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115th Congress    }                                 {    Rept. 115-935
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                 {           Part 1

======================================================================



 
          EMPOWERING SENIORS' ENROLLMENT DECISION ACT OF 2018

                                _______
                                

 September 10, 2018.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 6662]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6662) to amend title XVIII of the Social Security 
Act to extend the special election period under part C of the 
Medicare program for certain deemed individuals enrolled in a 
reasonable cost reimbursement contract to certain nondeemed 
individuals enrolled in such contract, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
  I. SUMMARY AND BACKGROUND...........................................2
          A. Purpose and Summary.................................     2
          B. Background and Need for Legislation.................     2
          C. Legislative History.................................     4
 II. EXPLANATION OF THE BILL..........................................4
          A. Empowering Seniors' Enrollment Decision Act of 2018.     4
III. VOTES OF THE COMMITTEE...........................................5
 IV. BUDGET EFFECTS OF THE BILL.......................................5
          A. Committee Estimate of Budgetary Effects.............     5
          B. Statement Regarding New Budget Authority and Tax 
              Expenditures Budget Authority......................     5
          C. Cost Estimate Prepared by the Congressional Budget 
              Office.............................................     5
  V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE.......6
          A. Committee Oversight Findings and Recommendations....     6
          B. Statement of General Performance Goals and 
              Objectives.........................................     6
          C. Information Relating to Unfunded Mandates...........     6
          D. Congressional Earmarks, Limited Tax Benefits, and 
              Limited Tariff Benefits............................     6
          E. Duplication of Federal Programs.....................     6
          F. Disclosure of Directed Rule Makings.................     7
 VI. CORRESPONDENCE...................................................8
VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED...........11
          A. Changes in Existing Law Proposed by the Bill, as 
              Reported...........................................    11

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Empowering Seniors' Enrollment 
Decision Act of 2018''.

SEC. 2. EXTENDING THE SPECIAL ELECTION PERIOD UNDER PART C OF THE 
                    MEDICARE PROGRAM FOR CERTAIN DEEMED INDIVIDUALS 
                    ENROLLED IN A REASONABLE COST REIMBURSEMENT 
                    CONTRACT TO CERTAIN NONDEEMED INDIVIDUALS ENROLLED 
                    IN SUCH CONTRACT.

  Section 1851(e)(2)(F) of the Social Security Act (42 U.S.C. 1395w-
21(e)(2)(F)) is amended--
          (1) in the header, by striking ``deemed elections'' and 
        inserting ``individuals enrolled in a reasonable cost 
        reimbursement contract''; and
          (2) by amending clause (i) to read as follows:
                          ``(i) In general.--
                                  ``(I) Election period.--At any time 
                                during the period beginning after the 
                                last day of the annual, coordinated 
                                election period under paragraph (3) 
                                occurring during an applicable plan 
                                year and ending on the last day of 
                                February of the first plan year 
                                following such applicable plan year, an 
                                individual who is an eligible 
                                individual (as defined in subclause 
                                (II)) with respect to such applicable 
                                plan year may change the election under 
                                subsection (a)(1) (including changing 
                                the MA plan or MA-PD plan in which the 
                                individual is enrolled) for such first 
                                plan year.
                                  ``(II) Eligible individual.--In this 
                                clause, the term `eligible individual' 
                                means, with respect to a plan year, an 
                                individual enrolled in a reasonable 
                                cost reimbursement contract under 
                                section 1876(h) that was extended or 
                                renewed for the last reasonable cost 
                                reimbursement contract year of the 
                                contract (as described in subclause (I) 
                                of section 1876(h)(5)(C)(iv)) pursuant 
                                to such section.''.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    The bill, H.R. 6662, the ``Empowering Seniors' Enrollment 
Decision Act of 2018,'' as ordered reported by the Committee on 
Ways and Means on September 5, 2018, codifies existing 
regulation which allows for non-deemed Medicare Cost Plan 
enrollees to take advantage of the Special Enrollment Period 
(SEP) offered in statute to the deemed Medicare Cost Plan 
enrollees. This will ensure beneficiaries have adequate time to 
make a decision about their Medicare coverage and know that the 
plan they have chosen best fits their needs.

                 B. Background and Need for Legislation

    A Medicare Cost Contract, also known as a Medicare Cost 
Plan, provides the full Medicare benefit package. Payment, 
however, is based on the reasonable cost of providing services 
rather than a capitated payment established through a plan bid 
and benchmark like Medicare Advantage (MA) Plans. Beneficiaries 
enrolled in such plan have no network restrictions.
    The Department of Health and Human Services Office of 
Inspector General (HHS-OIG) has previously expressed concerns 
over duplicative payments and higher costs that may result 
under Medicare Cost Plan contracts. Individual physician 
services are not identified by Medicare Cost Plans when they 
submit cost reports. The cost report states only the aggregate 
cost the plan has incurred for Medicare-covered physician 
services. Medicare's fee-for-service (FFS) claims processing 
contractors reimburse bills submitted by Cost Plans for any 
service that a health plan has paid for and included in its 
cost report. It is the responsibility of the Cost Plans to 
detect duplicate payments and bring them to the attention of 
FFS carriers and Medicare administrative contractors (MACs) for 
recoupment of overpayments. The HHS-OIG has in the past found 
that some cost plans lacked good systems for identifying 
duplicate payments. The cost reimbursement rules applied to 
Medicare Cost Plans allow the plans to pay their physicians 
rates higher than Medicare FFS rates as long as the plan has 
utilization control mechanisms in place; this has the potential 
of increasing total Medicare expenditures for Medicare Cost 
Plan enrollees above what the program would have otherwise 
incurred if members were in traditional Medicare FFS (or, in 
various geographic areas, enrolled in a MA Plan).
    While the Balanced Budget Act of 1997 initiated the process 
of phasing out Medicare Cost Plans, this transition has been 
extended multiple times over the past 20 years. The Medicare 
Access and CHIP Reauthorization Act (MACRA) of 2015 extended 
the transition date and specified additional transition rules. 
Under MACRA, a Medicare Cost Plan must transition to a MA Plan 
by January 1, 2019. Under the current transition rules, as of 
plan year 2019, Cost Plans may only operate if they: (1) have a 
low monthly enrollment (i.e. 1,500 enrollees in rural areas or 
5,000 enrollees in non-rural areas) and (2) if there are less 
than two competing MA plans servicing the area.
    There are approximately 628,989 Medicare beneficiaries 
enrolled in a Cost Plan across the country. Medicare Cost Plans 
are concentrated in certain states and territories such as 
Minnesota, Maryland, Wisconsin, Texas, Virginia, South Dakota, 
California, Colorado, Washington D.C., Iowa, Illinois, North 
Dakota, and New York. Under the existing rules, only 191,296 
beneficiaries, or 30 percent, will be able to remain in their 
current Cost Plan.
    Under existing regulations, certain Medicare beneficiaries 
are entitled to a SEP outside of the two statutory open 
enrollment periods for all Medicare beneficiaries. The first 
statutory open enrollment period begins on October 15th and 
ends on December 7th, and the second statutory open enrollment 
period begins on January 1st and ends on March 31st.
    In statute, Cost Plan enrollees impacted by the mandatory 
transition that are deemed into another MA Plan are able to 
participate in a SEP from December 8th to February 28th. This 
statutory SEP, however, does not apply to non-deemed enrollees. 
Non-deemed enrollees are beneficiaries that are enrolled in a 
Medicare Cost Plan that has decided not to transition to a MA 
Plan in the area in which the beneficiary lives. The non-deemed 
enrollees are able to participate in the SEP due to existing 
regulation.

