined under subsection (n)(1) for the area for the year)” for “(or, beginning with 2007, ⁄ of the applicable amount determined under subsection (k)(1)) for the area for the year”.

Pub. L. 111–148, § 3201(a)(1)(C)(ii)section 1395w–29(d)(2)(A) of this titlesection 1395w–29(d)(2)(A) of this title¹₁₂¹₁₂Pub. L. 111–152, § 1102(a), (iii), which, in cl. (i), directed substitution of “, an amount equal to—” for “, an amount equal to”, subcls. (I) to (VI) for “⁄ of the annual MA capitation rate under subsection (c)(1) (or, beginning with 2007, ⁄ of the applicable amount determined under subsection (k)(1)) for the area for the year, adjusted as appropriate (for years before 2007) for the purpose of risk adjustment; or”, and, in cl. (ii), directed substitution of “clause (i)” for “subparagraph (A)”, was repealed by . As enacted, subcls. (I) to (VI) read as follows:

¹₁₂“(I) for years before 2007, ⁄ of the annual MA capitation rate under subsection (c)(1) for the area for the year, adjusted as appropriate for the purpose of risk adjustment;

¹₁₂“(II) for 2007 through 2011, ⁄ of the applicable amount determined under subsection (k)(1) for the area for the year;

“(III) for 2012, the sum of—

“(aa) ⅔ of the quotient of—

“(AA) the applicable amount determined under subsection (k)(1) for the area for the year; and

“(BB) 12; and

“(bb) ⅓ of the MA competitive benchmark amount (determined under paragraph (2)) for the area for the month;

“(IV) for 2013, the sum of—

“(aa) ⅓ of the quotient of—

“(AA) the applicable amount determined under subsection (k)(1) for the area for the year; and

“(BB) 12; and

“(bb) ⅔ of the MA competitive benchmark amount (as so determined) for the area for the month;

“(V) for 2014, the MA competitive benchmark amount for the area for a month in 2013 (as so determined), increased by the national per capita MA growth percentage, described in subsection (c)(6) for 2014, but not taking into account any adjustment under subparagraph (C) of such subsection for a year before 2004; and

“(VI) for 2015 and each subsequent year, the MA competitive benchmark amount (as so determined) for the area for the month; or”.

See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(a)(1)(D)Pub. L. 111–152, § 1102(a)Subsec. (j)(2), (3). , which directed addition of pars. (2) and (3), was repealed by . As enacted, pars. (2) and (3) read as follows:

Computation of ma competitive benchmark amount.—“(2)

In generalsection 1395w–24(b)(2)(E) of this titlesection 1395w–27a(f)(4) of this titlesection 1395w–23(j)(2) of this title“(A) .—Subject to subparagraph (B) and paragraph (3), for months in each year (beginning with 2012) for each MA payment area the Secretary shall compute an MA competitive benchmark amount equal to the weighted average of the unadjusted MA statutory non-drug monthly bid amount (as defined in ) for each MA plan in the area, with the weight for each plan being equal to the average number of beneficiaries enrolled under such plan in the reference month (as defined in , except that, in applying such definition for purposes of this paragraph, ‘to compute the MA competitive benchmark amount under ’ shall be substituted for ‘to compute the percentage specified in subparagraph (A) and other relevant percentages under this part’).

Weighting rules.—“(B)

Single plan rule“(i) .—In the case of an MA payment area in which only a single MA plan is being offered, the weight under subparagraph (A) shall be equal to 1.

Use of simple average among multiple plans if no plans offered in previous year“(ii) .—In the case of an MA payment area in which no MA plan was offered in the previous year and more than 1 MA plan is offered in the current year, the Secretary shall use a simple average of the unadjusted MA statutory non-drug monthly bid amount (as so defined) for purposes of computing the MA competitive benchmark amount under subparagraph (A).

Cap on ma competitive benchmark amount“(3) .—In no case shall the MA competitive benchmark amount for an area for a month in a year 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 month in the year.”

See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(a)(1)(E)Pub. L. 111–152, § 1102(a)Subsec. (k)(2). , (2)(A), which directed amendment of par. (2) by substituting “and subsequent years” for “through 2010” in subpar. (A) and “(j)(1)(A)(i)” for “(j)(1)(A)” in subpar. (B)(ii)(III), and by adding, in subpar. (C), cl. (v), which read “for 2011 and subsequent years, 0.00.”, was repealed by . See Effective Date of 2010 Amendment note below.

Pub. L. 111–152, § 1102(b)(2)Subsec. (n). , added subsec. (n).

Pub. L. 111–148, § 3201(f)(1)(A)Pub. L. 111–152, § 1102(a), which directed addition of subsec. (n) relating to performance bonuses, was repealed by . As enacted, text read as follows:

Care coordination and management performance bonus.—“(1)

In general“(A) .—For years beginning with 2014, subject to subparagraph (B), in the case of an MA plan that conducts 1 or more programs described in subparagraph (C) with respect to the year, the Secretary shall, in addition to any other payment provided under this part, make monthly payments, with respect to coverage of an individual under this part, to the MA plan in an amount equal to the product of—

“(i) 0.5 percent of the national monthly per capita cost for expenditures for individuals enrolled under the original medicare fee-for-service program for the year; and

“(ii) the total number of programs described in clauses (i) through (ix) of subparagraph (C) that the Secretary determines the plan is conducting for the year under such subparagraph.

