12 2 STA T . 2 57 5 PUBLIC LA W 11 0– 275 —J UL Y 15 , 200 8otherind i c e s o fqual it yw ith res p ect to the require -m ents descri b ed in para g raphs (2) through ( 5 ) of sub- section (f) .S uch data may be based on claims data and shall be at the plan le v el. ’ ’. (2) EF F ECTIV E DA TE. —T he amendment made by paragraph ( 1 ) shall ta k e effect on a date specified by the Secretary of H ealth and Human Services (but in no case later than J anuary 1 , 2 0 10), and shall apply to all speciali z ed M edicare A dvantage plans for special needs individuals regardless of when the plan first entered the Medicare Advantage program under part C of title XVI II of the Social Security Act. (g) EFFECTIVE D ATE A N DA P P L ICATI O N.—The amendments made by subsections (c)(1), (d), and (e)(1) shall apply to plan years begin- ning on or after January 1, 2010, and shall apply to all specialized Medicare Advantage plans for special needs individuals regardless of when the plan first entered the Medicare Advantage program under part C of title XVIII of the Social Security Act. (h) N O AFFECT ON MEDICAID B ENEFIT S FO R D U ALS.—Nothing in the provisions of, or amendments made by, this section shall affect the benefits available under the Medicaid program under title XIX of the Social Security Act for special needs individuals described in section 1 8 5 9 (b)( 6 )(B)(ii) of such Act ( 4 2 U .S.C. 1 3 95w – 28(b)(6)(B)(ii)). SEC.165 . LIM I TA TI ON ONO U T - O F - P OC K ET COSTS FO RD UAL ELI G I- B LES AND Q UALIFIED MEDICARE BENEFICIARIES ENROLLED IN A SPECIALI Z ED MEDICARE AD V ANTAGE PLAN FOR SPECIAL NEEDS INDIVIDUALS. (a) IN G ENERAL.—Section 1852(a) of the Social Security Act (42 U.S.C. 1395w–22(a)) is amended by adding at the end the following new paragraph
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‘( 7 ) L I M ITATION ON COST-S H ARIN G FOR DUAL ELIGI B LES AND Q UALIFIED MEDICARE BENEFICIARIES.—In the case of an indi- vidual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)) or a qualified medicare beneficiary (as defined in section 1905(p)(1)) and who is enrolled in a special- ized Medicare Advantage plan for special needs individuals described in section 1859(b)(6)(B)(ii), the plan may not impose cost-sharing that e x ceeds the amount of cost-sharing that would be permitted with respect to the individual under title XIX if the individual were not enrolled in such plan.’’. (b) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to plan years beginning on or after January 1, 2010. SEC. 166. AD J USTMENT TO T H E MEDICARE ADVANTAGE STABILIZA- TION FUND. Section 1858(e)(2)(A)(i) of the Social Security Act (42 U.S.C. 1395w–27a(e)(2)(A)(i)), as amended by section 110 of the Medicare, Medicaid, and SCHI P Extension Act of 2007 (Public Law 110– 173), is amended— (1) by striking ‘‘2013’’ and inserting ‘‘2014’’
and (2) by striking ‘‘ $ 1,790,000,000’’ and inserting ‘‘$1’’. SEC. 16 7 . ACCESS TO MEDICARE REASONABLE COST CONTRACT PLANS. (a) E X TENSION OF R EASONABLE COST CONTRACTS.—Section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)), as amended by section 109 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110– 42USC1395w– 22 note. 42 USC 1395w–2 8 note. 42 USC 1395w–2 7 note. 42 USC 1395w–22 note.
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