Page:United States Statutes at Large Volume 120.djvu/81

 120 STAT. 50

PUBLIC LAW 109–171—FEB. 8, 2006 under subsection (c)(1) for the area and year, adjusted pursuant to subsection (a)(1)(C). ‘‘(III) RISK RATE.—The risk rate described in this subclause is the Secretary’s estimate of the total payments that would have been made under this part in the year if all the monthly payment amounts for all MA plans were equal to the amount described in subsection (j)(1)(A) (determined as if this paragraph had not applied) under subsection (j) for the area and year, adjusted pursuant to subsection (a)(1)(C). ‘‘(iii) DENOMINATOR BASED ON RISK RATE.—The denominator described in this clause is equal to the total amount estimated for the year under clause (ii)(III). ‘‘(iv) REQUIREMENTS.—In estimating the amounts under the previous clauses, the Secretary shall— ‘‘(I) use a complete set of the most recent and representative Medicare Advantage risk scores under subsection (a)(3) that are available from the risk adjustment model announced for the year; ‘‘(II) adjust the risk scores to reflect changes in treatment and coding practices in the fee-forservice sector; ‘‘(III) adjust the risk scores for differences in coding patterns between Medicare Advantage plans and providers under the original Medicare fee-for-service program under parts A and B to the extent that the Secretary has identified such differences, as required in subsection (a)(1)(C); ‘‘(IV) as necessary, adjust the risk scores for late data submitted by Medicare Advantage organizations; ‘‘(V) as necessary, adjust the risk scores for lagged cohorts; and ‘‘(VI) as necessary, adjust the risk scores for changes in enrollment in Medicare Advantage plans during the year. ‘‘(v) AUTHORITY.—In computing such amounts the Secretary may take into account the estimated health risk of enrollees in preferred provider organization plans (including MA regional plans) for the year. ‘‘(C) APPLICABLE PHASE-OUT FACTOR.—For purposes of subparagraph (A)(ii), the term ‘applicable phase-out factor’ means— ‘‘(i) for 2007, 0.55; ‘‘(ii) for 2008, 0.40; ‘‘(iii) for 2009, 0.25; and ‘‘(iv) for 2010, 0.05. ‘‘(D) TERMINATION OF APPLICATION.—Subparagraph (A) shall not apply in a year if the amount estimated under subparagraph (B)(ii)(III) for the year is equal to or greater than the amount estimated under subparagraph (B)(ii)(II) for the year. ‘‘(3) NO REVISION IN PERCENT.—

VerDate 14-DEC-2004

10:20 Jul 12, 2007

Jkt 059194

PO 00001

Frm 00048

Fmt 6580

Sfmt 6581

E:\PUBLAW\PUBL001.109

APPS06

PsN: PUBL001

