12 2 STA T . 2 57 2 PUBLIC LA W 11 0– 275 —J UL Y 15 , 200 8provide d un der s e ct ion 231( d ) o f t h e M edic a re P rescription D ru g,Im provement, and Moderni z ation A ctof2 0 03( 4 2 U.S . C . 13 95w– 21 note) to designate other p l ans as specialized MA plans for special needs individuals. (c) REQUIR E M E NTSFO R E NRO L LMENT. — (1) IN G ENER A L.—Section 1 8 59 of the Social Securit y Act (42 U.S.C. 1395w–28) is amended— (A) in su b section (b)( 6 )(A), by inserting ‘ ‘and that, as of J anuary 1, 2010, meets the applicable re q uirements of paragraph (2), (3), or (4) of subsection (f), as the case may be ’ ’ before the period at the end
and ( B ) in subsection (f)— (i) by amending the heading to read as follows
‘‘REQUIREMENTS REGAR D ING ENROLLMENT IN S P E C IAL - I Z ED MA PLANS FOR SPECIAL N EEDS INDI V IDUALS’’; (ii) by designating the sentence beginning ‘‘In the case of’’ as paragraph (1) with the heading ‘‘REQUIRE- MENTS FOR ENROLLMENT.—’’ and with appropriate indentation; and (iii) by adding at the end the following new para- graphs: ‘‘(2) ADDITIONAL REQUIREMENTS FOR INSTITUTIONAL SNPS.— In the case of a specialized MA plan for special needs individ- uals described in subsection (b)(6)(B)(i), the applicable require- ments described in this paragraph are as follows: ‘‘(A) Each individual that enrolls in the plan on or after January 1, 2010, is a special needs individuals described in subsection (b)(6)(B)(i). In the case of an indi- vidual who is living in the community but requires an institutional level of care, such individual shall not be considered a special needs individual described in sub- section (b)(6)(B)(i) unless the determination that the indi- vidual requires an institutional level of care was made— ‘‘(i) using a State assessment tool of the State in which the individual resides; and ‘‘(ii) by an entity other than the organization offering the plan. ‘‘(B) T he plan meets the requirements described in paragraph (5). ‘‘(3) ADDITIONAL REQUIREMENTS FOR DUAL SNPS.—In the case of a specialized MA plan for special needs individuals described in subsection (b)(6)(B)(ii), the applicable requirements described in this paragraph are as follows: ‘‘(A) Each individual that enrolls in the plan on or after January 1, 2010, is a special needs individuals described in subsection (b)(6)(B)(ii). ‘‘(B) The plan meets the requirements described in paragraph (5). ‘‘(C) The plan provides each prospective enrollee, prior to enrollment, with a comprehensive written statement (using standardized content and format established by the Secretary) that describes— ‘‘(i) the benefits and cost-sharing protections that the individual is entitled to under the State Medicaid program under title X IX; and ‘‘(ii) which of such benefits and cost-sharing protec- tions are covered under the plan. Ef f ectiv e da te . Effective date.
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