TITLE II--MEDICARE ADVANTAGE
Subtitle D--Additional Reforms
SEC. 231. SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS.
(a) TREATMENT AS COORDINATED CARE PLAN- Section
1851(a)(2)(A) (42 U.S.C. 1395w-21(a)(2)(A)), as amended by section 221(a), is
amended by adding at the end the following new clause:
`(ii) SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS-
Specialized MA plans for special needs individuals (as defined in
section 1859(b)(6)) may be any type of coordinated care
plan.'.
(b) SPECIALIZED MA PLAN FOR SPECIAL NEEDS INDIVIDUALS
DEFINED- Section 1859(b) (42 U.S.C. 1395w-29(b)), as amended by section 221(b),
is amended by adding at the end the following new paragraph:
`(6) SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS-
`(A) IN GENERAL- The term `specialized MA plan for special needs
individuals' means an MA plan that exclusively serves special needs
individuals (as defined in subparagraph (B)).
`(B) SPECIAL NEEDS INDIVIDUAL- The term `special needs individual'
means an MA eligible individual who--
`(i) is institutionalized (as defined by the Secretary);
`(ii) is entitled to medical assistance under a State plan under
title XIX; or
`(iii) meets such requirements as the Secretary may determine would
benefit from enrollment in such a specialized MA plan described in
subparagraph (A) for individuals with severe or disabling chronic
conditions.
The Secretary may waive application of section 1851(a)(3)(B) in the
case of an individual described in clause (i), (ii), or (iii) of this
subparagraph and may apply rules similar to the rules of section
1894(c)(4) for continued eligibility of special needs
individuals.'.
(c) RESTRICTION ON ENROLLMENT PERMITTED- Section
1859 (42 U.S.C. 1395w-29) is amended by adding at the end the following new
subsection:
`(f) RESTRICTION ON ENROLLMENT FOR SPECIALIZED MA PLANS FOR SPECIAL NEEDS
INDIVIDUALS- In the case of a specialized MA plan for special needs
individuals (as defined in subsection (b)(6)), notwithstanding any other
provision of this part and in accordance with regulations of the Secretary and
for periods before January 1, 2009, the plan may restrict the enrollment of
individuals under the plan to individuals who are within one or more classes
of special needs individuals.'.
(d) AUTHORITY TO DESIGNATE OTHER PLANS AS SPECIALIZED
MA PLANS- In promulgating regulations to carry out section 1851(a)(2)(A)(ii)
of the Social Security Act (as added by subsection (a)) and section 1859(b)(6)
of such Act (as added by subsection (b)), the Secretary may provide (notwithstanding
section 1859(b)(6)(A) of such Act) for the offering of specialized MA plans
for special needs individuals by MA plans that disproportionately serve special
needs individuals.
(e) REPORT TO CONGRESS- Not later than December
31, 2007, the Secretary shall submit to Congress a report that assesses the
impact of specialized MA plans for special needs individuals on the cost and
quality of services provided to enrollees. Such report shall include an assessment
of the costs and savings to the medicare program as a result of amendments made
by subsections (a), (b), and (c).
(1) IN GENERAL- The amendments made
by subsections (a), (b), and (c) shall take effect upon the date of the enactment
of this Act.
(2) DEADLINE FOR ISSUANCE OF REQUIREMENTS
FOR SPECIAL NEEDS INDIVIDUALS; TRANSITION- No later than 1 year after the
date of the enactment of this Act, the Secretary shall issue final regulations
to establish requirements for special needs individuals under section 1859(b)(6)(B)(iii)
of the Social Security Act, as added by subsection (b).