Limitation“(B) .—In no case may the total amount of payment with respect to a year under subparagraph (A) be greater than 2 percent of the national monthly per capita cost for expenditures for individuals enrolled under the original medicare fee-for-service program for the year, as determined prior to the application of risk adjustment under paragraph (4).

Programs described“(C) .—The following programs are described in this paragraph:

“(i) Care management programs that—

“(I) target individuals with 1 or more chronic conditions;

“(II) identify gaps in care; and

“(III) facilitate improved care by using additional resources like nurses, nurse practitioners, and physician assistants.

“(ii) Programs that focus on patient education and self-management of health conditions, including interventions that—

“(I) help manage chronic conditions;

“(II) reduce declines in health status; and

“(III) foster patient and provider collaboration.

“(iii) Transitional care interventions that focus on care provided around a hospital inpatient episode, including programs that target post-discharge patient care in order to reduce unnecessary health complications and readmissions.

“(iv) Patient safety programs, including provisions for hospital-based patient safety programs in contracts that the Medicare Advantage organization offering the MA plan has with hospitals.

“(v) Financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, capitation arrangements, or pay-for-performance programs.

“(vi) Programs that address, identify, and ameliorate health care disparities among principal at-risk subpopulations.

section 1395w–104(c) of this title“(vii) Medication therapy management programs that are more extensive than is required under (as determined by the Secretary).

“(viii) Health information technology programs, including clinical decision support and other tools to facilitate data collection and ensure patient-centered, appropriate care.

“(ix) Such other care management and coordination programs as the Secretary determines appropriate.

Conduct of program in urban and rural areas“(D) .—An MA plan may conduct a program described in subparagraph (C) in a manner appropriate for an urban or rural area, as applicable.

Reporting of data“(E) .—Each Medicare Advantage organization shall provide to the Secretary the information needed to determine whether they are eligible for a care coordination and management performance bonus at a time and in a manner specified by the Secretary.

Periodic auditing“(F) .—The Secretary shall provide for the annual auditing of programs described in subparagraph (C) for which an MA plan receives a care coordination and management performance bonus under this paragraph. The Comptroller General shall monitor auditing activities conducted under this subparagraph.

Quality performance bonuses.—“(2)

Quality bonus“(A) .—For years beginning with 2014, the Secretary shall, in addition to any other payment provided under this part, make monthly payments, with respect to coverage of an individual under this part, to an MA plan that achieves at least a 3 star rating (or comparable rating) on a rating system described in subparagraph (C) in an amount equal to—

“(i) in the case of a plan that achieves a 3 star rating (or comparable rating) on such system 2 percent of the national monthly per capita cost for expenditures for individuals enrolled under the original medicare fee-for-service program for the year; and

“(ii) in the case of a plan that achieves a 4 or 5 star rating (or comparable rating[)] on such system, 4 percent of such national monthly per capita cost for the year.

Improved quality bonus“(B) .—For years beginning with 2014, in the case of an MA plan that does not receive a quality bonus under subparagraph (A) and is an improved quality MA plan with respect to the year (as identified by the Secretary), the Secretary shall, in addition to any other payment provided under this part, make monthly payments, with respect to coverage of an individual under this part, to the MA plan in an amount equal to 1 percent of such national monthly per capita cost for the year.

Use of rating system“(C) .—For purposes of subparagraph (A), a rating system described in this paragraph is—

“(i) a rating system that uses up to 5 stars to rate clinical quality and enrollee satisfaction and performance at the Medicare Advantage contract or MA plan level; or

“(ii) such other system established by the Secretary that provides for the determination of a comparable quality performance rating to the rating system described in clause (i).

Data used in determining score.—“(D)

In general“(i) .—The rating of an MA plan under the rating system described in subparagraph (C) with respect to a year shall be based on based on the most recent data available.

Plans that fail to report data“(ii) .—An MA plan which does not report data that enables the Secretary to rate the plan for purposes of subparagraph (A) or identify the plan for purposes of subparagraph (B) shall be counted, for purposes of such rating or identification, as having the lowest plan performance rating and the lowest percentage improvement, respectively.

Quality bonus for new and low enrollment ma plans.—“(3)

New ma planssection 1395w–24(a)(1)(A) of this titlesection 1395w–21(e) of this title“(A) .—For years beginning with 2014, in the case of an MA plan that first submits a bid under for 2012 or a subsequent year, only receives enrollments made during the coverage election periods described in , and is not able to receive a bonus under subparagraph (A) or (B) of paragraph (2) for the year, the Secretary shall, in addition to any other payment provided under this part, make monthly payments, with respect to coverage of an individual under this part, to the MA plan in an amount equal to 2 percent of national monthly per capita cost for expenditures for individuals enrolled under the original medicare fee-for-service program for the year. In its fourth year of operation, the MA plan shall be paid in the same manner as other MA plans with comparable enrollment.

