1.This Act may be cited as the
Medicare Cost Contract Extension and
Refinement Act of 2005
.
2.Extension of
reasonable cost contracts
(a)Extension of
period reasonable cost plans can remain in the marketSection 1876(h)(5)(C)(ii) of the Social
Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii) is amended—
(1)in the matter preceding subclause
(I)—
(A)by striking January 1, 2008
and inserting January 1, 2012
;
(B)by striking year
and
inserting two years
; and
(C)by inserting entirely
after
was
;
(2)in subclause (I), by inserting ,
provided that all such plans are not offered by the same Medicare Advantage
organization
before the semicolon at the end; and
(3)in subclause (II), by inserting ,
provided that all such plans are not offered by the same Medicare Advantage
organization
before the semicolon at the end.
(b)Extension of
period reasonable cost plans can expand their service areaSection 1876(h)(5)(B)(i) of the Social
Security Act (42 U.S.C. 1395mm(h)(5)(B)(i)) is amended to read as
follows:
(i)the conditions for prohibiting an extension
or renewal of a contract under subparagraph (C)(ii) are not applicable to such
service area at the time of the
application.
.
3.Application of certain
Medicare Advantage requirements to cost contracts extended or renewed after
2003Section 1876(h) of the
Social Security Act (42 U.S.C.
1395mm(h)), as amended by section (2), is amended—
(1)by redesignating paragraph (5) as paragraph
(6); and
(2)by inserting after paragraph (4) the
following new paragraph:
(5)(A)Any reasonable cost reimbursement contract
with an eligible organization under this subsection that is extended or renewed
on or after the date of enactment of the Medicare Cost Contract Extension and
Refinement Act of 2005 shall provide that the provisions of the Medicare
Advantage program under part C described in subparagraph (B) shall apply to
such organization and such contract in a substantially similar manner as such
provisions apply to Medicare Advantage organizations and Medicare Advantage
plans under such part.
(B)The provisions described in this
subparagraph are as follows:
(i)Section 1851(d) (relating to the provision
of information to promote informed choice).
(ii)Section 1851(h) (relating to the approval
of marketing material and application forms).
(iii)Section 1852(a)(3)(A) (regarding the
authority of organizations to include mandatory supplemental health care
benefits under the plan subject to the approval of the Secretary).
(iv)Section 1852(e) (relating to the
requirement of having an ongoing quality improvement program and treatment of
accreditation in the same manner as such provisions apply to Medicare Advantage
local plans that are preferred provider organization plans).
(v)Section 1852(j)(4) (relating to limitations
on physician incentive plans).
(vi)Section 1854(c) (relating to the
requirement of uniform premiums among individuals enrolled in the plan).
(vii)Section 1854(g) (relating to restrictions
on imposition of premium taxes with respect to payments to
organizations).
(viii)Section 1856(b)(3) (relating to relation to
State laws).
(ix)Section 1857(i) (relating to Medicare
Advantage program compatibility with employer or union group health
plans).
(x)The provisions of part C relating to
timelines for contract renewal and beneficiary
notification.
.