Page:United States Statutes at Large Volume 111 Part 1.djvu/329

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 305 the Secretary shall adjust all area-specific and national Medicare+Choice capitation rates (and beginning in 2000, the minimum amount) for the previous year for the dif- ferences between the projections of the national per capita Medicare+Choice growth percentage for that year and previous years and the current estimate of such percentage for such years. "(7) ADJUSTMENT FOR NATIONAL COVERAGE DETERMINA- TIONS. —I f the Secretary makes a determination with respect to coverage under this title that the Secretary projects will result in a significant increase in the costs to Medicare+Choice of providing benefits under contracts under this part (for periods after any period described in section 1852(a)(5)), the Secretary shall adjust appropriately the payments to such organizations under this part. " (d) MEDICARE+CHOICE PAYMENT AREA DEFINED. — "(1) IN GENERAL.—In this part, except as provided in paragraph (3), the term 'Medicare+Choice pa3anent area' means a county, or equivalent area specified by the Secretary. "(2) RULE FOR ESRD BENEFICIARIES.—In the case of individuals who are determined to have end stage renal disease, the Medicare+Choice payment area shall be a State or such other payment area as the Secretary specifies. "(3) GEOGRAPHIC ADJUSTMENT.— "(A) IN GENERAL.— Upon written request of the chief executive officer of a State for a contract year (beginning after 1998) made by not later than February 1 of the previous year, the Secretary shall make a geographic adjustment to a Medicare+Choice payment area in the State otherwise determined under paragraph (1)— "(i) to a single statewide Medicare+Choice payment area, "(ii) to the metropolitan based system described in subparagraph (C), or "(iii) to consolidating into a single Medicare+Choice payment area noncontiguous counties (or equivalent areas described in paragraph (1)) within a State. Such adjustment shall be effective for payments for months beginning with January of the year following the year in which the request is received. "(B) BUDGET NEUTRALITY ADJUSTMENT.—In the case of a State requesting an adjustment under this paragraph, the Secretary shall initially (sind annually thereafter) adjust the pa)Tnent rates otherwise established under this section for Medicare+Choice payment areas in the State in a manner so that the aggregate of the payments under this section in the State shall not exceed the aggregate payments that would have been made under this section for Medicare+Choice payment areas in the State in the absence of the adjustment under this paragraph. "(C) METROPOLITAN BASED SYSTEM.— The metropolitan based system described in this subparagraph is one in which— "(i) all the portions of each metropolitan statistical area in the State or in the case of a consolidated metropolitan statistical area, all of the portions of each primary metropolitan statistical area within the

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