Low enrollment plans“(B) .—For years beginning with 2014, in the case of an MA plan that has low enrollment (as defined by the Secretary) and would not otherwise be able to receive a bonus under subparagraph (A) or (B) of paragraph (2) or subparagraph (A) of this paragraph for the year (referred to in this subparagraph as a ‘low enrollment plan’), the Secretary shall use a regional or local mean of the rating of all MA plans in the region or local area, as determined appropriate by the Secretary, on measures used to determine whether MA plans are eligible for a quality or an improved quality bonus, as applicable, to determine whether the low enrollment plan is eligible for a bonus under such a subparagraph.

Risk adjustmentsection 1395w–24(b)(1)(C) of this title“(4) .—The Secretary shall risk adjust a performance bonus under this subsection in the same manner as the Secretary risk adjusts beneficiary rebates described in .

Notification“(5) .—The Secretary, in the annual announcement required under subsection (b)(1)(B) for 2014 and each succeeding year, shall notify the Medicare Advantage organization of any performance bonus (including a care coordination and management performance bonus under paragraph (1), a quality performance bonus under paragraph (2), and a quality bonus for new and low enrollment plans under paragraph (3)) that the organization will receive under this subsection with respect to the year. The Secretary shall provide for the publication of the information described in the previous sentence on the Internet website of the Centers for Medicare & Medicaid Services.”

See Effective Date of 2010 Amendment note below.

Pub. L. 111–152, § 1102(c)(2)oSubsec. (n)(2)(B). , which directed insertion of “, subject to subsection ()” after “as follows” could not be executed because “as follows” did not appear in text.

Pub. L. 111–148, § 3202(b)(2)Pub. L. 111–148, § 3201(f)Pub. L. 111–152, § 1102(a)Subsec. (n)(6). , which directed that subsec. (n), as added by , be amended by adding a par. (6), was not executed to reflect the probable intent of Congress and the subsequent repeal of § 3201(f) by . See Amendment note above.

oPub. L. 111–152, § 1102(c)(3)oSubsec. (). , added subsec. ().

Pub. L. 111–148, § 3201(g)oPub. L. 111–152, § 1102(a), which directed addition of subsec. () relating to grandfathering supplemental benefits for current enrollees after implementation of competitive bidding, was repealed by . As enacted, text read as follows:

Identification of areassection 1395w–24(a) of this titlesection 1395mm(a)(4) of this titleo“(1) .—The Secretary shall identify MA local areas in which, with respect to 2009, average bids submitted by an MA organization under for MA local plans in the area are not greater than 75 percent of the adjusted average per capita cost for the year involved, determined under , for the area for individuals who are not enrolled in an MA plan under this part for the year, but adjusted to exclude costs attributable to payments under section 1395w–4(), 1395ww(n), and 1395ww(h) of this title.

Election to provide rebates to grandfathered enrollees.—“(2)

In generalsection 1395w–24(b)(1)(C) of this title“(A) .—For years beginning with 2012, each Medicare Advantage organization offering an MA local plan in an area identified by the Secretary under paragraph (1) may elect to provide rebates to grandfathered enrollees under . In the case where an MA organization makes such an election, the monthly per capita dollar amount of such rebates shall not exceed the applicable amount for the year (as defined in subparagraph (B)).

Applicable amount“(B) .—For purposes of this subsection, the term ‘applicable amount’ means—

“(i) for 2012, the monthly per capita dollar amount of such rebates provided to enrollees under the MA local plan with respect to 2011; and

“(ii) for a subsequent year, 95 percent of the amount determined under this subparagraph for the preceding year.

Special rules for plans in identified areas“(3) .—Notwithstanding any other provision of this part, the following shall apply with respect to each Medicare Advantage organization offering an MA local plan in an area identified by the Secretary under paragraph (1) that makes an election described in paragraph (2):

Payments“(A) .—The amount of the monthly payment under this section to the Medicare Advantage organization, with respect to coverage of a grandfathered enrollee under this part in the area for a month, shall be equal to—

“(i) for 2012 and 2013, the sum of—

section 1395w–24(a) of this title“(I) the bid amount under for the MA local plan; and

“(II) the applicable amount (as defined in paragraph (2)(B)) for the MA local plan for the year.

“(ii) for 2014 and subsequent years, the sum of—

“(I) the MA competitive benchmark amount under subsection (j)(1)(A)(i) for the area for the month, adjusted, only to the extent the Secretary determines necessary, to account for induced utilization as a result of rebates provided to grandfathered enrollees (except that such adjustment shall not exceed 0.5 percent of such MA competitive benchmark amount); and

“(II) the applicable amount (as so defined) for the MA local plan for the year.

Requirement to submit bids under competitive biddingsection 1395w–24(a) of this title“(B) .—The Medicare Advantage organization shall submit a single bid amount under for the MA local plan. The Medicare Advantage organization shall remove from such bid amount any effects of induced demand for care that may result from the higher rebates available to grandfathered enrollees under this subsection.

