Page:United States Statutes at Large Volume 111 Part 1.djvu/324

 m STAT. 300 PUBLIC LAW 105-33 —AUG. 5, 1997 ^ contributed to by the individual's employer or former employer (or the employer or former employer of the individual's spouse) and ending on the date on which the individual is enrolled in the organization under this part, except that for purposes of making such retroactive adjustments under this subparagraph, such period may not exceed 90 days. "(ii) EXCEPTION.— No adjustment may be made under clause (i) with respect to any individual who does not certify that the organization provided the individual with the disclosure statement described in section 1852(c) at the time the individual enrolled with the organization. " (3) ESTABLISHMENT OF RISK ADJUSTMENT FACTORS. — "(A) REPORT.— The Secretary shall develop, and submit to Congress by not later than March 1, 1999, a report on the method of risk adjustment of payment rates under this section, to be implemented under subparagraph (C), that accounts for variations in per capita costs based on health status. Such report shall include an evaluation of such method by an outside, independent actuary of the actuarial soundness of the proposal. "(B) DATA COLLECTION.— In order to carry out this paragraph, the Secretary shall require Medicare+Choice organizations (and eligible organizations with risk-sharing contracts under section 1876) to submit data regarding inpatient hospital services for periods beginning on or after July 1, 1997, and data regarding other services and other information as the Secretary deems necessary for periods beginning on or after July 1, 1998. The Secretary may not require an organization to submit such data before January 1, 1998. "(C) INITIAL IMPLEMENTATION.—The Secretary shall first provide for implementation of a risk adjustment methodology that accounts for variations in per capita costs based on health status and other demographic factors for payments by no later than January 1, 2000. " (D) UNIFORM APPLICATION TO ALL TYPES OF PLANS.— Subject to section 1859(e)(4), the methodology shall be applied uniformly without regard to the type of plan. " (b) ANNUAL ANNOUNCEMENT OF PAYMENT RATES.— "(1) ANNUAL ANNOUNCEMENT.—The Secretary shall annually determine, and shall announce (in a manner intended to provide notice to interested parties) not later than March 1 before the calendar year concerned— "(A) the annual Medicare-i -Choice capitation rate for each Medicare+Choice payment area for the year, and "(B) the risk and other factors to be used in adjusting such rates under subsection (a)(1)(A) for payments for months in that year. " (2) ADVANCE NOTICE OF METHODOLOGICAL CHANGES.—At least 45 days before making the announcement under paragraph (1) for a year, the Secretary shall provide for notice to Medicare+Choice organizations of proposed changes to be made in the methodology from the methodology and assumptions used in the previous announcement and shall provide

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