Page:United States Statutes at Large Volume 111 Part 1.djvu/311

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 287 "(3) SUPPLEMENTAL BENEFITS. — "(A) BENEFITS INCLUDED SUBJECT TO SECRETARY'S APPROVAL.—Each Medicare+Choice organization may provide to individuals enrolled under this part, other than under an MSA plan, (without affording those individuals an option to decline the coverage) supplemental health care benefits that the Secretary may approve. The Secretary shall approve any such supplemental benefits unless the Secretary determines that including such supplemental benefits would substantially discourage enrollment by Medicare+Choice eligible individuals with the organization. " (B) AT ENROLLEES' OPTION.— "(i) IN GENERAL.— Subject to clause (ii), a Medicare+Choice organization may provide to individuals enrolled under this part supplemental health care benefits that the individuals may elect, at their option, to have covered. " (ii) SPECIAL RULE FOR MSA PLANS. —A Medicare+Choice organization may not provide, under an MSA plan, supplemental health care benefits that cover the deductible described in section 1859(b)(2)(B). In applying the previous sentence, health benefits described in section 1882(u)(2)(B) shall not be treated as covering such deductible. " (C) APPLICATION TO MEDICARE+CHOICE PRIVATE FEE- FOR-SERVICE PLANS. —Nothing in this paragraph shall be construed as preventing a Medicare+Choice private feefor-service plan from offering supplemental benefits that include payment for some or all of the balance billing amounts permitted consistent with section 1852(k) and coverage of additional services that the plan finds to be medically necessary. " (4) ORGANIZATION AS SECONDARY PAYER. —Notwithstanding any other provision of law, a Medicare+Choice organization may (in the case of the provision of items and services to an individual under a Medicare+Choice plan under circumstances in which payment under this title is made secondary pursuant to section 1862(b)(2)) charge or authorize the provider of such services to charge, in accordance with the charges allowed under a law, plan, or policy described in such section— "(A) the insurance carrier, employer, or other entity which under such law, plan, or policy is to pay for the provision of such services, or "(B) such individual to the extent that the individual has been paid under such law, plan, or policy for such services. "(5) NATIONAL COVERAGE DETERMINATIONS. — If there is a national coverage determination made in the period beginning on the date of an announcement under section 1853(b) and ending on the date of the next announcement under such section and the Secretary projects that the determination will result in a significant change in the costs to a Medicare+Choice organization of providing the benefits that are the subject of such national coverage determination and that such change in costs was not incorporated in the determination of the annual Medicare+Choice capitation rate under section 1853 included

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