Page:United States Statutes at Large Volume 117.djvu/2113

 117 STAT. 2094

PUBLIC LAW 108–173—DEC. 8, 2003 ‘‘(A) an actuarial valuation of standard prescription drug coverage under section 1860D–2(b); ‘‘(B) actuarial valuations relating to alternative prescription drug coverage under section 1860D–2(c)(1); ‘‘(C) an actuarial valuation of the reinsurance subsidy payments under section 1860D–15(b); ‘‘(D) the use of generally accepted actuarial principles and methodologies; and ‘‘(E) applying the same methodology for determinations of actuarial valuations under subparagraphs (A) and (B). ‘‘(2) ACCOUNTING FOR DRUG UTILIZATION.—Such processes and methods for determining actuarial valuation shall take into account the effect that providing alternative prescription drug coverage (rather than standard prescription drug coverage) has on drug utilization. ‘‘(3) RESPONSIBILITIES.— ‘‘(A) PLAN RESPONSIBILITIES.—PDP sponsors and MA organizations are responsible for the preparation and submission of actuarial valuations required under this part for prescription drug plans and MA–PD plans they offer. ‘‘(B) USE OF OUTSIDE ACTUARIES.—Under the processes and methods established under paragraph (1), PDP sponsors offering prescription drug plans and MA organizations offering MA–PD plans may use actuarial opinions certified by independent, qualified actuaries to establish actuarial values. ‘‘(d) REVIEW OF INFORMATION AND NEGOTIATION.— ‘‘(1) REVIEW OF INFORMATION.—The Secretary shall review the information filed under subsection (b) for the purpose of conducting negotiations under paragraph (2). ‘‘(2) NEGOTIATION REGARDING TERMS AND CONDITIONS.— Subject to subsection (i), in exercising the authority under paragraph (1), the Secretary— ‘‘(A) has the authority to negotiate the terms and conditions of the proposed bid submitted and other terms and conditions of a proposed plan; and ‘‘(B) has authority similar to the authority of the Director of the Office of Personnel Management with respect to health benefits plans under chapter 89 of title 5, United States Code. ‘‘(e) APPROVAL OF PROPOSED PLANS.— ‘‘(1) IN GENERAL.—After review and negotiation under subsection (d), the Secretary shall approve or disapprove the prescription drug plan. ‘‘(2) REQUIREMENTS FOR APPROVAL.—The Secretary may approve a prescription drug plan only if the following requirements are met: ‘‘(A) COMPLIANCE WITH REQUIREMENTS.—The plan and the PDP sponsor offering the plan comply with the requirements under this part, including the provision of qualified prescription drug coverage. ‘‘(B) ACTUARIAL DETERMINATIONS.—The Secretary determines that the plan and PDP sponsor meet the requirements under this part relating to actuarial determinations, including such requirements under section 1860D–2(c). ‘‘(C) APPLICATION OF FEHBP STANDARD.—

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