117 STAT. 2184
PUBLIC LAW 108–173—DEC. 8, 2003 ‘‘(D) TARGET AMOUNT DESCRIBED.—For purposes of this paragraph, the term ‘target amount’ means, with respect to an MA regional plan offered by an organization in a year, an amount equal to— ‘‘(i) the sum of— ‘‘(I) the total monthly payments made to the organization for enrollees in the plan for the year that are attributable to benefits under the original medicare fee-for-service program option (as defined in section 1852(a)(1)(B)); ‘‘(II) the total of the MA monthly basic beneficiary premium collectable for such enrollees for the year; and ‘‘(III) the total amount of the rebates under section 1854(b)(1)(C)(ii) that are attributable to rebatable integrated benefits; reduced by ‘‘(ii) the amount of administrative expenses assumed in the bid insofar as the bid is attributable to benefits described in clause (i)(I) or (i)(III). ‘‘(3) DISCLOSURE OF INFORMATION.— ‘‘(A) IN GENERAL.—Each contract under this part shall provide— ‘‘(i) that an MA organization offering an MA regional plan shall provide the Secretary with such information as the Secretary determines is necessary to carry out this subsection; and ‘‘(ii) that, pursuant to section 1857(d)(2)(B), the Secretary has the right to inspect and audit any books and records of the organization that pertain to the information regarding costs provided to the Secretary under paragraph (1)(B). ‘‘(B) RESTRICTION ON USE OF INFORMATION.—Information disclosed or obtained pursuant to the provisions of this subsection may be used by officers, employees, and contractors of the Department of Health and Human Services only for the purposes of, and to the extent necessary in, carrying out this subsection. ‘‘(d) ORGANIZATIONAL AND FINANCIAL REQUIREMENTS.— ‘‘(1) IN GENERAL.—In the case of an MA organization that is offering an MA regional plan in an MA region and— ‘‘(A) meets the requirements of section 1855(a)(1) with respect to at least one such State in such region; and ‘‘(B) with respect to each other State in such region in which it does not meet requirements, it demonstrates to the satisfaction of the Secretary that it has filed the necessary application to meet such requirements, the Secretary may waive such requirement with respect to each State described in subparagraph (B) for such period of time as the Secretary determines appropriate for the timely processing of such an application by the State (and, if such application is denied, through the end of such plan year as the Secretary determines appropriate to provide for a transition). ‘‘(2) SELECTION OF APPROPRIATE STATE.—In applying paragraph (1) in the case of an MA organization that meets the requirements of section 1855(a)(1) with respect to more than one State in a region, the organization shall select, in a manner
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