Sec. 302. Ensuring adequate coverage in areas with fewer than 3 health insurance issuers offering qualified health plans on the State Exchange
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Section 1857(e) of the Social Security Act ( 42 U.S.C. 1395w–27(e) ) is amended by adding at the end the following new paragraph: A contract under this section with an MA organization described in subparagraph
(B)shall require the organization to, in each applicable area in which the organization offers an MA plan, also offer, through the individual market in the Exchange operating in the State, at least one qualified health plan in the silver level of coverage and at least one qualified health plan in the gold level of coverage, as described in section 1302(d) of the Patient Protection and Affordable Care Act. An MA organization described in this subparagraph is an MA organization that, in addition to offering an MA plan in an applicable area, offers health insurance coverage in the group market or individual market in the State but does not offer such coverage through the Exchange operating in the State. The Secretary, or the State in the case of an MA organization offering an MA plan in an applicable area in a State with an Exchange operated by the State, shall notify each MA organization that is required to offer a qualified health plan under subparagraph
(A)for a plan year of such requirement. Such notification shall be provided each year— beginning with respect to the requirement for plan years beginning after December 31, 2019; and not less than 1 year prior to the rate filing deadline for the plan year for the Exchange operating in the State in which the MA organization will be required to offer such plan. The Secretary, or the State in the case of an MA organization offering an MA plan in an applicable area in a State with an Exchange operated by the State, may waive the requirement under subparagraph
(A)if— by the first day of the plan year, the number of health insurance issuers offering a qualified health plan through the individual market in the Exchange has increased such that the applicable area no longer has fewer than 3 health insurance issuers offering a qualified health plan through the individual market in the Exchange operating in the State; or the Secretary, or the State in such a case, determines that the requirement under subparagraph
(A)would cause the MA organization to become insolvent. In this paragraph: The term applicable area means an area in which, at the time the Secretary or the State sends the notification under subparagraph (C), fewer than 3 health insurance issuers offer a qualified health plan through the individual market in the Exchange operating in the State. The term Exchange means an American Health Benefit Exchange established under section 1311 or section 1321 of the Patient Protection and Affordable Care Act. The term group market has the meaning given such term in section 1304 of the Patient Protection and Affordable Care Act. The term health insurance coverage has the meaning given the term in section 2791(b) of the Public Health Service Act. The term individual market has the meaning given such term in section 1304 of the Patient Protection and Affordable Care Act. The term qualified health plan has the meaning given that term in section 1301(a) of the Patient Protection and Affordable Care Act. . The amendment made by this subsection shall apply to contracts entered into or renewed after December 31, 2019. Section 1903(m)(2)(A) of the Social Security Act ( 42 U.S.C. 1396b(m)(2)(A) ) is amended— in clause (xii), by striking ; and and inserting a semicolon; by realigning the left margin of clause
(xiii)to align with the left margin of clause (xii); in clause (xiii), by striking the period at the end and inserting ; and ; and by inserting after clause
(xiii)the following: such contract requires that the entity meets the requirements described in section 1857(e)(5) in the same manner as such requirements apply to an MA organization. . The amendments made by this subsection shall apply to contracts entered into or renewed after December 31, 2019.
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- 42 USC 1395w–27(e)
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Sec. 302
Ensuring adequate coverage in areas with fewer than 3 health insurance issuers offering qualified health plans on the State Exchange
Cite42 USC 1395w–27(e)
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