Page:United States Statutes at Large Volume 124.djvu/477

 124 STAT. 451 PUBLIC LAW 111–148—MAR. 23, 2010 Section 1853 of the Social Security Act (42 U.S.C. 1395w–23), as amended by subsection (f), is amended by adding at the end the following new subsection: ‘‘(o) GRANDFATHERING SUPPLEMENTAL BENEFITS FOR CURRENT ENROLLES AFTER IMPLEMENTATION OF COMPETITIVE BIDDING.— ‘‘(1) IDENTIFICATION OF AREAS.—The Secretary shall iden- tify MA local areas in which, with respect to 2009, average bids submitted by an MA organization under section 1854(a) for MA local plans in the area are not greater than 75 percent of the adjusted average per capita cost for the year involved, determined under section 1876(a)(4), for the area for individuals who are not enrolled in an MA plan under this part for the year, but adjusted to exclude costs attributable to payments under section 1848(o), 1886(n), and 1886(h). ‘‘(2) ELECTION TO PROVIDE REBATES TO GRANDFATHERED ENROLLEES.— ‘‘(A) IN GENERAL.—For years beginning with 2012, each Medicare Advantage organization offering an MA local plan in an area identified by the Secretary under paragraph (1) may elect to provide rebates to grandfathered enrollees under section 1854(b)(1)(C). In the case where an MA organization makes such an election, the monthly per capita dollar amount of such rebates shall not exceed the applicable amount for the year (as defined in subparagraph (B)). ‘‘(B) APPLICABLE AMOUNT.—For purposes of this sub- section, the term ‘applicable amount’ means— ‘‘(i) for 2012, the monthly per capita dollar amount of such rebates provided to enrollees under the MA local plan with respect to 2011; and ‘‘(ii) for a subsequent year, 95 percent of the amount determined under this subparagraph for the preceding year. ‘‘(3) SPECIAL RULES FOR PLANS IN IDENTIFIED AREAS.—Not- withstanding any other provision of this part, the following shall apply with respect to each Medicare Advantage organiza- tion offering an MA local plan in an area identified by the Secretary under paragraph (1) that makes an election described in paragraph (2): ‘‘(A) PAYMENTS.—The amount of the monthly payment under this section to the Medicare Advantage organization, with respect to coverage of a grandfathered enrollee under this part in the area for a month, shall be equal to— ‘‘(i) for 2012 and 2013, the sum of— ‘‘(I) the bid amount under section 1854(a) for the MA local plan; and ‘‘(II) the applicable amount (as defined in para- graph (2)(B)) for the MA local plan for the year. ‘‘(ii) for 2014 and subsequent years, the sum of— ‘‘(I) the MA competitive benchmark amount under subsection (j)(1)(A)(i) for the area for the month, adjusted, only to the extent the Secretary determines necessary, to account for induced utili- zation as a result of rebates provided to grand- fathered enrollees (except that such adjustment shall not exceed 0.5 percent of such MA competi- tive benchmark amount); and Applicability. Definition. Effective date.