Nonapplication of bonus payments and any other rebates“(C) .—The Medicare Advantage organization offering the MA local plan shall not be eligible for any bonus payment under subsection (n) or any rebate under this part (other than as provided under this subsection) with respect to grandfathered enrollees.

Nonapplication of uniform bid and premium amounts to grandfathered enrolleesSection 1395w–24(c) of this title“(D) .— shall not apply with respect to the MA local plan.

Nonapplication of limitation on application of plan rebates toward payment of part b premiumsection 1395w–24(b)(1)(C) of this title“(E) .—Notwithstanding clause (iii) of , in the case of a grandfathered enrollee, a rebate under such section may be used for the purpose described in clause (ii)(III) of such section.

Risk adjustmentsection 1395w–24(b)(1)(C) of this title“(F) .—The Secretary shall risk adjust rebates to grandfathered enrollees under this subsection in the same manner as the Secretary risk adjusts beneficiary rebates described in .

Definition of grandfathered enrolleeMarch 23, 2010“(4) .—In this subsection, the term ‘grandfathered enrollee’ means an individual who is enrolled (effective as of ) in an MA local plan in an area that is identified by the Secretary under paragraph (1).”

See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 3201(h)Pub. L. 111–152, § 1102(a)Subsec. (p). , which directed addition of subsec. (p) relating to transitional extra benefits, was repealed by . As enacted, text read as follows:

In generalsection 1395w–24(b)(1)(C) of this title“(1) .—For years beginning with 2012, the Secretary shall provide transitional rebates under for the provision of extra benefits (as specified by the Secretary) to enrollees described in paragraph (2).

Enrollees described“(2) .—An enrollee described in this paragraph is an individual who—

“(A) enrolls in an MA local plan in an applicable area; and

section 1395w–24(b)(1)(C) of this title“(B) experiences a significant reduction in extra benefits described in clause (ii) of as a result of competitive bidding under this part (as determined by the Secretary).

Applicable areas“(3) .—In this subsection, the term ‘applicable area’ means the following:

“(A) The 2 largest metropolitan statistical areas, if the Secretary determines that the total amount of such extra benefits for each enrollee for the month in those areas is greater than $100.

“(B) A county where—

“(i) the MA area-specific non-drug monthly benchmark amount for a month in 2011 is equal to the legacy urban floor amount (as described in subsection (c)(1)(B)(iii)), as determined by the Secretary for the area for 2011;

“(ii) the percentage of Medicare Advantage eligible beneficiaries in the county who are enrolled in an MA plan for 2009 is greater than 30 percent (as determined by the Secretary); and

section 1395w–24(a) of this titlesection 1395mm(a)(4) of this titleo“(iii) average bids submitted by an MA organization under for MA local plans in the county for 2011 are not greater than the adjusted average per capita cost for the year involved, determined under , for the county for individuals who are not enrolled in an MA plan under this part for the year, but adjusted to exclude costs attributable to payments under section 1395w–4(), 1395ww(n), and 1395ww(h) of this title.

“(C) If the Secretary determines appropriate, a county contiguous to an area or county described in subparagraph (A) or (B), respectively.

Review of plan bidssection 1395w–24(a) of this title“(4) .—In the case of a bid submitted by an MA organization under for an MA local plan in an applicable area, the Secretary shall review such bid in order to ensure that extra benefits (as specified by the Secretary) are provided to enrollees described in paragraph (2).

Fundingsection 1395i of this titlesection 1395t of this titlesection 1395w–24(b)(1)(C) of this title“(5) .—The Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund under and the Federal Supplementary Medical Insurance Trust Fund established under , in such proportion as the Secretary determines appropriate, of an amount not to exceed $5,000,000,000 for the period of fiscal years 2012 through 2019 for the purpose of providing transitional rebates under for the provision of extra benefits under this subsection.”

See Effective Date of 2010 Amendment note below.

Pub. L. 111–148, § 10318Pub. L. 111–148, § 3201(h)Pub. L. 111–152, § 1102(a)Subsec. (p)(3)(A). , which directed that subsec. (p)(3)(A), as added by , be amended by inserting “in 2009” before the period at the end, was not executed to reflect the probable intent of Congress and the subsequent repeal of § 3201(h) by . See Amendment note above.

Pub. L. 111–5, § 4101(e)(1)l2009—Subsec. (a)(1)(A). , substituted “(i), and ()” for “and (i)”.

Pub. L. 111–5, § 4102(d)(3)(A)(i)ooSubsec. (c)(1)(D)(i). , substituted “, 1395w–4(), and 1395ww(n)” for “1395w–4()”.

Pub. L. 111–5, § 4101(e)(2)(A)osection 1395ww(h) of this title, substituted “sections 1395w–4() and 1395ww(h) of this title” for “”.

Pub. L. 111–5, § 4102(d)(3)(A)(ii)section 1395ww of this titleSubsec. (c)(6)(A). , inserted “and subsections (b)(3)(B)(ix) and (n) of ” after “1395w–4 of this title”.

