I 111th CONGRESS 1st Session H. R. 2501 IN THE HOUSE OF REPRESENTATIVES May 19, 2009 Mr. Pomeroy (for himself and Mr. Paulsen) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to extend reasonable cost contracts under Medicare.

1.

Short title

This Act may be cited as the Medicare Cost Contract Extension and Refinement Act of 2009.

2.

Extension of reasonable cost contracts

(a)

Extension of period reasonable cost plans can remain in the market

Section 1876(h)(5)(C) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)) is amended— (1)in clause (ii), by striking January 1, 2010 and inserting January 1, 2013; and (2)in clause (iii), by striking the service area for the year and inserting the portion of the plan’s service area for the year that is within the service area of a reasonable cost reimbursement contract. (b)

Extension of period reasonable cost plans can expand their service area

Section 1876(h)(5)(B)(i) of such 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; and .

3.

Application of certain medicare advantage requirements to cost contracts extended or renewed after enactment

Section 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 2009 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(g) (relating to restrictions on imposition of premium taxes with respect to payments to organizations). (vii)Section 1856(b)(3) (relating to relation to State laws). (viii)Section 1857(i) (relating to Medicare Advantage program compatibility with employer or union group health plans). (ix)The provisions of part C relating to timelines for contract renewal and beneficiary notification. .