117 STAT. 2180
PUBLIC LAW 108–173—DEC. 8, 2003 (4) PLANS
Deadline.
REQUIRED TO PROVIDE NOTICE OF CHANGES IN
PLAN BENEFITS.—In
the case of an organization offering a plan under part C of title XVIII of the Social Security Act that revises its submission of the information described in section 1854(a)(1) of such Act (42 U.S.C. 1395w–23(a)(1)) for a plan pursuant to the application of paragraph (2), if such revision results in changes in beneficiary premiums, beneficiary costsharing, or benefits under the plan, then by not later than 3 weeks after the date the Secretary approves such submission, the organization offering the plan shall provide each beneficiary enrolled in the plan with written notice of such changes. (5) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869 or section 1878 of the Social Security Act (42 U.S.C. 1395ff and 1395oo), or otherwise of any determination made by the Secretary under this subsection or the application of the payment rates determined pursuant to this subsection. (j) ADDITIONAL AMENDMENTS.—Section 1852(d)(4) (42 U.S.C. 1395w–22(d)(4)) is amended— (1) in subparagraph (B), by inserting ‘‘(other than deemed contracts or agreements under subsection (j)(6))’’ after ‘‘the plan has contracts or agreements’’; and (2) in the last sentence, by inserting before the period at the end the following: ‘‘, except that, if a plan entirely meets such requirement with respect to a category of health care professional or provider on the basis of subparagraph (B), it may provide for a higher beneficiary copayment in the case of health care professionals and providers of that category who do not have contracts or agreements (other than deemed contracts or agreements under subsection (j)(6)) to provide covered services under the terms of the plan’’.
Subtitle C—Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition SEC. 221. ESTABLISHMENT OF MA REGIONAL PLANS. 42 USC 1395w–21.
42 USC 1395w–21 note.
VerDate 11-MAY-2000
13:59 Aug 30, 2004
Jkt 019194
(a) OFFERING OF MA REGIONAL PLANS.— (1) IN GENERAL.—Section 1851(a)(2)(A) is amended— (A) by striking ‘‘COORDINATED CARE PLANS.—Coordinated’’ and inserting the following: ‘‘COORDINATED CARE PLANS (INCLUDING REGIONAL PLANS).— ‘‘(i) IN GENERAL.—Coordinated’’; (B) by inserting ‘‘regional or local’’ before ‘‘preferred provider organization plans’’; and (C) by inserting ‘‘ (including MA regional plans)’’ after ‘‘preferred provider organization plans’’. (2) MORATORIUM ON NEW LOCAL PREFERRED PROVIDER ORGANIZATION PLANS.—The Secretary shall not permit the offering of a local preferred provider organization plan under part C of title XVIII of the Social Security Act during 2006 or 2007 in a service area unless such plan was offered under such part (including under a demonstration project under such part) in such area as of December 31, 2005. (b) DEFINITION OF MA REGIONAL PLAN; MA LOCAL PLAN.—
PO 00000
Frm 00116
Fmt 6580
Sfmt 6581
D:\STATUTES\2003\19194PT3.001
APPS10
PsN: 19194PT3
�
