Page:United States Statutes at Large Volume 124.djvu/472

124 STAT. 446 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(ii) for 2012 and succeeding years, a service area that is an entire urban or rural area, as applicable (as described in paragraph (5)); and’’; and (C) by adding at the end the following new paragraph: ‘‘(5) MA LOCAL PLAN SERVICE AREA.—For 2012 and suc- ceeding years, the service area for an MA local plan shall be an entire urban or rural area in each State as follows: ‘‘(A) URBAN AREAS.— ‘‘(i) IN GENERAL.—Subject to clause (ii) and sub- paragraphs (C) and (D), the service area for an MA local plan in an urban area shall be the Core Based Statistical Area (in this paragraph referred to as a ‘CBSA’) or, if applicable, a conceptually similar alter- native classification, as defined by the Director of the Office of Management and Budget. ‘‘(ii) CBSA COVERING MORE THAN ONE STATE.— In the case of a CBSA (or alternative classification) that covers more than one State, the Secretary shall divide the CBSA (or alternative classification) into separate service areas with respect to each State cov- ered by the CBSA (or alternative classification). ‘‘(B) RURAL AREAS.—Subject to subparagraphs (C) and (D), the service area for an MA local plan in a rural area shall be a county that does not qualify for inclusion in a CBSA (or alternative classification), as defined by the Director of the Office of Management and Budget. ‘‘(C) REFINEMENTS TO SERVICE AREAS.—For 2015 and succeeding years, in order to reflect actual patterns of health care service utilization, the Secretary may adjust the boundaries of service areas for MA local plans in urban areas and rural areas under subparagraphs (A) and (B), respectively, but may only do so based on recent analyses of actual patterns of care. ‘‘(D) ADDITIONAL AUTHORITY TO MAKE LIMITED EXCEP- TIONS TO SERVICE AREA REQUIREMENTS FOR MA LOCAL PLANS.—The Secretary may, in addition to any adjustments under subparagraph (C), make limited exceptions to service area requirements otherwise applicable under this part for MA local plans that have in effect (as of the date of enactment of the Patient Protection and Affordable Care Act)— ‘‘(i) agreements with another MA organization or MA plan that preclude the offering of benefits through- out an entire service area; or ‘‘(ii) limitations in their structural capacity to sup- port adequate networks throughout an entire service area as a result of the delivery system model of the MA local plan.’’. (2) CONFORMING AMENDMENTS.— (A) IN GENERAL.— (i) Section 1851(b)(1) of the Social Security Act (42 U.S.C. 1395w–21(b)(1)) is amended by striking subparagraph (C). (ii) Section 1853(b)(1)(B)(i) of such Act (42 U.S.C. 1395w–23(b)(1)(B)(i))—