Sec. 50322. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES

641 words·~3 min read·/statute-compilations/comps-14173/sec-50322

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

## SEC. 50322 EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES ###

(a)In General Section 1852(a)(3) of the Social Security Act (42 U.S.C. 1395w–22(a)(3)) is amended— ####

(1)in subparagraph (A), by striking “Each” and inserting “Subject to subparagraph (D), each”; and ####

(2)by adding at the end the following new subparagraph: > > ##### “(D) Expanding supplemental benefits to meet the needs of chronically ill enrollees > > > ###### “(i) In general > > For plan year 2020 and subsequent plan years, in addition to any supplemental health care benefits otherwise provided under this paragraph, an MA plan, including a specialized MA plan for special needs individuals (as defined in section 1859(b)(6)), may provide supplemental benefits described in clause

(ii)to a chronically ill enrollee (as defined in clause (iii)). > > > ###### “(ii) Supplemental benefits described > > > ###### “(I) In general > > Supplemental benefits described in this clause are supplemental benefits that, with respect to a chronically ill enrollee, have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits. > > > ###### “(II) Authority to waive uniformity requirements > > The Secretary may, only with respect to supplemental benefits provided to a chronically ill enrollee under this subparagraph, waive the uniformity requirements under this part, as determined appropriate by the Secretary. > > > ###### “(iii) Chronically ill enrollee defined > > In this subparagraph, the term ‘chronically ill enrollee’ means an enrollee in an MA plan that the Secretary determines— > > > ###### “(I) > > has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee; > > > ###### “(II) > > has a high risk of hospitalization or other adverse health outcomes; and > > > ###### “(III) > > requires intensive care coordination.” > . ###

(b)GAO Study and Report ####

(1)Study The Comptroller General of the United States (in this subsection referred to as the “Comptroller General”) shall conduct a study on supplemental benefits provided to enrollees in Medicare Advantage plans under part C of title XVIII of the Social Security Act, including specialized MA plans for special needs individuals (as defined in section 1859(b)(6) of such Act (42 U.S.C. 1395w–28(b)(6))). To the extend data are available, such study shall include an analysis of the following: #####

(A)The type of supplemental benefits provided to such enrollees, the total number of enrollees receiving each supplemental benefit, and whether the supplemental benefit is covered by the standard benchmark cost of the benefit or with an additional premium. #####

(B)The frequency in which supplemental benefits are utilized by such enrollees. #####

(C)The impact supplemental benefits have on— ######

(i)indicators of the quality of care received by such enrollees, including overall health and function of the enrollees; ######

(ii)the utilization of items and services for which benefits are available under the original Medicare fee-for-service program option under parts A and B of such title XVIII by such enrollees; and ######

(iii)the amount of the bids submitted by Medicare Advantage Organizations for Medicare Advantage plans under such part C. ####

(2)Consultation In conducting the study under paragraph (1), the Comptroller General shall, as necessary, consult with the Centers for Medicare & Medicaid Services and Medicare Advantage organizations offering Medicare Advantage plans. ####

(3)Report Not later than 5 years after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

Connections2 off-index

2 references not yet in our index

42 USC 1395w–22(a)(3)
42 USC 1395w–28(b)(6)

Citation graph

cites case law

Sec. 50322

EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES

Cite42 USC 1395w–22(a)(3)

Cite42 USC 1395w–28(b)(6)

Cites 2Cited by 0 across 0 sources