Sec. 3202. BENEFIT PROTECTION AND SIMPLIFICATION

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## SEC. 3202 BENEFIT PROTECTION AND SIMPLIFICATION ###

(a)Limitation on Variation of Cost Sharing for Certain Benefits ####

(1)In general Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended— #####

(A)in clause (i), by inserting “, subject to clause (iii),” after “and B or”; and #####

(B)by adding at the end the following new clauses: > > ###### “(iii) Limitation on variation of cost sharing for certain benefits > > Subject to clause (v), cost-sharing for services described in clause

(iv)shall not exceed the cost-sharing required for those services under parts A and B. > > > ###### “(iv) Services described > > The following services are described in this clause: > > > ###### “(I) > > Chemotherapy administration services. > > > ###### “(II) > > Renal dialysis services (as defined in section 1881(b)(14)(B)). > > > ###### “(III) > > Skilled nursing care. > > > ###### “(IV) > > Such other services that the Secretary determines appropriate (including services that the Secretary determines require a high level of predictability and transparency for beneficiaries). > > > ###### “(v) Exception > > In the case of services described in clause

(iv)for which there is no cost-sharing required under parts A and B, cost-sharing may be required for those services in accordance with clause (i).” > . ####

(2)Effective date **[**[42 U.S.C. 1395ww–22 note](/us/usc/t42/s1395ww–22)**]** The amendments made by this subsection shall apply to plan years beginning on or after January 1, 2011. ###

(b)Application of Rebates, Performance Bonuses, and Premiums ####

(1)Application of rebates Section 1854(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w–24(b)(1)(C)) is amended— #####

(A)in clause (ii), by striking “rebate.—A rebate” and inserting “rebate for plan years before 2012.—For plan years before 2012, a rebate”; #####

(B)by redesignating clauses

(iii)and

(iv)as clauses

(vii)and

(viii); and #####

(C)by inserting after clause

(ii)the following new clause: > > ###### “(iii) Applicable rebate percentage > > The applicable rebate percentage specified in this clause for a plan for a year, based on the system under section 1853(o)(4)(A), is the sum of— > > > ###### “(I) > > the product of the old phase-in proportion for the year under clause

(iv)and 75 percent; and > > > ###### “(II) > > the product of the new phase-in proportion for the year under clause

(iv)and the final applicable rebate percentage under clause (v). > > > ###### “(iv) Old and new phase-in proportions > > For purposes of clause (iv)— > > > ###### “(I) > > for 2012, the old phase-in proportion is ⅔ and the new phase-in proportion is ⅓; > > > ###### “(II) > > for 2013, the old phase-in proportion is ⅓ and the new phase-in proportion is ⅔; and > > > ###### “(III) > > for 2014 and any subsequent year, the old phase-in proportion is 0 and the new phase-in proportion is 1. > > > ###### “(v) Final applicable rebate percentage > > Subject to clause (vi), the final applicable rebate percentage under this clause is— > > > ###### “(I) > > in the case of a plan with a quality rating under such system of at least 4.5 stars, 70 percent; > > > ###### “(II) > > in the case of a plan with a quality rating under such system of at least 3.5 stars and less than 4.5 stars, 65 percent; and > > > ###### “(III) > > in the case of a plan with a quality rating under such system of less than 3.5 stars, 50 percent. > > > ###### “(vi) Treatment of low enrollment and new plans > > For purposes of clause (v)— > > > ###### “(I) > > for 2012, in the case of a plan described in subclause

(I)of subsection (o)(3)(A)(ii), the plan shall be treated as having a rating of 4.5 stars; and > > > ###### “(II) > > for 2012 or a subsequent year, in the case of a new MA plan (as defined under subclause

(III)of subsection (o)(3)(A)(iii)) that is treated as a qualifying plan pursuant to subclause

(I)of such subsection, the plan shall be treated as having a rating of 3.5 stars.” > . ####

(2)Application of performance bonuses Section 1853(n) of the Social Security Act, as added by section 3201(f), is amended by adding at the end the following new paragraph: > > #### “(6) Application of performance bonuses > > For plan years beginning on or after January 1, 2014, any performance bonus paid to an MA plan under this subsection shall be used for the purposes, and in the priority order, described in subclauses

(I)through

(III)of section 1854(b)(1)(C)(iii).” > . ####

(3)Application of MA monthly supplementary beneficiary premium Section 1854(b)(2)(C) of the Social Security Act (42 U.S.C. 1395w–24(b)(2)(C)) is amended— #####

(A)by striking “ Premium.—The term ” and inserting `` Premium.— > > ###### “(i) In general > > The term” > ; and #####

(B)by adding at the end the following new clause: > > ###### “(ii) Application of MA monthly supplementary beneficiary premium > > For plan years beginning on or after January 1, 2012, any MA monthly supplementary beneficiary premium charged to an individual enrolled in an MA plan shall be used for the purposes, and in the priority order, described in subclauses

(I)through

(III)of paragraph (1)(C)(iii).'” > . **[**Section 3203 (and the amendments made by such section) was repealed by section 1102(a) of the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152.**]**

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42 USC 1395w–22(a)(1)(B)
42 USC 1395ww–22
42 USC 1395w–24(b)(1)(C)
42 USC 1395w–24(b)(2)(C)
Pub. L. 111-152

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cites case law

Sec. 3202

BENEFIT PROTECTION AND SIMPLIFICATION

Cite42 USC 1395w–22(a)(1)(B)

Cite42 USC 1395ww–22

Cite42 USC 1395w–24(b)(1)(C)

Cite42 USC 1395w–24(b)(2)(C)

Pub. L.Pub. L. 111-152

Cites 5Cited by 0 across 0 sources