                         C. Legislative History


Background

    H.R. 6662 was introduced on August 10, 2018, and was 
referred to the Committee on Ways and Means and additionally 
the Committee on Energy and Commerce.

Committee hearings

    On September 21, 2012, the Subcommittee on Health held a 
hearing on Medicare Health Plans to examine the current status 
of the Medicare Advantage program and other health plans, 
including Medicare Cost Plans.

Committee action

    The Committee on Ways and Means marked up H.R. 6662, the 
``Empowering Seniors' Enrollment Decision Act of 2018,'' on 
September 5, 2018, and ordered the bill, as amended, favorably 
reported (with a quorum being present).

                      II. EXPLANATION OF THE BILL


         A. Empowering Seniors' Enrollment Decision Act of 2018


                              PRESENT LAW

    Cost Plan enrollees impacted by the mandatory transition 
that are deemed into another Medicare Advantage (MA) plan are 
able to participate in a special enrollment period (SEP) from 
December 8 to February 28. This statutory SEP, however, does 
not apply to non-deemed enrollees.

                           REASONS FOR CHANGE

    The reason for this change is to align regulation with 
statute and ensure that all impacted Cost Plan enrollees will 
always have access to the SEP from December 8th to February 
28th.

                       EXPLANATION OF PROVISIONS

    Section 1: Short Title: ``Empowering Seniors' Enrollment 
Decision Act of 2018''.
    Section 2: Extending the Special Election Period Under Part 
C of the Medicare Program for Certain Deemed Individuals 
Enrolled in a Reasonable Cost Reimbursement Contract to Certain 
Non-Deemed Individuals Enrolled in Such Contract.
    This section changes the existing statute header to read 
``INDIVIDUALS ENROLLED IN A REASONABLE COST REIMBURSEMENT 
CONTRACT'' and changes the existing statute to include non-
deemed individuals as eligible individuals for the purpose of a 
special enrollment period beginning after the last day of the 
annual, coordinated election period (December 8th) until the 
last day of February of the first plan year (February 28th).

                             EFFECTIVE DATE

    Beginning after the last day of the annual, coordinated 
election period (December 8th) until the last of February of 
the first plan year (February 28th).

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the vote of the Committee on Ways and Means in its 
consideration of H.R. 6662, the ``Empowering Seniors' 
Enrollment Decision Act of 2018,'' on September 5, 2018.
    The Chairman's amendment in the nature of a substitute was 
adopted by a voice vote (with a quorum being present).
    The bill, H.R. 6662, was ordered favorably reported as 
amended by voice vote (with a quorum being present).

                     IV. BUDGET EFFECTS OF THE BILL


               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6662, as 
reported. The Committee agrees with the estimate prepared by 
the Congressional Budget Office (CBO), which is included below.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill involves no new or increased budget authority. The 
Committee states further that the bill involves no new or 
increased tax expenditures.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, requiring a cost estimate 
prepared by the CBO, the following statement by CBO is 
provided.

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 10, 2018.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 6662, the 
Empowering Seniors' Enrollment Decision Act of 2018.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lori Housman.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

H.R. 6662--Empowering Seniors' Enrollment Decision Act of 2018

    H.R. 6662 would codify a current practice that allows 
certain Medicare beneficiaries to use an existing election 
period to change their enrollment in Medicare Advantage plans.
    CBO estimates that enacting this bill would have no 
significant effect on the federal budget. Enacting H.R. 6662 
would not affect direct spending or revenues; therefore, pay-
as-you-go procedures do not apply. CBO estimates that enacting 
H.R. 6662 would not increase net direct spending or on-budget 
deficits in any of the four consecutive 10-year periods 
beginning in 2029.
    H.R. 6662 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Lori Housman 
(for federal costs) and Andrew Laughlin (for private-sector 
mandates). The estimate was reviewed by Theresa Gullo, 
Assistant Director for Budget Analysis.

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE


          A. Committee Oversight Findings and Recommendations

    With respect to clause 3(c)(1) of rule XIII of the Rules of 
the House of Representatives, the Committee made findings and 
recommendations that are reflected in this report.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes funding, so no 
statement of general performance goals and objectives for which 
any measure authorizes funding is required.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

  D. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill, and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   E. Duplication of Federal Programs

    In compliance with Sec. 3(g)(2) of H. Res. 5 (114th 
Congress), the Committee states that no provision of the bill 
establishes or reauthorizes: (1) a program of the Federal 
Government known to be duplicative of another Federal program; 
(2) a program included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139; or (3) a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance, published pursuant to the Federal Program 
Information Act (Pub. L. No. 95-220, as amended by Pub. L. No. 
98-169).

                 F. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (114th Congress), 
the following statement is made concerning directed rule 
makings: The Committee estimates that the bill requires no 
directed rule makings within the meaning of such section.


       VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED


      A. Changes in Existing Law Proposed by the Bill, as Reported

    In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                          SOCIAL SECURITY ACT




           *       *       *       *       *       *       *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

