Sec. 4. Chronic special needs plans

278 words·~1 min read·/bill/113/hr/3890/ih/section-4

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Section 1859 of the Social Security Act ( 42 U.S.C. 1395w–28 ) is amended— in subsection (f)(4)— by striking In the case of and inserting Subject to subsection (h), in the case of ; and by adding at the end the following flush text: Notwithstanding any other provision of this section, on or after January 1, 2014, the Secretary shall establish procedures for the transition of those individuals to a Medicare Advantage plan qualified BCP in accordance with subsection (h). ; and by adding at the end the following new subsection:

A Medicare Advantage plan that is certified as a qualified BCP (referred to in this subsection as a Medicare Advantage plan qualified BCP )— is deemed to be a specialized MA plan for special needs individuals described in subsection (b)(6)(B)(iii); and may enroll such special needs individuals. A Medicare Advantage plan qualified BCP shall have the flexibility to offer specialized benefit packages to enrollees described in subsection (b)(6)(B)(iii), consistent with the value-based insurance requirements under section 1899B(f).

A Medicare Advantage plan qualified BCP shall be subject to all requirements applicable to a qualified BCP under section 1899B, including enrollment periods under subsection

(c)of that section, applicable criteria relating to network adequacy, requirements with respect to individual patient-centered chronic care plans under subsection (d)(2) of that section, applicable criteria with respect to care management processes, and quality reporting under subsection

(h)of that section. The provisions of this part, including the provisions relating to specialized MA plans for special needs individuals described in subsection (b)(6)(B)(iii), shall apply to a Medicare Advantage plan qualified BCP to the extent they are consistent with the provisions of section 1899B. .

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42 USC 1395w–28

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Sec. 4

Chronic special needs plans

Cite42 USC 1395w–28

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