124 STAT. 457 PUBLIC LAW 111–148—MAR. 23, 2010 SEC. 3205. EXTENSION FOR SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS. (a) EXTENSION OF SNP AUTHORITY.—Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w–28(f)(1)), as amended by sec- tion 164(a) of the Medicare Improvements for Patients and Pro- viders Act of 2008 (Public Law 110–275), is amended by striking ‘‘2011’’ and inserting ‘‘2014’’. (b) AUTHORITY TO APPLY FRAILTY ADJUSTMENT UNDER PACE PAYMENT RULES.—Section 1853(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–23(a)(1)(B)) is amended by adding at the end the following new clause: ‘‘(iv) AUTHORITY TO APPLY FRAILTY ADJUSTMENT UNDER PACE PAYMENT RULES FOR CERTAIN SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS.— ‘‘(I) IN GENERAL.—Notwithstanding the pre- ceding provisions of this paragraph, for plan year 2011 and subsequent plan years, in the case of a plan described in subclause (II), the Secretary may apply the payment rules under section 1894(d) (other than paragraph (3) of such section) rather than the payment rules that would otherwise apply under this part, but only to the extent necessary to reflect the costs of treating high concentrations of frail individuals. ‘‘(II) PLAN DESCRIBED.—A plan described in this subclause is a specialized MA plan for special needs individuals described in section 1859(b)(6)(B)(ii) that is fully integrated with capitated contracts with States for Medicaid bene- fits, including long-term care, and that have similar average levels of frailty (as determined by the Secretary) as the PACE program.’’. (c) TRANSITION AND EXCEPTION REGARDING RESTRICTION ON ENROLLMENT.—Section 1859(f) of the Social Security Act (42 U.S.C. 1395w–28(f)) is amended by adding at the end the following new paragraph: ‘‘(6) TRANSITION AND EXCEPTION REGARDING RESTRICTION ON ENROLLMENT.— ‘‘(A) IN GENERAL.—Subject to subparagraph (C), the Secretary shall establish procedures for the transition of applicable individuals to— ‘‘(i) a Medicare Advantage plan that is not a specialized MA plan for special needs individuals (as defined in subsection (b)(6)); or ‘‘(ii) the original medicare fee-for-service program under parts A and B. ‘‘(B) APPLICABLE INDIVIDUALS.—For purposes of clause (i), the term ‘applicable individual’ means an individual who— ‘‘(i) is enrolled under a specialized MA plan for special needs individuals (as defined in subsection (b)(6)); and ‘‘(ii) is not within the 1 or more of the classes of special needs individuals to which enrollment under the plan is restricted to. ‘‘(C) EXCEPTION.—The Secretary shall provide for an exception to the transition described in subparagraph (A) Definition. Procedures.