           *       *       *       *       *       *       *



                    Part C--Medicare+Choice Program


                 eligibility, election, and enrollment

  Sec. 1851. (a) Choice of Medicare Benefits Through 
Medicare+Choice Plans.--
          (1) In general.--Subject to the provisions of this 
        section, each Medicare+Choice eligible individual (as 
        defined in paragraph (3)) is entitled to elect to 
        receive benefits (other than qualified prescription 
        drug benefits) under this title--
                  (A) through the original medicare fee-for-
                service program under parts A and B, or
                  (B) through enrollment in a Medicare+Choice 
                plan under this part,
        and may elect qualified prescription drug coverage in 
        accordance with section 1860D-1.
          (2) Types of medicare+choice plans that may be 
        available.--A Medicare+Choice plan may be any of the 
        following types of plans of health insurance:
                  (A) Coordinated care plans (including 
                regional plans).--
                          (i) In general.--Coordinated care 
                        plans which provide health care 
                        services, including but not limited to 
                        health maintenance organization plans 
                        (with or without point of service 
                        options), plans offered by provider-
                        sponsored organizations (as defined in 
                        section 1855(d)), and regional or local 
                        preferred provider organization plans 
                        (including MA regional plans).
                          (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) Combination of msa plan and contributions 
                to medicare+choice msa.--An MSA plan, as 
                defined in section 1859(b)(3), and a 
                contribution into a Medicare+Choice medical 
                savings account (MSA).
                  (C) Private fee-for-service plans.--A 
                Medicare+Choice private fee-for-service plan, 
                as defined in section 1859(b)(2).
          (3) Medicare+choice eligible individual.--In this 
        title, the term ``Medicare+Choice eligible individual'' 
        means an individual who is entitled to benefits under 
        part A and enrolled under part B.
  (b) Special Rules.--
          (1) Residence requirement.--
                  (A) In general.--Except as the Secretary may 
                otherwise provide and except as provided in 
                subparagraph (C), an individual is eligible to 
                elect a Medicare+Choice plan offered by a 
                Medicare+Choice organization only if the plan 
                serves the geographic area in which the 
                individual resides.
                  (B) Continuation of enrollment permitted.--
                Pursuant to rules specified by the Secretary, 
                the Secretary shall provide thatan MA local 
                plan may offer to all individuals residing in a 
                geographic area the option to continue 
                enrollment in the plan, notwithstanding that 
                the individual no longer resides in the service 
                area of the plan, so long as the plan provides 
                that individuals exercising this option have, 
                as part of the benefits under the original 
                medicare fee-for-service program option, 
                reasonable access within that geographic area 
                to the full range of basic benefits, subject to 
                reasonable cost sharing liability in obtaining 
                such benefits.
                  (C) Continuation of enrollment permitted 
                where service changed.--Notwithstanding 
                subparagraph (A) and in addition to 
                subparagraph (B), if a Medicare+Choice 
                organization eliminates from its service area a 
                Medicare+Choice payment area that was 
                previously within its service area, the 
                organization may elect to offer individuals 
                residing in all or portions of the affected 
                area who would otherwise be ineligible to 
                continue enrollment the option to continue 
                enrollment in an MA local plan it offers so 
                long as--
                          (i) the enrollee agrees to receive 
                        the full range of basic benefits 
                        (excluding emergency and urgently 
                        needed care) exclusively at facilities 
                        designated by the organization within 
                        the plan service area; and
                          (ii) there is no other 
                        Medicare+Choice plan offered in the 
                        area in which the enrollee resides at 
                        the time of the organization's 
                        election.
          (2) Special rule for certain individuals covered 
        under fehbp or eligible for veterans or military health 
        benefits, veterans.--
                  (A) FEHBP.--An individual who is enrolled in 
                a health benefit plan under chapter 89 of title 
                5, United States Code, is not eligible to 
                enroll in an MSA plan until such time as the 
                Director of the Office of Management and Budget 
                certifies to the Secretary that the Office of 
                Personnel Management has adopted policies which 
                will ensure that the enrollment of such 
                individuals in such plans will not result in 
                increased expenditures for the Federal 
                Government for health benefit plans under such 
                chapter.
                  (B) VA and dod.--The Secretary may apply 
                rules similar to the rules described in 
                subparagraph (A) in the case of individuals who 
                are eligible for health care benefits under 
                chapter 55 of title 10, United States Code, or 
                under chapter 17 of title 38 of such Code.
          (3) Limitation on eligibility of qualified medicare 
        beneficiaries and other medicaid beneficiaries to 
        enroll in an msa plan.--An individual who is a 
        qualified medicare beneficiary (as defined in section 
        1905(p)(1)), a qualified disabled and working 
        individual (described in section 1905(s)), an 
        individual described in section 1902(a)(10)(E)(iii), or 
        otherwise entitled to medicare cost-sharing under a 
        State plan under title XIX is not eligible to enroll in 
        an MSA plan.
          (4) Coverage under msa plans.--
                  (A) In general.--Under rules established by 
                the Secretary, an individual is not eligible to 
                enroll (or continue enrollment) in an MSA plan 
                for a year unless the individual provides 
                assurances satisfactory to the Secretary that 
                the individual will reside in the United States 
                for at least 183 days during the year.
                  (B) Evaluation.--The Secretary shall 
                regularly evaluate the impact of permitting 
                enrollment in MSA plans under this part on 
                selection (including adverse selection), use of 
                preventive care, access to care, and the 
                financial status of the Trust Funds under this 
                title.
                  (C) Reports.--The Secretary shall submit to 
                Congress periodic reports on the numbers of 
                individuals enrolled in such plans and on the 
                evaluation being conducted under subparagraph 
                (B).
  (c) Process for Exercising Choice.--
          (1) In general.--The Secretary shall establish a 
        process through which elections described in subsection 
        (a) are made and changed, including the form and manner 
        in which such elections are made and changed. Subject 
        to paragraph (4), such elections shall be made or 
        changed only during coverage election periods specified 
        under subsection (e) and shall become effective as 
        provided in subsection (f).
          (2) Coordination through medicare+choice 
        organizations.--
                  (A) Enrollment.--Such process shall permit an 
                individual who wishes to elect a 
                Medicare+Choice plan offered by a 
                Medicare+Choice organization to make such 
                election through the filing of an appropriate 
                election form with the organization.
                  (B) Disenrollment.--Such process shall permit 
                an individual, who has elected a 
                Medicare+Choice plan offered by a 
                Medicare+Choice organization and who wishes to 
                terminate such election, to terminate such 
                election through the filing of an appropriate 
                election form with the organization.
          (3) Default.--
                  (A) Initial election.--
                          (i) In general.--Subject to clause 
                        (ii), an individual who fails to make 
                        an election during an initial election 
                        period under subsection (e)(1) is 
                        deemed to have chosen the original 
                        medicare fee-for-service program 
                        option.
                          (ii) Seamless continuation of 
                        coverage.--The Secretary may establish 
                        procedures under which an individual 
                        who is enrolled in a health plan (other 
                        than Medicare+Choice plan) offered by a 
                        Medicare+Choice organization at the 
                        time of the initial election period and 
                        who fails to elect to receive coverage 
                        other than through the organization is 
                        deemed to have elected the 
                        Medicare+Choice plan offered by the 
                        organization (or, if the organization 
                        offers more than one such plan, such 
                        plan or plans as the Secretary 
                        identifies under such procedures).
                  (B) Continuing periods.--An individual who 
                has made (or is deemed to have made) an 
                election under this section is considered to 
                have continued to make such election until such 
                time as--
                          (i) the individual changes the 
                        election under this section, or
                          (ii) the Medicare+Choice plan with 
                        respect to which such election is in 
                        effect is discontinued or, subject to 
                        subsection (b)(1)(B), no longer serves 
                        the area in which the individual 
                        resides.
          (4) Deemed enrollment relating to converted 
        reasonable cost reimbursement contracts.--
                  (A) In general.--On the first day of the 
                annual, coordinated election period under 
                subsection (e)(3) for plan years beginning on 
                or after January 1, 2017, an MA eligible 
