117 STAT. 2182
PUBLIC LAW 108–173—DEC. 8, 2003
insurance markets, to determine how the regions should be established. ‘‘(3) NATIONAL PLAN.—Nothing in this subsection shall be construed as preventing an MA regional plan from being offered in more than one MA region (including all regions). ‘‘(b) APPLICATION OF SINGLE DEDUCTIBLE AND CATASTROPHIC LIMIT ON OUT-OF-POCKET EXPENSES.—An MA regional plan shall include the following: ‘‘(1) SINGLE DEDUCTIBLE.—Any deductible for benefits under the original medicare fee-for-service program option shall be a single deductible (instead of a separate inpatient hospital deductible and a part B deductible) and may be applied differentially for in-network services and may be waived for preventive or other items and services. ‘‘(2) CATASTROPHIC LIMIT.— ‘‘(A) IN-NETWORK.—A catastrophic limit on out-ofpocket expenditures for in-network benefits under the original medicare fee-for-service program option. ‘‘(B) TOTAL.—A catastrophic limit on out-of-pocket expenditures for all benefits under the original medicare fee-for-service program option. ‘‘(c) PORTION OF TOTAL PAYMENTS TO AN ORGANIZATION SUBJECT TO RISK FOR 2006 AND 2007.— ‘‘(1) APPLICATION OF RISK CORRIDORS.— ‘‘(A) IN GENERAL.—This subsection shall only apply to MA regional plans offered during 2006 or 2007. ‘‘(B) NOTIFICATION OF ALLOWABLE COSTS UNDER THE PLAN.—In the case of an MA organization that offers an MA regional plan in an MA region in 2006 or 2007, the organization shall notify the Secretary, before such date in the succeeding year as the Secretary specifies, of— ‘‘(i) its total amount of costs that the organization incurred in providing benefits covered under the original medicare fee-for-service program option for all enrollees under the plan in the region in the year and the portion of such costs that is attributable to administrative expenses described in subparagraph (C); and ‘‘(ii) its total amount of costs that the organization incurred in providing rebatable integrated benefits (as defined in subparagraph (D)) and with respect to such benefits the portion of such costs that is attributable to administrative expenses described in subparagraph (C) and not described in clause (i) of this subparagraph. ‘‘(C) ALLOWABLE COSTS DEFINED.—For purposes of this subsection, the term ‘allowable costs’ means, with respect to an MA regional plan for a year, the total amount of costs described in subparagraph (B) for the plan and year, reduced by the portion of such costs attributable to administrative expenses incurred in providing the benefits described in such subparagraph. ‘‘(D) REBATABLE INTEGRATED BENEFITS.—For purposes of this subsection, the term ‘rebatable integrated benefits’ means such non-drug supplemental benefits under subclause (I) of section 1854(b)(1)(C)(ii) pursuant to a rebate under such section that the Secretary determines are
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