PUBLIC LAW 108–173—DEC. 8, 2003
117 STAT. 2181
(1) IN GENERAL.—Section 1859(b) (42 U.S.C. 1395w–29(b)) is amended by adding at the end the following new paragraphs: ‘‘(4) MA REGIONAL PLAN.—The term ‘MA regional plan’ means an MA plan described in section 1851(a)(2)(A)(i)— ‘‘(A) that has a network of providers that have agreed to a contractually specified reimbursement for covered benefits with the organization offering the plan; ‘‘(B) that provides for reimbursement for all covered benefits regardless of whether such benefits are provided within such network of providers; and ‘‘(C) the service area of which is one or more entire MA regions. ‘‘(5) MA LOCAL PLAN.—The term ‘MA local plan’ means an MA plan that is not an MA regional plan.’’. (2) CONSTRUCTION.—Nothing in part C of title XVIII of the Social Security Act 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. (c) RULES FOR MA REGIONAL PLANS.—Part C of title XVIII (42 U.S.C. 1395w–21 et seq.) is amended by inserting after section 1857 the following new section: ‘‘SPECIAL
13:59 Aug 30, 2004
42 USC 1395w–21 note.
RULES FOR MA REGIONAL PLANS
‘‘SEC. 1858. (a) REGIONAL SERVICE AREA; ESTABLISHMENT OF MA REGIONS.— ‘‘(1) COVERAGE OF ENTIRE MA REGION.—The service area for an MA regional plan shall consist of an entire MA region established under paragraph (2) and the provisions of section 1854(h) shall not apply to such a plan. ‘‘(2) ESTABLISHMENT OF MA REGIONS.— ‘‘(A) MA REGION.—For purposes of this title, the term ‘MA region’ means such a region within the 50 States and the District of Columbia as established by the Secretary under this paragraph. ‘‘(B) ESTABLISHMENT.— ‘‘(i) INITIAL ESTABLISHMENT.—Not later than January 1, 2005, the Secretary shall first establish and publish MA regions. ‘‘(ii) PERIODIC REVIEW AND REVISION OF SERVICE AREAS.—The Secretary may periodically review MA regions under this paragraph and, based on such review, may revise such regions if the Secretary determines such revision to be appropriate. ‘‘(C) REQUIREMENTS FOR MA REGIONS.—The Secretary shall establish, and may revise, MA regions under this paragraph in a manner consistent with the following: ‘‘(i) NUMBER OF REGIONS.—There shall be no fewer than 10 regions, and no more than 50 regions. ‘‘(ii) MAXIMIZING AVAILABILITY OF PLANS.—The regions shall maximize the availability of MA regional plans to all MA eligible individuals without regard to health status, especially those residing in rural areas. ‘‘(D) MARKET SURVEY AND ANALYSIS.—Before establishing MA regions, the Secretary shall conduct a market survey and analysis, including an examination of current
42 USC 1395w–28.
42 USC 1395w–27a.