Pub. L. 111–5, § 4101(e)(2)(B)osection 1395w–4 of this title, inserted “excluding expenditures attributable to subsections (a)(7) and () of ,” after “under part B,”.

Pub. L. 111–5, § 4102(d)(3)(B)lSubsec. (f). , inserted “and subsection (m)” after “under subsection ()”.

Pub. L. 111–5, § 4101(e)(3)l, inserted “and for payments under subsection ()” after “with the organization”.

lPub. L. 111–5, § 4101(c)lSubsec. (). , added subsec. ().

Pub. L. 111–5, § 4102(c)Subsec. (m). , added subsec. (m).

Pub. L. 110–275, § 161(a)(1)2008—Subsec. (k)(1). , (b), substituted “paragraphs (2) and (4)” for “paragraph (2)” in introductory provisions and cl. (i) of subpar. (B).

Pub. L. 110–275, § 161(a)(2)Subsec. (k)(4). , added par. (4).

Pub. L. 109–171, § 5301(b)2006—Subsec. (a)(1)(C). , designated existing provisions as cl. (i), inserted heading, and added cl. (ii).

Pub. L. 109–171, § 5301(a)(1)(A)¹₁₂Subsec. (j)(1)(A). , inserted “(or, beginning with 2007, ⁄ of the applicable amount determined under subsection (k)(1))” after “subsection (c)(1)” and “(for years before 2007)” after “adjusted as appropriate”.

Pub. L. 109–171, § 5301(a)(1)(B)Subsec. (j)(1)(B). , inserted “(for years before 2007)” after “adjusted as appropriate”.

Pub. L. 109–171, § 5301(a)(2)Subsec. (k). , added subsec. (k).

Pub. L. 108–173, § 222(e)(1)(B)¹₁₂section 1395w–24(f)(1)(E) of this title2003—Subsec. (a)(1)(A). , substituted “amount determined as follows:” and cls. (i) and (ii) for “amount” and provisions describing amount equal to ⁄ of the annual Medicare+Choice capitation rate, reduced by the amount of any reduction elected under and adjusted for certain factors.

Pub. L. 108–173, § 222(e)(1)(B)Subsec. (a)(1)(B) to (G). , added subpars. (B) to (G). Former subpar. (B) redesignated (H).

Pub. L. 108–173, § 222(i)Dec. 8, 2003Subsec. (a)(1)(H). , substituted as second sentence provisions relating to actuarial equivalence of rates of payment to rates that would have been paid with respect to other enrollees in the MA payment area under this section as in effect before , for provisions relating to actuarial equivalence of rates of payment to rates paid to other enrollees in the Medicare+Choice payment area and inserted sentence at end authorizing application of the competitive bidding methodology provided for in this section, with appropriate adjustments to account for the risk adjustment methodology applied to end stage renal disease payments.

Pub. L. 108–173, § 222(e)(1)(A), redesignated subpar. (B) as (H).

Pub. L. 108–173, § 736(d)(1)(A)Subsec. (a)(3)(C)(ii). , substituted “clause (iv)” for “clause (iii)” in introductory provisions.

Pub. L. 108–173, § 736(d)(1)(B)Subsec. (a)(3)(C)(iii), (iv). , redesignated cl. (iii), relating to full implementation of risk adjustment for congestive heart failure enrollees for 2001, as (iv).

Pub. L. 108–173, § 237(b)(1)Subsec. (a)(4). , added par. (4).

Pub. L. 108–173, § 222(f)(1)Subsec. (b)(1). , amended heading and text of par. (1) generally, substituting provisions relating to announcements of payment rates for 2005 and for 2006 and subsequent years for provisions relating to announcement for years before 2004, for 2004 and 2005, and for years after 2005.

Pub. L. 108–173, § 241(b)(1)(B)Subsec. (b)(1)(B)(iii). , added cl. (iii).

Pub. L. 108–173, § 222(f)(2)Subsec. (b)(3). , substituted “in such announcement” for “in the announcement in sufficient detail so that Medicare+Choice organizations can compute monthly adjusted Medicare+Choice capitation rates for individuals in each Medicare+Choice payment area which is in whole or in part within the service area of such an organization”.

Pub. L. 108–173, § 900(e)(1)(G)(i)Subsec. (b)(4). , substituted “Centers for Medicare & Medicaid Services” for “Health Care Financing Administration” in introductory provisions.

Pub. L. 108–173, § 221(d)(4)Subsec. (c)(1). , inserted “that is an MA local area” after “for a Medicare+Choice payment area” in introductory provisions.

Pub. L. 108–173, § 211(a)(2), substituted “(C), or (D)” for “or (C)” in introductory provisions.

Pub. L. 108–173, § 211(b)(1)Subsec. (c)(1)(A). , (c)(1)(A), substituted “For a year before 2005, the sum” for “The sum” in introductory provisions and inserted “(for a year other than 2004)” after “multiplied” in concluding provisions.

Pub. L. 108–173, § 211(c)(1)(B)Subsec. (c)(1)(B)(iv). , substituted “, 2003, and 2004” for “and each succeeding year”.