                individual described in clause (i) or (ii) of 
                subparagraph (B) is deemed, unless the 
                individual elects otherwise, to have elected to 
                receive benefits under this title through an 
                applicable MA plan (and shall be enrolled in 
                such plan) beginning with such plan year, if--
                          (i) the individual is enrolled in a 
                        reasonable cost reimbursement contract 
                        under section 1876(h) in the previous 
                        plan year;
                          (ii) such reasonable cost 
                        reimbursement contract was extended or 
                        renewed for the last reasonable cost 
                        reimbursement contract year of the 
                        contract (as described in subclause (I) 
                        of section 1876(h)(5)(C)(iv)) pursuant 
                        to such section;
                          (iii) the eligible organization that 
                        is offering such reasonable cost 
                        reimbursement contract provided the 
                        notice described in subclause (III) of 
                        such section that the contract was to 
                        be converted;
                          (iv) the applicable MA plan--
                                  (I) is the plan that was 
                                converted from the reasonable 
                                cost reimbursement contract 
                                described in clause (iii);
                                  (II) is offered by the same 
                                entity (or an organization 
                                affiliated with such entity 
                                that has a common ownership 
                                interest of control) that 
                                entered into such contract; and
                                  (III) is offered in the 
                                service area where the 
                                individual resides;
                          (v) in the case of reasonable cost 
                        reimbursement contracts that provide 
                        coverage under parts A and B (and, to 
                        the extent the Secretary determines it 
                        to be feasible, contracts that provide 
                        only part B coverage), the difference 
                        between the estimated individual costs 
                        (as determined applicable by the 
                        Secretary) for the applicable MA plan 
                        and such costs for the predecessor cost 
                        plan does not exceed a threshold 
                        established by the Secretary; and
                          (vi) the applicable MA plan--
                                  (I) provides coverage for 
                                enrollees transitioning from 
                                the converted reasonable cost 
                                reimbursement contract to such 
                                plan to maintain current 
                                providers of services and 
                                suppliers and course of 
                                treatment at the time of 
                                enrollment for a period of at 
                                least 90 days after enrollment; 
                                and
                                  (II) during such period, pays 
                                such providers of services and 
                                suppliers for items and 
                                services furnished to the 
                                enrollee an amount that is not 
                                less than the amount of payment 
                                applicable for such items and 
                                services under the original 
                                Medicare fee-for-service 
                                program under parts A and B.
                  (B) MA eligible individuals described.--
                          (i) Without prescription drug 
                        coverage.--An MA eligible individual 
                        described in this clause, with respect 
                        to a plan year, is an MA eligible 
                        individual who is enrolled in a 
                        reasonable cost reimbursement contract 
                        under section 1876(h) in the previous 
                        plan year and who is not, for such 
                        previous plan year, enrolled in a 
                        prescription drug plan under part D, 
                        including coverage under section 1860D-
                        22.
                          (ii) With prescription drug 
                        coverage.--An MA eligible individual 
                        described in this clause, with respect 
                        to a plan year, is an MA eligible 
                        individual who is enrolled in a 
                        reasonable cost reimbursement contract 
                        under section 1876(h) in the previous 
                        plan year and who, for such previous 
                        plan year, is enrolled in a 
                        prescription drug plan under part D--
                                  (I) through such contract; or
                                  (II) through a prescription 
                                drug plan, if the sponsor of 
                                such plan is the same entity 
                                (or an organization affiliated 
                                with such entity) that entered 
                                into such contract.
                  (C) Applicable ma plan defined.--In this 
                paragraph, the term ``applicable MA plan'' 
                means, in the case of an individual described 
                in--
                          (i) subparagraph (B)(i), an MA plan 
                        that is not an MA-PD plan; and
                          (ii) subparagraph (B)(ii), an MA-PD 
                        plan.
                  (D) Identification and notification of deemed 
                individuals.--Not later than 45 days before the 
                first day of the annual, coordinated election 
                period under subsection (e)(3) for plan years 
                beginning on or after January 1, 2017, the 
                Secretary shall identify and notify the 
                individuals who will be subject to deemed 
                elections under subparagraph (A) on the first 
                day of such period.
  (d) Providing Information To Promote Informed Choice.--
          (1) In general.--The Secretary shall provide for 
        activities under this subsection to broadly disseminate 
        information to medicare beneficiaries (and prospective 
        medicare beneficiaries) on the coverage options 
        provided under this section in order to promote an 
        active, informed selection among such options.
          (2) Provision of notice.--
                  (A) Open season notification.--At least 15 
                days before the beginning of each annual, 
                coordinated election period (as defined in 
                subsection (e)(3)(B)), the Secretary shall mail 
                to each Medicare+Choice eligible individual 
                residing in an area the following:
                          (i) General information.--The general 
                        information described in paragraph (3).
                          (ii) List of plans and comparison of 
                        plan options.--A list identifying the 
                        Medicare+Choice plans that are (or will 
                        be) available to residents of the area 
                        and information described in paragraph 
                        (4) concerning such plans. Such 
                        information shall be presented in a 
                        comparative form.
                          (iii) Additional information.--Any 
                        other information that the Secretary 
                        determines will assist the individual 
                        in making the election under this 
                        section.
                The mailing of such information shall be 
                coordinated, to the extent practicable, with 
                the mailing of any annual notice under section 
                1804.
                  (B) Notification to newly eligible 
                medicare+choice eligible individuals.--To the 
                extent practicable, the Secretary shall, not 
                later than 30 days before the beginning of the 
                initial Medicare+Choice enrollment period for 
                an individual described in subsection (e)(1), 
                mail to the individual the information 
                described in subparagraph (A).
                          (ii) Notification related to certain 
                        deemed elections.--The Secretary shall 
                        require a Medicare Advantage 
                        organization that is offering a 
                        Medicare Advantage plan that has been 
                        converted from a reasonable cost 
                        reimbursement contract pursuant to 
                        section 1876(h)(5)(C)(iv) to mail, not 
                        later than 30 days prior to the first 
                        day of the annual, coordinated election 
                        period under subsection (e)(3) of a 
                        year, to any individual enrolled under 
                        such contract and identified by the 
                        Secretary under subsection (c)(4)(D) 
                        for such year--
                                  (I) a notification that such 
                                individual will, on such day, 
                                be deemed to have made an 
                                election with respect to such 
                                plan to receive benefits under 
                                this title through an MA plan 
                                or MA-PD plan (and shall be 
                                enrolled in such plan) for the 
                                next plan year under subsection 
                                (c)(4)(A), but that the 
                                individual may make a different 
                                election during the annual, 
                                coordinated election period for 
                                such year;
                                  (II) the information 
                                described in subparagraph (A);
                                  (III) a description of the 
                                differences between such MA 
                                plan or MA-PD plan and the 
                                reasonable cost reimbursement 
                                contract in which the 
                                individual was most recently 
                                enrolled with respect to 
                                benefits covered under such 
                                plans, including cost-sharing, 
                                premiums, drug coverage, and 
                                provider networks;
                                  (IV) information about the 
