12 2 STA T . 2 570PUBLIC LA W 110 – 275 —J UL Y 15 , 200 8‘ ‘ (A)INGE NE RAL.—Forplanye ar 201 1an dsub se q uen t plan years ,i nt h e c ase o f a M edicare Ad v anta g e private fee - for-service plan not described in paragraph (1) or (2) of section 1 857 (i) operating in a net w or k area (as defined in subparagraph ( B )), the plan shall m eet the access stand- ards under paragraph ( 4 ) in that area only through entering into written contracts as provided for under subparagraph (B) of such paragraph and not, in whole or in part, through the establishment of payment rates meeting the requirements under subparagraph (A) of such paragraph. ‘‘(B) N E TWO R K AREA D E FI NED.—For purposes of subparagraph (A), the term ‘network area ’ means, for a plan year, an area which the S ecretary identifies (in the Secretary’s announcement of the proposed payment rates for the previous plan year under section 185 3 (b)(1)(B)) as having at least 2 network-based plans (as defined in subparagraph ( C )) with enrollment under this part as of the first day of the year in which such announcement is made. ‘‘(C) NETWORK- B A S ED P LAN DEFINED.— ‘‘(i) IN GENERAL.—For purposes of subparagraph (B), the term ‘network-based plan’ means— ‘‘(I) e x cept as provided in clause (ii), a Medi- care Advantage plan that is a coordinated care plan described in section 1851(a)(2)(A)(i)
‘‘(II) a network-based MSA plan; and ‘‘(III) a reasonable cost reimbursement plan under section 187 6 . ‘‘(ii) EXC L U SION OF NON-NETWORK REGIONAL PPOS.— T he term ‘network-based plan’ shall not include an MA regional plan that, with respect to the area, meets access adequacy standards under this part substantially through the authority of section 422.112(a)(1)(ii) of title 42, Code of Federal R egula- tions, rather than through written contracts.’’. (2) E M PLO Y ER PLANS.—Section 1852(d) of the Social Secu- rity Act (42 U .S.C. 13 9 5w – 22(d)), as amended by paragraph (1), is amended— (A) in paragraph (4), in the second sentence, by striking ‘‘paragraph (5)’’ and inserting ‘‘paragraphs (5) and (6)’’; and (B) by adding at the end the following new paragraph
‘‘(6) RE Q UIREMENT OF ALL EMPLOYER MEDICARE AD V ANTAGE PRIVATE FEE-FOR-SERVICE PLANS TO USE CONTRACTS WIT H PRO- VIDERS.—For plan year 2011 and subsequent plan years, in the case of a Medicare Advantage private fee-for-service plan that is described in paragraph (1) or (2) of section 1857(i), the plan shall meet the access standards under paragraph (4) only through entering into written contracts as provided for under subparagraph (B) of such paragraph and not, in whole or in part, through the establishment of payment rates meeting the requirements under subparagraph (A) of such para- graph.’’. (3) ACCESS REQUIREMENTS.— (A) IN GENERAL.—Section 1852(d)(4)(B) of the Social Security Act (42 U.S.C. 1395w–22(d)(4)(B)) is amended by
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