Pub. L. 108–173, § 211(c)(1)(C)Subsec. (c)(1)(C)(iv). , substituted “and 2003” for “and each succeeding year”.

Pub. L. 108–173, § 211(c)(1)(D)Subsec. (c)(1)(C)(v). , added cl. (v).

Pub. L. 108–173, § 211(a)(1)Subsec. (c)(1)(D). , added subpar. (D).

Pub. L. 108–173, § 211(d)(1)Subsec. (c)(3)(A). , substituted “subparagraphs (B) and (E)” for “subparagraph (B)” in introductory provisions.

Pub. L. 108–173, § 211(d)(2)Subsec. (c)(3)(E). , added subpar. (E).

Pub. L. 108–173, § 736(d)(1)(C)Subsec. (c)(5). , substituted “(a)(3)(C)(iv)” for “(a)(3)(C)(iii)”.

Pub. L. 108–173, § 237(b)(2)(B), substituted “subsections (a)(3)(C)(iii), (a)(4), and (i)” for “subsections (a)(3)(C)(iii) and (i)”.

Pub. L. 108–173, § 211(b)(2), inserted “(other than 2004)” after “for each year”.

Pub. L. 108–173, § 211(c)(2)Subsec. (c)(6)(C). , inserted “, except that for purposes of paragraph (1)(C)(v)(II), no such adjustment shall be made for a year before 2004” before period at end.

Pub. L. 108–173, § 900(e)(1)(G)(ii)Subsec. (c)(7). , substituted “Centers for Medicare & Medicaid Services” for “Health Care Financing Administration”.

Pub. L. 108–173, § 221(d)(1)(A)Subsec. (d). , substituted “MA payment area; MA local area; MA region defined” for “ ‘Medicare+Choice payment area’ defined” in heading.

Pub. L. 108–173, § 221(d)(1)(C)Subsec. (d)(1). , amended heading and text of par. (1) generally. Prior to amendment, text read as follows: “In this part, except as provided in paragraph (3), the term ‘Medicare+Choice payment area’ means a county, or equivalent area specified by the Secretary.”

Pub. L. 108–173, § 221(d)(1)(B)Subsec. (d)(2), (3). , (D), added par. (2) and redesignated former par. (2) as (3). Former par. (3) redesignated (4).

Pub. L. 108–173, § 221(d)(1)(B)Subsec. (d)(4). , redesignated par. (3) as (4).

Pub. L. 108–173, § 221(d)(1)(E)(i)Subsec. (d)(4)(A). , inserted “for MA local plans” after “paragraph (1)” in introductory provisions.

Pub. L. 108–173, § 221(d)(1)(E)(ii)Subsec. (d)(4)(A)(iii). , substituted “paragraph (1)(A)” for “paragraph (1)”.

Pub. L. 108–173, § 221(d)(1)(E)(iii)Subsec. (d)(4)(B). , inserted “with respect to MA local plans” after “established under this section” and “for such plans” after “payments under this section” and “made under this section”.

Pub. L. 108–173, § 101(e)(3)(D)Subsec. (f). , in heading, substituted “Trust Funds” for “Trust Fund” and, after first sentence, inserted “Payments to MA organizations for statutory drug benefits provided under this subchapter are made from the Medicare Prescription Drug Account in the Federal Supplementary Medical Insurance Trust Fund.”

Pub. L. 108–173, § 211(e)(1)(A)section 1395ww(d)(1)(B)(ii) of this titlesection 1395ww(d)(1)(B) of this titlesection 1395ww(d)(1)(B)(iv) of this titleSubsec. (g). , inserted “, a rehabilitation hospital described in or a distinct part rehabilitation unit described in the matter following clause (v) of , or a long-term care hospital (described in )” after “1395ww(d)(1)(B) of this title)” in introductory provisions.

Pub. L. 108–173, § 211(e)(1)(B)Subsec. (g)(2)(B). , inserted “or other payment provision under this subchapter for inpatient services for the type of facility, hospital, or unit involved, described in the matter preceding paragraph (1), as the case may be,” after “1395ww(d) of this title”.

Pub. L. 108–173, § 222(d)Subsec. (j). , added subsec. (j).

Pub. L. 108–173, § 241(b)(1)(A)section 1395w–29(d)(2)(A) of this titleSubsec. (j)(1)(A). , inserted “subject to ,” after “within an MA local area,”.

Pub. L. 107–1882002—Subsec. (b)(1). in introductory provisions substituted “for years before 2004 and after 2005 not later than March 1 before the calendar year concerned and for 2004 and 2005 not later than the second Monday in May before the respective calendar year” for “not later than March 1 before the calendar year concerned”.

Pub. L. 106–554, § 1(a)(6) [title VI, § 606(a)(2)(A)]section 1395w–24(f)(1)(E) of this title2000—Subsec. (a)(1)(A). , inserted “reduced by the amount of any reduction elected under and” after “for that area,”.