                                special period for elections 
                                under subsection (e)(2)(F); and
                                  (V) other information the 
                                Secretary may specify.
                  (C) Form.--The information disseminated under 
                this paragraph shall be written and formatted 
                using language that is easily understandable by 
                medicare beneficiaries.
                  (D) Periodic updating.--The information 
                described in subparagraph (A) shall be updated 
                on at least an annual basis to reflect changes 
                in the availability of Medicare+Choice plans 
                and the benefits and Medicare+Choice monthly 
                basic and supplemental beneficiary premiums for 
                such plans.
          (3) General information.--General information under 
        this paragraph, with respect to coverage under this 
        part during a year, shall include the following:
                  (A) Benefits under original medicare fee-for-
                service program option.--A general description 
                of the benefits covered under the original 
                medicare fee-for-service program under parts A 
                and B, including--
                          (i) covered items and services,
                          (ii) beneficiary cost sharing, such 
                        as deductibles, coinsurance, and 
                        copayment amounts, and
                          (iii) any beneficiary liability for 
                        balance billing.
                  (B) Election procedures.--Information and 
                instructions on how to exercise election 
                options under this section.
                  (C) Rights.--A general description of 
                procedural rights (including grievance and 
                appeals procedures) of beneficiaries under the 
                original medicare fee-for-service program and 
                the Medicare+Choice program and the right to be 
                protected against discrimination based on 
                health status-related factors under section 
                1852(b).
                  (D) Information on medigap and medicare 
                select.--A general description of the benefits, 
                enrollment rights, and other requirements 
                applicable to medicare supplemental policies 
                under section 1882 and provisions relating to 
                medicare select policies described in section 
                1882(t).
                  (E) Potential for contract termination.--The 
                fact that a Medicare+Choice organization may 
                terminate its contract, refuse to renew its 
                contract, or reduce the service area included 
                in its contract, under this part, and the 
                effect of such a termination, nonrenewal, or 
                service area reduction may have on individuals 
                enrolled with the Medicare+Choice plan under 
                this part.
                  (F) Catastrophic coverage and single 
                deductible.--In the case of an MA regional 
                plan, a description of the catastrophic 
                coverage and single deductible applicable under 
                the plan.
          (4) Information comparing plan options.--Information 
        under this paragraph, with respect to a Medicare+Choice 
        plan for a year, shall include the following:
                  (A) Benefits.--The benefits covered under the 
                plan, including the following:
                          (i) Covered items and services beyond 
                        those provided under the original 
                        medicare fee-for-service program.
                          (ii) Any beneficiary cost sharing, 
                        including information on the single 
                        deductible (if applicable) under 
                        section 1858(b)(1).
                          (iii) Any maximum limitations on out-
                        of-pocket expenses.
                          (iv) In the case of an MSA plan, 
                        differences in cost sharing, premiums, 
                        and balance billing under such a plan 
                        compared to under other Medicare+Choice 
                        plans.
                          (v) In the case of a Medicare+Choice 
                        private fee-for-service plan, 
                        differences in cost sharing, premiums, 
                        and balance billing under such a plan 
                        compared to under other Medicare+Choice 
                        plans.
                          (vi) The extent to which an enrollee 
                        may obtain benefits through out-of-
                        network health care providers.
                          (vii) The extent to which an enrollee 
                        may select among in-network providers 
                        and the types of providers 
                        participating in the plan's network.
                          (viii) The organization's coverage of 
                        emergency and urgently needed care.
                  (B) Premiums.--
                          (i) In general.--The monthly amount 
                        of the premium charged to an 
                        individual.
                          (ii) Reductions.--The reduction in 
                        part B premiums, if any.
                  (C) Service area.--The service area of the 
                plan.
                  (D) Quality and performance.--To the extent 
                available, plan quality and performance 
                indicators for the benefits under the plan (and 
                how they compare to such indicators under the 
                original medicare fee-for-service program under 
                parts A and B in the area involved), 
                including--
                          (i) disenrollment rates for medicare 
                        enrollees electing to receive benefits 
                        through the plan for the previous 2 
                        years (excluding disenrollment due to 
                        death or moving outside the plan's 
                        service area),
                          (ii) information on medicare enrollee 
                        satisfaction,
                          (iii) information on health outcomes, 
                        and
                          (iv) the recent record regarding 
                        compliance of the plan with 
                        requirements of this part (as 
                        determined by the Secretary).
                  (E) Supplemental benefits.--Supplemental 
                health care benefits, including any reductions 
                in cost-sharing under section 1852(a)(3) and 
                the terms and conditions (including premiums) 
                for such benefits.
          (5) Maintaining a toll-free number and internet 
        site.--The Secretary shall maintain a toll-free number 
        for inquiries regarding Medicare+Choice options and the 
        operation of this part in all areas in which 
        Medicare+Choice plans are offered and an Internet site 
        through which individuals may electronically obtain 
        information on such options and Medicare+Choice plans.
          (6) Use of non-federal entities.--The Secretary may 
        enter into contracts with non-Federal entities to carry 
        out activities under this subsection.
          (7) Provision of information.--A Medicare+Choice 
        organization shall provide the Secretary with such 
        information on the organization and each 
        Medicare+Choice plan it offers as may be required for 
        the preparation of the information referred to in 
        paragraph (2)(A).
  (e) Coverage Election Periods.--
          (1) Initial choice upon eligibility to make election 
        if medicare+choice plans available to individual.--If, 
        at the time an individual first becomes entitled to 
        benefits under part A and enrolled under part B, there 
        is one or more Medicare+Choice plans offered in the 
        area in which the individual resides, the individual 
        shall make the election under this section during a 
        period specified by the Secretary such that if the 
        individual elects a Medicare+Choice plan during the 
        period, coverage under the plan becomes effective as of 
        the first date on which the individual may receive such 
        coverage. If any portion of an individual's initial 
        enrollment period under part B occurs after the end of 
        the annual, coordinated election period described in 
        paragraph (3)(B)(iii), the initial enrollment period 
        under this part shall further extend through the end of 
        the individual's initial enrollment period under part 
        B.
          (2) Open enrollment and disenrollment 
        opportunities.--Subject to paragraph (5)--
                  (A) Continuous open enrollment and 
                disenrollment through 2005.--At any time during 
                the period beginning January 1, 1998, and 
                ending on December 31, 2005, a Medicare+Choice 
                eligible individual may change the election 
                under subsection (a)(1).
                  (B) Continuous open enrollment and 
                disenrollment for first 6 months during 2006.--
                          (i) In general.--Subject to clause 
                        (ii), subparagraph(C)(iii), and 
                        subparagraph (D), at any time during 
                        the first 6 months of 2006, or, if the 
                        individual first becomes a 
                        Medicare+Choice eligible individual 
                        during 2006, during the first 6 months 
                        during 2006 in which the individual is 
                        a Medicare+Choice eligible individual, 
                        a Medicare+Choice eligible individual 
                        may change the election under 
                        subsection (a)(1).
                          (ii) Limitation of one change.--An 
                        individual may exercise the right under 
                        clause (i) only once. The limitation 
                        under this clause shall not apply to 
                        changes in elections effected during an 
                        annual, coordinated election period 
                        under paragraph (3) or during a special 
                        enrollment period under the first 
                        sentence of paragraph (4).
                  (C) Annual 45-day period from 2011 through 
                2018 for disenrollment from ma plans to elect 
                to receive benefits under the original medicare 
                fee-for-service program.--Subject to 
                subparagraph (D), at any time during the first 
                45 days of a year (beginning with 2011 and 
                ending with 2018), an individual who is 
                enrolled in a Medicare Advantage plan may 
                change the election under subsection (a)(1), 
                but only with respect to coverage under the 
                original medicare fee-for-service program under 
                parts A and B, and may elect qualified 
                prescription drug coverage in accordance with 
