117 STAT. 2100
For purposes of this paragraph, an entity shall be treated as submitting a bid with respect to a prescription drug plan or offering a fallback prescription drug plan if the entity is acting as a subcontractor of a PDP sponsor that is offering such a plan. The previous sentence shall not apply to entities that are subcontractors of an MA organization except insofar as such organization is acting as a PDP sponsor with respect to a prescription drug plan. ‘‘(3) INCORPORATION OF CERTAIN MEDICARE ADVANTAGE CONTRACT REQUIREMENTS.—Except as otherwise provided, the following provisions of section 1857 shall apply to contracts under this section in the same manner as they apply to contracts under section 1857(a): ‘‘(A) MINIMUM ENROLLMENT.—Paragraphs (1) and (3) of section 1857(b), except that— ‘‘(i) the Secretary may increase the minimum number of enrollees required under such paragraph (1) as the Secretary determines appropriate; and ‘‘(ii) the requirement of such paragraph (1) shall be waived during the first contract year with respect to an organization in a region. ‘‘(B) CONTRACT PERIOD AND EFFECTIVENESS.—Section 1857(c), except that in applying paragraph (4)(B) of such section any reference to payment amounts under section 1853 shall be deemed payment amounts under section 1860D–15. ‘‘(C) PROTECTIONS AGAINST FRAUD AND BENEFICIARY PROTECTIONS.—Section 1857(d). ‘‘(D) ADDITIONAL CONTRACT TERMS.—Section 1857(e); except that section 1857(e)(2) shall apply as specified to PDP sponsors and payments under this part to an MA– PD plan shall be treated as expenditures made under part D. ‘‘(E) INTERMEDIATE SANCTIONS.—Section 1857(g) (other than paragraph (1)(F) of such section), except that in applying such section the reference in section 1857(g)(1)(B) to section 1854 is deemed a reference to this part. ‘‘(F) PROCEDURES FOR TERMINATION.—Section 1857(h). ‘‘(c) WAIVER OF CERTAIN REQUIREMENTS TO EXPAND CHOICE.— ‘‘(1) AUTHORIZING WAIVER.— ‘‘(A) IN GENERAL.—In the case of an entity that seeks to offer a prescription drug plan in a State, the Secretary shall waive the requirement of subsection (a)(1) that the entity be licensed in that State if the Secretary determines, based on the application and other evidence presented to the Secretary, that any of the grounds for approval of the application described in paragraph (2) have been met. ‘‘(B) APPLICATION OF REGIONAL PLAN WAIVER RULE.— In addition to the waiver available under subparagraph (A), the provisions of section 1858(d) shall apply to PDP sponsors under this part in a manner similar to the manner in which such provisions apply to MA organizations under part C, except that no application shall be required under paragraph (1)(B) of such section in the case of a State that does not provide a licensing process for such a sponsor. ‘‘(2) GROUNDS FOR APPROVAL.—
Applicability.
VerDate 11-MAY-2000
13:59 Aug 30, 2004
PUBLIC LAW 108–173—DEC. 8, 2003
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