Pub. L. 106–554, § 1(a)(6) [title VI, § 605(a)]Subsec. (a)(1)(B). , inserted at end “In establishing such rates, the Secretary shall provide for appropriate adjustments to increase each rate to reflect the demonstration rate (including the risk adjustment methodology associated with such rate) of the social health maintenance organization end-stage renal disease capitation demonstrations (established by section 2355 of the Deficit Reduction Act of 1984, as amended by section 13567(b) of the Omnibus Budget Reconciliation Act of 1993), and shall compute such rates by taking into account such factors as renal treatment modality, age, and the underlying cause of the end-stage renal disease.”

Pub. L. 106–554, § 1(a)(6) [title VI, § 607(a)(1)]Subsec. (a)(3)(C)(ii). , substituted “Except as provided in clause (iii), such risk adjustment” for “Such risk adjustment”.

Pub. L. 106–554, § 1(a)(6) [title VI, § 603(1)(A)]Subsec. (a)(3)(C)(ii)(I). , substituted “and each succeeding year through 2003” for “and 2001” and struck out “and” at end.

Pub. L. 106–554, § 1(a)(6) [title VI, § 603(1)(B)]Subsec. (a)(3)(C)(ii)(II) to (V). , added subcls. (II) to (V) and struck out former subcl. (II) which read as follows: “not more than 20 percent of such capitation rate in 2002.”

Pub. L. 106–554, § 1(a)(6) [title VI, § 607(a)(2)]Subsec. (a)(3)(C)(iii). , added cl. (iii) relating to full implementation of risk adjustment for congestive heart failure enrollees for 2001.

Pub. L. 106–554, § 1(a)(6) [title VI, § 603(2)], added cl. (iii) relating to data for risk adjustment methodology.

Pub. L. 106–554, § 1(a)(6) [title VI, § 601(a)(2)]Subsec. (c)(1)(B)(ii), (iii). , added cls. (ii) and (iii). Former cl. (ii) redesignated (iv).

Pub. L. 106–554, § 1(a)(6) [title VI, § 601(a)(1), (3)]Subsec. (c)(1)(B)(iv). , redesignated cl. (ii) as (iv) and substituted “2002 and each succeeding year” for “a succeeding year” and “clause (iii)” for “clause (i)”.

Pub. L. 106–554, § 1(a)(6) [title VI, § 602(a)(2)]Subsec. (c)(1)(C)(ii), (iii). , added cls. (ii) and (iii). Former cl. (ii) redesignated (iv).

Pub. L. 106–554, § 1(a)(6) [title VI, § 602(a)(1), (3)]Subsec. (c)(1)(C)(iv). , redesignated cl. (ii) as (iv) and substituted “2002 and each succeeding year” for “a subsequent year”.

Pub. L. 106–554, § 1(a)(6) [title VI, § 607(b)]Subsec. (c)(5). , substituted “subsections (a)(3)(C)(iii) and (i)” for “subsection (i)”.

Pub. L. 106–554, § 1(a)(6) [title VI, § 611(a)]section 1395w–22(a)(5) of this titleSubsec. (c)(7). , amended heading and text of par. (7) generally. Prior to amendment, text read as follows: “If the Secretary makes a determination with respect to coverage under this subchapter that the Secretary projects will result in a significant increase in the costs to Medicare+Choice of providing benefits under contracts under this part (for periods after any period described in ), the Secretary shall adjust appropriately the payments to such organizations under this part.”

Pub. L. 106–554, § 1(a)(6) [title VI, § 608(a)]October 3, 2000January 1, 2001January 1, 2000Subsec. (i)(1). , in introductory provisions, inserted “, or filed notice with the Secretary as of , that they will not be offering such a plan as of ” after “”.

Pub. L. 106–113, § 1000(a)(6) [title V, § 512(1)]1999—Subsec. (a)(1)(A). , substituted “subsections (e), (g), and (i)” for “subsections (e) and (f)”.

Pub. L. 106–113, § 1000(a)(6) [title V, § 511(a)]Subsec. (a)(3)(C). , designated existing provisions as cl. (i), inserted heading, and added cl. (ii).

Pub. L. 106–113, § 1000(a)(6) [title V, § 514(a)]Subsec. (b)(4). , added par. (4).

Pub. L. 106–113, § 1000(a)(6) [title V, § 512(2)]Subsec. (c)(5). , inserted “(other than those attributable to subsection (i))” after “payments under this part”.

Pub. L. 106–113, § 1000(a)(6) [title V, § 517]Subsec. (c)(6)(B)(v). , substituted “0.3 percentage points” for “0.5 percentage points”.

Pub. L. 106–113, § 1000(a)(6) [title V, § 512(3)]Subsec. (i). , added subsec. (i).

Statutory Notes and Related Subsidiaries

Change of Name

section 201 of Pub. L. 108–173section 1395w–21 of this titleReferences to Medicare+Choice deemed to refer to Medicare Advantage or MA, subject to an appropriate transition provided by the Secretary of Health and Human Services in the use of those terms, see , set out as a note under .

Effective Date of 2015 Amendment

Pub. L. 114–113Pub. L. 111–5section 602(d) of Pub. L. 114–113section 1395ww of this titleAmendment by applicable as if included in the enactment of , with certain exceptions, see , set out as a note under .