                section 1860D-1.
                  (D) Continuous open enrollment for 
                institutionalized individuals.--At any time 
                after 2005 in the case of a Medicare+Choice 
                eligible individual who is institutionalized 
                (as defined by the Secretary), the individual 
                may elect under subsection (a)(1)--
                          (i) to enroll in a Medicare+Choice 
                        plan; or
                          (ii) to change the Medicare+Choice 
                        plan in which the individual is 
                        enrolled.
                  (E) Limited continuous open enrollment of 
                original fee-for-service enrollees in medicare 
                advantage non-prescription drug plans.--
                          (i) In general.--On any date during 
                        the period beginning on January 1, 
                        2007, and ending on July 31, 2007, on 
                        which a Medicare Advantage eligible 
                        individual is an unenrolled fee-for-
                        service individual (as defined in 
                        clause (ii)), the individual may elect 
                        under subsection (a)(1) to enroll in a 
                        Medicare Advantage plan that is not an 
                        MA-PD plan.
                          (ii) Unenrolled fee-for-service 
                        individual defined.--In this 
                        subparagraph, the term ``unenrolled 
                        fee-for-service individual'' means, 
                        with respect to a date, a Medicare 
                        Advantage eligible individual who--
                                  (I) is receiving benefits 
                                under this title through 
                                enrollment in the original 
                                medicare fee-for-service 
                                program under parts A and B;
                                  (II) is not enrolled in an MA 
                                plan on such date; and
                                  (III) as of such date is not 
                                otherwise eligible to elect to 
                                enroll in an MA plan.
                          (iii) Limitation of one change during 
                        the applicable period.--An individual 
                        may exercise the right under clause (i) 
                        only once during the period described 
                        in such clause.
                          (iv) No effect on coverage under a 
                        prescription drug plan.--Nothing in 
                        this subparagraph shall be construed as 
                        permitting an individual exercising the 
                        right under clause (i)--
                                  (I) who is enrolled in a 
                                prescription drug plan under 
                                part D, to disenroll from such 
                                plan or to enroll in a 
                                different prescription drug 
                                plan; or
                                  (II) who is not enrolled in a 
                                prescription drug plan, to 
                                enroll in such a plan.
                  (F) Special period for certain [deemed 
                elections] individuals enrolled in a reasonable 
                cost reimbursement contract.--
                          [(i) In general.--At any time during 
                        the period beginning after the last day 
                        of the annual, coordinated election 
                        period under paragraph (3) in which an 
                        individual is deemed to have elected to 
                        enroll in an MA plan or MA-PD plan 
                        under subsection (c)(4) and ending on 
                        the last day of February of the first 
                        plan year for which the individual is 
                        enrolled in such plan, such individual 
                        may change the election under 
                        subsection (a)(1) (including changing 
                        the MA plan or MA-PD plan in which the 
                        individual is enrolled).]
                          (i) In general.--
                                  (I) Election period.--At any 
                                time during the period 
                                beginning after the last day of 
                                the annual, coordinated 
                                election period under paragraph 
                                (3) occurring during an 
                                applicable plan year and ending 
                                on the last day of February of 
                                the first plan year following 
                                such applicable plan year, an 
                                individual who is an eligible 
                                individual (as defined in 
                                subclause (II)) with respect to 
                                such applicable plan year may 
                                change the election under 
                                subsection (a)(1) (including 
                                changing the MA plan or MA-PD 
                                plan in which the individual is 
                                enrolled) for such first plan 
                                year.
                                  (II) Eligible individual.--In 
                                this clause, the term 
                                ``eligible individual'' means, 
                                with respect to a plan year, an 
                                individual enrolled in a 
                                reasonable cost reimbursement 
                                contract under section 1876(h) 
                                that was extended or renewed 
                                for the last reasonable cost 
                                reimbursement contract year of 
                                the contract (as described in 
                                subclause (I) of section 
                                1876(h)(5)(C)(iv)) pursuant to 
                                such section.
                          (ii) Limitation of one change.--An 
                        individual may exercise the right under 
                        clause (i) only once during the 
                        applicable period described in such 
                        clause. The limitation under this 
                        clause shall not apply to changes in 
                        elections effected during an annual, 
                        coordinated election period under 
                        paragraph (3) or during a special 
                        enrollment period under paragraph (4).
                  (G) Continuous open enrollment and 
                disenrollment for first 3 months in 2016 and 
                subsequent years.--
                          (i) In general.--Subject to clause 
                        (ii) and subparagraph (D)--
                                  (I) in the case of an MA 
                                eligible individual who is 
                                enrolled in an MA plan, at any 
                                time during the first 3 months 
                                of a year (beginning with 
                                2019); or
                                  (II) in the case of an 
                                individual who first becomes an 
                                MA eligible individual during a 
                                year (beginning with 2019) and 
                                enrolls in an MA plan, during 
                                the first 3 months during such 
                                year in which the individual is 
                                an MA eligible individual;
                        such MA eligible individual may change 
                        the election under subsection (a)(1).
                          (ii) Limitation of one change during 
                        open enrollment period each year.--An 
                        individual may change the election 
                        pursuant to clause (i) only once during 
                        the applicable 3-month period described 
                        in such clause in each year. The 
                        limitation under this clause shall not 
                        apply to changes in elections effected 
                        during an annual, coordinated election 
                        period under paragraph (3) or during a 
                        special enrollment period under 
                        paragraph (4).
                          (iii) Limited application to part 
                        d.--Clauses (i) and (ii) of this 
                        subparagraph shall only apply with 
                        respect to changes in enrollment in a 
                        prescription drug plan under part D in 
                        the case of an individual who, previous 
                        to such change in enrollment, is 
                        enrolled in a Medicare Advantage plan.
                          (iv) Limitations on marketing.--
                        Pursuant to subsection (j), no 
                        unsolicited marketing or marketing 
                        materials may be sent to an individual 
                        described in clause (i) during the 
                        continuous open enrollment and 
                        disenrollment period established for 
                        the individual under such clause, 
                        notwithstanding marketing guidelines 
                        established by the Centers for Medicare 
                        & Medicaid Services.
          (3) Annual, coordinated election period.--
                  (A) In general.--Subject to paragraph (5), 
                each individual who is eligible to make an 
                election under this section may change such 
                election during an annual, coordinated election 
                period.
                  (B) Annual, coordinated election period.--For 
                purposes of this section, the term ``annual, 
                coordinated election period'' means--
                          (i) with respect to a year before 
                        2002, the month of November before such 
                        year;
                          (ii) with respect to 2002, 2003, 
                        2004, and 2005, the period beginning on 
                        November 15 and ending on December 31 
                        of the year before such year;
                          (iii) with respect to 2006, the 
                        period beginning on November 15, 2005, 
                        and ending on May 15, 2006;
                          (iv) with respect to 2007, 2008, 
                        2009, and 2010, the period beginning on 
                        November 15 and ending on December 31 
                        of the year before such year; and
                          (v) with respect to 2012 and 
                        succeeding years, the period beginning 
                        on October 15 and ending on December 7 
                        of the year before such year.
                  (C) Medicare+choice health information 
