117 STAT. 2122
PUBLIC LAW 108–173—DEC. 8, 2003
‘‘Subpart 3—Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans ‘‘APPLICATION 42 USC 1395w–131.
VerDate 11-MAY-2000
13:59 Aug 30, 2004
TO MEDICARE ADVANTAGE PROGRAM AND RELATED MANAGED CARE PROGRAMS
‘‘SEC. 1860D–21. (a) SPECIAL RULES RELATING TO OFFERING OF QUALIFIED PRESCRIPTION DRUG COVERAGE.— ‘‘(1) IN GENERAL.—An MA organization on and after January 1, 2006— ‘‘(A) may not offer an MA plan described in section 1851(a)(2)(A) in an area unless either that plan (or another MA plan offered by the organization in that same service area) includes required prescription drug coverage (as defined in paragraph (2)); and ‘‘(B) may not offer prescription drug coverage (other than that required under parts A and B) to an enrollee— ‘‘(i) under an MSA plan; or ‘‘(ii) under another MA plan unless such drug coverage under such other plan provides qualified prescription drug coverage and unless the requirements of this section with respect to such coverage are met. ‘‘(2) QUALIFYING COVERAGE.—For purposes of paragraph (1)(A), the term ‘required coverage’ means with respect to an MA–PD plan— ‘‘(A) basic prescription drug coverage; or ‘‘(B) qualified prescription drug coverage that provides supplemental prescription drug coverage, so long as there is no MA monthly supplemental beneficiary premium applied under the plan (due to the application of a credit against such premium of a rebate under section 1854(b)(1)(C)). ‘‘(b) APPLICATION OF DEFAULT ENROLLMENT RULES.— ‘‘(1) SEAMLESS CONTINUATION.—In applying section 1851(c)(3)(A)(ii), an individual who is enrolled in a health benefits plan shall not be considered to have been deemed to make an election into an MA–PD plan unless such health benefits plan provides any prescription drug coverage. ‘‘(2) MA CONTINUATION.—In applying section 1851(c)(3)(B), an individual who is enrolled in an MA plan shall not be considered to have been deemed to make an election into an MA–PD plan unless— ‘‘(A) for purposes of the election as of January 1, 2006, the MA plan provided as of December 31, 2005, any prescription drug coverage; or ‘‘(B) for periods after January 1, 2006, such MA plan is an MA–PD plan. ‘‘(3) DISCONTINUANCE OF MA–PD ELECTION DURING FIRST YEAR OF ELIGIBILITY.—In applying the second sentence of section 1851(e)(4) in the case of an individual who is electing to discontinue enrollment in an MA–PD plan, the individual shall be permitted to enroll in a prescription drug plan under part D at the time of the election of coverage under the original medicare fee-for-service program. ‘‘(4) RULES REGARDING ENROLLEES IN MA PLANS NOT PROVIDING QUALIFIED PRESCRIPTION DRUG COVERAGE.—In the case
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