Effective Date of 2010 Amendment

Pub. L. 111–148Pub. L. 111–148section 1102(a) of Pub. L. 111–152section 1395w–21 of this titleRepeal of sections 3201 and 3203 of and the amendments made by such sections, effective as if included in the enactment of , see , set out as a note under .

Effective Date of 2003 Amendment

Pub. L. 108–173, title II, § 211(e)(2)Dec. 8, 2003117 Stat. 2178

Pub. L. 108–173Jan. 1, 2006section 223(a) of Pub. L. 108–173section 1395w–21 of this titleAmendment by sections 221(d)(1), (4) and 222(d)–(f), (i) of applicable with respect to plan years beginning on or after , see , set out as a note under .

Pub. L. 108–173Jan. 1, 2006section 237(e) of Pub. L. 108–173section 1320a–7b of this titleAmendment by section 237(b)(1), (2)(B) of applicable to services provided on or after , and contract years beginning on or after such date, see , set out as a note under .

Effective Date of 2002 Amendment

Pub. L. 107–188, title V, § 532(d)(2)June 12, 2002116 Stat. 697

Effective Date of 2000 Amendment

Pub. L. 106–554, § 1(a)(6) [title VI, § 605(b)]Dec. 21, 2000114 Stat. 2763

Pub. L. 106–554Pub. L. 106–554section 1395r of this titleAmendment by section 1(a)(6) [title VI, § 606(a)(2)(A)] of applicable to years beginning with 2003, see section 1(a)(6) [title VI, § 606(b)] of , set out as a note under .

Pub. L. 106–554, § 1(a)(6) [title VI, § 608(b)]Dec. 21, 2000114 Stat. 2763

Pub. L. 106–554Dec. 21, 2000Pub. L. 106–554section 1395w–22 of this titleAmendment by section 1(a)(6) [title VI, § 611(a)] of effective , and applicable to national coverage determinations and legislative changes in benefits occurring on or after such date, see section 1(a)(6) [title VI, § 611(c)] of , set out as a note under .

Reports on Risk Adjustment Models

Pub. L. 114–255, div. C, title XVII, § 17006(f)(2)(A)(ii)Dec. 13, 2016130 Stat. 1337

MedPAC Study of AAPCC

Pub. L. 108–173, title II, § 211(f)Dec. 8, 2003117 Stat. 2178 section 1395mm(a)(4) of this titleDec. 8, 2003, , , directed the Medicare Payment Advisory Commission to conduct a study that would assess the method used for determining the adjusted average per capita cost (AAPCC) under , as applied under subsection (c)(1)(A) of this section, and to submit to Congress a report on such study not later than 18 months after .

Implementation of 2003 Amendment

Pub. L. 108–173, title II, § 211(i)Dec. 8, 2003117 Stat. 2179

Special Rule for January and February of 2001

Pub. L. 106–554, § 1(a)(6) [title VI, § 601(b)]Dec. 21, 2000114 Stat. 2763

Pub. L. 106–554, § 1(a)(6) [title VI, § 602(b)]Dec. 21, 2000114 Stat. 2763

Transition to Revised Medicare+Choice Payment Rates

Pub. L. 106–554, § 1(a)(6) [title VI, § 604]Dec. 21, 2000114 Stat. 2763

Publication

Pub. L. 106–554, § 1(a)(6) [title VI, § 605(c)]Dec. 21, 2000114 Stat. 2763

Report on Inclusion of Certain Costs of the Department of Veterans Affairs and Military Facility Services in Calculating Medicare+Choice Payment Rates

Pub. L. 106–554, § 1(a)(6) [title VI, § 609]Dec. 21, 2000114 Stat. 2763

MedPAC Study and Report

Pub. L. 106–113, div. B, § 1000(a)(6) [title V, § 511(b)]Nov. 29, 1999113 Stat. 1536

Study and Report Regarding Reporting of Encounter Data

Pub. L. 106–113, div. B, § 1000(a)(6) [title V, § 511(c)]Nov. 29, 1999113 Stat. 1536

Special Rule for 2001

Pub. L. 106–113, div. B, § 1000(a)(6) [title V, § 514(b)]Nov. 29, 1999113 Stat. 1536

Development of Special Payment Rules Under Medicare+Choice Program for Frail Elderly Enrolled in Specialized Programs

Pub. L. 106–113, div. B, § 1000(a)(6) [title V, § 552(a)]Nov. 29, 1999113 Stat. 1536

Publication of New Capitation Rates

Pub. L. 105–33, title IV, § 4002(i)Aug. 5, 1997111 Stat. 330

Medicare+Choice Competitive Pricing Demonstration Project

Pub. L. 105–33, title IVAug. 5, 1997111 Stat. 334–336 Pub. L. 106–113, div. B, § 1000(a)(6) [title V, § 533]Nov. 29, 1999113 Stat. 1536 Pub. L. 117–286, § 4(a)(254)Dec. 27, 2022136 Stat. 4333