                fairs.--During the fall season of each year 
                (beginning with 1999) and during the period 
                described in subparagraph (B)(iii), in 
                conjunction with the annual coordinated 
                election period defined in subparagraph (B), 
                the Secretary shall provide for a nationally 
                coordinated educational and publicity campaign 
                to inform Medicare+Choice eligible individuals 
                about Medicare+Choice plans and the election 
                process provided under this section.
                  (D) Special information campaigns.--During 
                November 1998 the Secretary shall provide for 
                an educational and publicity campaign to inform 
                Medicare+Choice eligible individuals about the 
                availability of Medicare+Choice plans, and 
                eligible organizations with risk-sharing 
                contracts under section 1876, offered in 
                different areas and the election process 
                provided under this section. During the period 
                described in subparagraph (B)(iii), the 
                Secretary shall provide for an educational and 
                publicity campaign to inform MA eligible 
                individuals about the availability of MA plans 
                (including MA-PD plans) offered in different 
                areas and the election process provided under 
                this section.
          (4) Special election periods.--Effective as of 
        January 1, 2006, an individual may discontinue an 
        election of a Medicare+Choice plan offered by a 
        Medicare+Choice organization other than during an 
        annual, coordinated election period and make a new 
        election under this section if--
                  (A)(i) the certification of the organization 
                or plan under this part has been terminated, or 
                the organization or plan has notified the 
                individual of an impending termination of such 
                certification; or
                  (ii) the organization has terminated or 
                otherwise discontinued providing the plan in 
                the area in which the individual resides, or 
                has notified the individual of an impending 
                termination or discontinuation of such plan;
                  (B) the individual is no longer eligible to 
                elect the plan because of a change in the 
                individual's place of residence or other change 
                in circumstances (specified by the Secretary, 
                but not including termination of the 
                individual's enrollment on the basis described 
                in clause (i) or (ii) of subsection (g)(3)(B));
                  (C) the individual demonstrates (in 
                accordance with guidelines established by the 
                Secretary) that--
                          (i) the organization offering the 
                        plan substantially violated a material 
                        provision of the organization's 
                        contract under this part in relation to 
                        the individual (including the failure 
                        to provide an enrollee on a timely 
                        basis medically necessary care for 
                        which benefits are available under the 
                        plan or the failure to provide such 
                        covered care in accordance with 
                        applicable quality standards); or
                          (ii) the organization (or an agent or 
                        other entity acting on the 
                        organization's behalf) materially 
                        misrepresented the plan's provisions in 
                        marketing the plan to the individual; 
                        or
                  (D) the individual meets such other 
                exceptional conditions as the Secretary may 
                provide.
        Effective as of January 1, 2006, an individual who, 
        upon first becoming eligible for benefits under part A 
        at age 65, enrolls in a Medicare+Choice plan under this 
        part, the individual may discontinue the election of 
        such plan, and elect coverage under the original fee-
        for-service plan, at any time during the 12-month 
        period beginning on the effective date of such 
        enrollment.
          (5) Special rules for msa plans.--Notwithstanding the 
        preceding provisions of this subsection, an 
        individual--
                  (A) may elect an MSA plan only during--
                          (i) an initial open enrollment period 
                        described in paragraph (1), or
                          (ii) an annual, coordinated election 
                        period described in paragraph (3)(B);
                  (B) subject to subparagraph (C), may not 
                discontinue an election of an MSA plan except 
                during the periods described in clause (ii) or 
                (iii) of subparagraph (A) and under the first 
                sentence of paragraph (4); and
                  (C) who elects an MSA plan during an annual, 
                coordinated election period, and who never 
                previously had elected such a plan, may revoke 
                such election, in a manner determined by the 
                Secretary, by not later than December 15 
                following the date of the election.
          (6) Open enrollment periods.--Subject to paragraph 
        (5), a Medicare+Choice organization--
                  (A) shall accept elections or changes to 
                elections during the initial enrollment periods 
                described in paragraph (1), during the period 
                described in paragraph (2)(F), during the month 
                of November 1998 and during the annual, 
                coordinated election period under paragraph (3) 
                for each subsequent year, and during special 
                election periods described in the first 
                sentence of paragraph (4); and
                  (B) may accept other changes to elections at 
                such other times as the organization provides.
  (f) Effectiveness of Elections and Changes of Elections.--
          (1) During initial coverage election period.--An 
        election of coverage made during the initial coverage 
        election period under subsection (e)(1) subsection 
        (e)(1) shall take effect upon the date the individual 
        becomes entitled to benefits under part A and enrolled 
        under part B, except as the Secretary may provide 
        (consistent with section 1838) in order to prevent 
        retroactive coverage.
          (2) During continuous open enrollment periods.--An 
        election or change of coverage made under subsection 
        (e)(2) shall take effect with the first day of the 
        first calendar month following the date on which the 
        election or change is made.
          (3) Annual, coordinated election period.--An election 
        or change of coverage made during an annual, 
        coordinated election period (as defined in subsection 
        (e)(3)(B), other than the period described in clause 
        (iii) of such subsection) in a year shall take effect 
        as of the first day of the following year.
          (4) Other periods.--An election or change of coverage 
        made during any other period under subsection (e)(4) 
        shall take effect in such manner as the Secretary 
        provides in a manner consistent (to the extent 
        practicable) with protecting continuity of health 
        benefit coverage.
  (g) Guaranteed Issue and Renewal.--
          (1) In general.--Except as provided in this 
        subsection, a Medicare+Choice organization shall 
        provide that at any time during which elections are 
        accepted under this section with respect to a 
        Medicare+Choice plan offered by the organization, the 
        organization will accept without restrictions 
        individuals who are eligible to make such election.
          (2) Priority.--If the Secretary determines that a 
        Medicare+Choice organization, in relation to a 
        Medicare+Choice plan it offers, has a capacity limit 
        and the number of Medicare+Choice eligible individuals 
        who elect the plan under this section exceeds the 
        capacity limit, the organization may limit the election 
        of individuals of the plan under this section but only 
        if priority in election is provided--
                  (A) first to such individuals as have elected 
                the plan at the time of the determination, and
                  (B) then to other such individuals in such a 
                manner that does not discriminate, on a basis 
                described in section 1852(b), among the 
                individuals (who seek to elect the plan).
        The preceding sentence shall not apply if it would 
        result in the enrollment of enrollees substantially 
        nonrepresentative, as determined in accordance with 
        regulations of the Secretary, of the medicare 
        population in the service area of the plan.
          (3) Limitation on termination of election.--
                  (A) In general.--Subject to subparagraph (B), 
                a Medicare+Choice organization may not for any 
                reason terminate the election of any individual 
                under this section for a Medicare+Choice plan 
                it offers.
                  (B) Basis for termination of election.--A 
                Medicare+Choice organization may terminate an 
                individual's election under this section with 
                respect to a Medicare+Choice plan it offers 
                if--
                          (i) any Medicare+Choice monthly basic 
                        and supplemental beneficiary premiums 
                        required with respect to such plan are 
                        not paid on a timely basis (consistent 
                        with standards under section 1856 that 
                        provide for a grace period for late 
                        payment of such premiums),
                          (ii) the individual has engaged in 
                        disruptive behavior (as specified in 
                        such standards), or
                          (iii) the plan is terminated with 
                        respect to all individuals under this 
                        part in the area in which the 
                        individual resides.
                  (C) Consequence of termination.--
                          (i) Terminations for cause.--Any 
                        individual whose election is terminated 
                        under clause (i) or (ii) of 
                        subparagraph (B) is deemed to have 
                        elected the original medicare fee-for-
                        service program option described in 
                        subsection (a)(1)(A).
                          (ii) Termination based on plan 
                        termination or service area 
                        reduction.--Any individual whose 
                        election is terminated under 
                        subparagraph (B)(iii) shall have a 
                        special election period under 
                        subsection (e)(4)(A) in which to change 
