Sectin 3201

SEC. 3202. BENEFIT PROTECTION AND SIMPLIFICATION.

[a] Limitation on Variation of Cost Sharing for Certain Benefits-

[1] IN GENERAL- Section 1852[a][1][B] of the Social Security Act [42 U.S.C. 1395w-22[a][1][B]] is amended--

[A] in clause [i], by inserting ', subject to clause [iii],' after 'and B or'; and

[B] by adding at the end the following new clauses:

'[iii] LIMITATION ON VARIATION OF COST SHARING FOR CERTAIN BENEFITS- Subject to clause [v], cost-sharing for services described in clause [iv] shall not exceed the cost-sharing required for those services under parts A and B.

'[iv] SERVICES DESCRIBED- The following services are described in this clause:

'[I] Chemotherapy administration services.

'[II] Renal dialysis services [as defined in section 1881[b][14][B]].

'[III] Skilled nursing care.

'[IV] Such other services that the Secretary determines appropriate [including services that the Secretary determines require a high level of predictability and transparency for beneficiaries].

'[v] EXCEPTION- In the case of services described in clause [iv] for which there is no cost-sharing required under parts A and B, cost-sharing may be required for those services in accordance with clause [i].'.

[2] EFFECTIVE DATE- The amendments made by this subsection shall apply to plan years beginning on or after January 1, 2011.

[b] Application of Rebates, Performance Bonuses, and Premiums-

[1] APPLICATION OF REBATES- Section 1854[b][1][C] of the Social Security Act [42 U.S.C. 1395w-24[b][1][C]] is amended--

[A] in clause [ii], by striking 'REBATE- A rebate' and inserting 'REBATE FOR PLAN YEARS BEFORE 2012- For plan years before 2012, a rebate';

[B] by redesignating clauses [iii] and [iv] as clauses [iv] and [v]; and

[C] by inserting after clause [ii] the following new clause:

'[iii] FORM OF REBATE FOR PLAN YEAR 2012 AND SUBSEQUENT PLAN YEARS- For plan years beginning on or after January 1, 2012, a rebate required under this subparagraph may not be used for the purpose described in clause [ii][III] and shall be provided through the application of the amount of the rebate in the following priority order:

'[I] First, to use the most significant share to meaningfully reduce cost-sharing otherwise applicable for benefits under the original medicare fee-for-service program under parts A and B and for qualified prescription drug coverage under part D, including the reduction of any deductibles, copayments, and maximum limitations on out-of-pocket expenses otherwise applicable. Any reduction of maximum limitations on out-of-pocket expenses under the preceding sentence shall apply to all benefits under the original medicare fee-for-service program option. The Secretary may provide guidance on meaningfully reducing cost-sharing under this subclause, except that such guidance may not require a particular amount of cost-sharing or reduction in cost-sharing.

'[II] Second, to use the next most significant share to meaningfully provide coverage of preventive and wellness health care benefits [as defined by the Secretary] which are not benefits under the original medicare fee-for-service program, such as smoking cessation, a free flu shot, and an annual physical examination.

'[III] Third, to use the remaining share to meaningfully provide coverage of other health care benefits which are not benefits under the original medicare fee-for-service program, such as eye examinations and dental coverage, and are not benefits described in subclause [II].'.

[2] APPLICATION OF PERFORMANCE BONUSES- Section 1853[n] of the Social Security Act, as added by section 3201[f], is amended by adding at the end the following new paragraph:

'[6] APPLICATION OF PERFORMANCE BONUSES- For plan years beginning on or after January 1, 2014, any performance bonus paid to an MA plan under this subsection shall be used for the purposes, and in the priority order, described in subclauses [I] through [III] of section 1854[b][1][C][iii].'.

[3] APPLICATION OF MA MONTHLY SUPPLEMENTARY BENEFICIARY PREMIUM- Section 1854[b][2][C] of the Social Security Act [42 U.S.C. 1395w-24[b][2][C]] is amended--

[A] by striking 'PREMIUM- The term' and inserting 'PREMIUM-

'[i] IN GENERAL- The term'; and

[B] by adding at the end the following new clause:

'[ii] APPLICATION OF MA MONTHLY SUPPLEMENTARY BENEFICIARY PREMIUM- For plan years beginning on or after January 1, 2012, any MA monthly supplementary beneficiary premium charged to an individual enrolled in an MA plan shall be used for the purposes, and in the priority order, described in subclauses [I] through [III] of paragraph [1][C][iii].'.