                        coverage to coverage under another 
                        Medicare+Choice plan. Such an 
                        individual who fails to make an 
                        election during such period is deemed 
                        to have chosen to change coverage to 
                        the original medicare fee-for-service 
                        program option described in subsection 
                        (a)(1)(A).
                  (D) Organization obligation with respect to 
                election forms.--Pursuant to a contract under 
                section 1857, each Medicare+Choice organization 
                receiving an election form under subsection 
                (c)(2) shall transmit to the Secretary (at such 
                time and in such manner as the Secretary may 
                specify) a copy of such form or such other 
                information respecting the election as the 
                Secretary may specify.
  (h) Approval of Marketing Material and Application Forms.--
          (1) Submission.--No marketing material or application 
        form may be distributed by a Medicare+Choice 
        organization to (or for the use of) Medicare+Choice 
        eligible individuals unless--
                  (A) at least 45 days (or 10 days in the case 
                described in paragraph (5)) before the date of 
                distribution the organization has submitted the 
                material or form to the Secretary for review, 
                and
                  (B) the Secretary has not disapproved the 
                distribution of such material or form.
          (2) Review.--The standards established under section 
        1856 shall include guidelines for the review of any 
        material or form submitted and under such guidelines 
        the Secretary shall disapprove (or later require the 
        correction of) such material or form if the material or 
        form is materially inaccurate or misleading or 
        otherwise makes a material misrepresentation.
          (3) Deemed approval (1-stop shopping).--In the case 
        of material or form that is submitted under paragraph 
        (1)(A) to the Secretary or a regional office of the 
        Department of Health and Human Services and the 
        Secretary or the office has not disapproved the 
        distribution of marketing material or form under 
        paragraph (1)(B) with respect to a Medicare+Choice plan 
        in an area, the Secretary is deemed not to have 
        disapproved such distribution in all other areas 
        covered by the plan and organization except with regard 
        to that portion of such material or form that is 
        specific only to an area involved.
          (4) Prohibition of certain marketing practices.--Each 
        Medicare+Choice organization shall conform to fair 
        marketing standards, in relation to Medicare+Choice 
        plans offered under this part, included in the 
        standards established under section 1856. Such 
        standards--
                  (A) shall not permit a Medicare+Choice 
                organization to provide for, subject to 
                subsection (j)(2)(C), cash, gifts, prizes, or 
                other monetary rebates as an inducement for 
                enrollment or otherwise;
                  (B) may include a prohibition against a 
                Medicare+Choice organization (or agent of such 
                an organization) completing any portion of any 
                election form used to carry out elections under 
                this section on behalf of any individual;
                  (C) shall not permit a Medicare Advantage 
                organization (or the agents, brokers, and other 
                third parties representing such organization) 
                to conduct the prohibited activities described 
                in subsection (j)(1); and
                  (D) shall only permit a Medicare Advantage 
                organization (and the agents, brokers, and 
                other third parties representing such 
                organization) to conduct the activities 
                described in subsection (j)(2) in accordance 
                with the limitations established under such 
                subsection.
          (5) Special treatment of marketing material following 
        model marketing language.--In the case of marketing 
        material of an organization that uses, without 
        modification, proposed model language specified by the 
        Secretary, the period specified in paragraph (1)(A) 
        shall be reduced from 45 days to 10 days.
          (6) Required inclusion of plan type in plan name.--
        For plan years beginning on or after January 1, 2010, a 
        Medicare Advantage organization must ensure that the 
        name of each Medicare Advantage plan offered by the 
        Medicare Advantage organization includes the plan type 
        of the plan (using standard terminology developed by 
        the Secretary).
          (7) Strengthening the ability of states to act in 
        collaboration with the secretary to address fraudulent 
        or inappropriate marketing practices.--
                  (A) Appointment of agents and brokers.--Each 
                Medicare Advantage organization shall--
                          (i) only use agents and brokers who 
                        have been licensed under State law to 
                        sell Medicare Advantage plans offered 
                        by the Medicare Advantage organization;
                          (ii) in the case where a State has a 
                        State appointment law, abide by such 
                        law; and
                          (iii) report to the applicable State 
                        the termination of any such agent or 
                        broker, including the reasons for such 
                        termination (as required under 
                        applicable State law).
                  (B) Compliance with state information 
                requests.--Each Medicare Advantage organization 
                shall comply in a timely manner with any 
                request by a State for information regarding 
                the performance of a licensed agent, broker, or 
                other third party representing the Medicare 
                Advantage organization as part of an 
                investigation by the State into the conduct of 
                the agent, broker, or other third party.
  (i) Effect of Election of Medicare+Choice Plan Option.--
          (1) Payments to organizations.--Subject to sections 
        1852(a)(5), 1853(a)(4), 1853(g), 1853(h), 1886(d)(11), 
        1886(h)(3)(D), and 1853(m), payments under a contract 
        with a Medicare+Choice organization under section 
        1853(a) with respect to an individual electing a 
        Medicare+Choice plan offered by the organization shall 
        be instead of the amounts which (in the absence of the 
        contract) would otherwise be payable under parts A and 
        B for items and services furnished to the individual.
          (2) Only organization entitled to payment.--Subject 
        to sections 1853(a)(4), 1853(e), 1853(g), 1853(h), 
        1857(f)(2), 1858(h), 1886(d)(11), and 1886(h)(3)(D), 
        only the Medicare+Choice organization shall be entitled 
        to receive payments from the Secretary under this title 
        for services furnished to the individual.
          (3) FFS payment for expenses for kidney 
        acquisitions.--Paragraphs (1) and (2) shall not apply 
        with respect to expenses for organ acquisitions for 
        kidney transplants described in section 
        1852(a)(1)(B)(i).
  (j) Prohibited Activities Described and Limitations on the 
Conduct of Certain Other Activities.--
          (1) Prohibited activities described.--The following 
        prohibited activities are described in this paragraph:
                  (A) Unsolicited means of direct contact.--Any 
                unsolicited means of direct contact of 
                prospective enrollees, including soliciting 
                door-to-door or any outbound telemarketing 
                without the prospective enrollee initiating 
                contact.
                  (B) Cross-selling.--The sale of other non-
                health related products (such as annuities and 
                life insurance) during any sales or marketing 
                activity or presentation conducted with respect 
                to a Medicare Advantage plan.
                  (C) Meals.--The provision of meals of any 
                sort, regardless of value, to prospective 
                enrollees at promotional and sales activities.
                  (D) Sales and marketing in health care 
                settings and at educational events.--Sales and 
                marketing activities for the enrollment of 
                individuals in Medicare Advantage plans that 
                are conducted--
                          (i) in health care settings in areas 
                        where health care is delivered to 
                        individuals (such as physician offices 
                        and pharmacies), except in the case 
                        where such activities are conducted in 
                        common areas in health care settings; 
                        and
                          (ii) at educational events.
          (2) Limitations.--The Secretary shall establish 
        limitations with respect to at least the following:
                  (A) Scope of marketing appointments.--The 
                scope of any appointment with respect to the 
                marketing of a Medicare Advantage plan. Such 
                limitation shall require advance agreement with 
                a prospective enrollee on the scope of the 
                marketing appointment and documentation of such 
                agreement by the Medicare Advantage 
                organization. In the case where the marketing 
                appointment is in person, such documentation 
                shall be in writing.
                  (B) Co-branding.--The use of the name or logo 
                of a co-branded network provider on Medicare 
                Advantage plan membership and marketing 
                materials.
                  (C) Limitation of gifts to nominal dollar 
                value.--The offering of gifts and other 
                promotional items other than those that are of 
                nominal value (as determined by the Secretary) 
                to prospective enrollees at promotional 
                activities.
                  (D) Compensation.--The use of compensation 
                other than as provided under guidelines 
                established by the Secretary. Such guidelines 
                shall ensure that the use of compensation 
                creates incentives for agents and brokers to 
                enroll individuals in the Medicare Advantage 
                plan that is intended to best meet their health 
                care needs.
                  (E) Required training, annual retraining, and 
                testing of agents, brokers, and other third 
                parties.--The use by a Medicare Advantage 
                organization of any individual as an agent, 
                broker, or other third party representing the 
                organization that has not completed an initial 
                training and testing program and does not 
                complete an annual retraining and testing 
                program.

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