I 

108TH CONGRESS 

1ST SESSION H. R. 841

To amend title XVIII of the Social Security Act to improve access to 

Medicare+Choice plans for special needs Medicare beneficiaries by allowing plans to target enrollment to special needs beneficiaries. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 13, 2003

Mr. RAMSTAD (for himself and Mr. CARDIN) introduced the following bill; 

which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of 

such provisions as fall within the jurisdiction of the committee concerned 

A BILL

To amend title XVIII of the Social Security Act to improve 

access to Medicare+Choice plans for special needs Medicare beneficiaries by allowing plans to target enrollment 

to special needs beneficiaries.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Improve5 ments for Special Needs Beneficiaries Act of 2003’’. 
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1 SEC. 2. SPECIALIZED MEDICARE+CHOICE PLANS FOR SPE2 CIAL NEEDS BENEFICIARIES. 

3 (a) TREATMENT AS COORDINATED CARE PLAN.—

4 Section 1851(a)(2)(A) of the Social Security Act (42 

5 U.S.C. 1395w–21(a)(2)(A)) is amended by adding at the 

6 end the following new sentence: ‘‘Specialized 

7 Medicare+Choice plans for special needs beneficiaries (as 

8 defined in section 1859(b)(4)) may be any type of coordi9 nated care plan.’’. 

10 (b) SPECIALIZED MEDICARE+CHOICE PLAN FOR

11 SPECIAL NEEDS BENEFICIARIES DEFINED.—Section 

12 1859(b) of such Act (42 U.S.C. 1395w–29(b)) is amended 

13 by adding at the end the following new paragraph: 

14 ‘‘(4) SPECIALIZED MEDICARE+CHOICE PLANS

15 FOR SPECIAL NEEDS BENEFICIARIES.—

16 ‘‘(A) IN GENERAL.—The term ‘specialized 

17 Medicare+Choice plan for special needs bene18 ficiaries’ means a Medicare+Choice plan that 

19 exclusively serves special needs beneficiaries (as 

20 defined in subparagraph (B)). 

21 ‘‘(B) SPECIAL NEEDS BENEFICIARY.—The 

22 term ‘special needs beneficiary’ means a 

23 Medicare+Choice eligible individual who—

24 ‘‘(i) is institutionalized (as defined by 

25 the Secretary); 
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1 ‘‘(ii) is entitled to medical assistance 

2 under a State plan under title XIX; or 

3 ‘‘(iii) meets such requirements as the 

4 Secretary may determine would benefit 

5 from enrollment in such a specialized 

6 Medicare+Choice plan described in sub7 paragraph (A) for individuals with severe 

8 or disabling chronic conditions.’’. 

9 (c) RESTRICTION ON ENROLLMENT PERMITTED.—

10 Section 1859 of such Act (42 U.S.C. 1395w–29) is 

11 amended by adding at the end the following new sub12 section: 

13 ‘‘(f) RESTRICTION ON ENROLLMENT FOR SPECIAL14 IZED MEDICARE+CHOICE PLANS FOR SPECIAL NEEDS

15 BENEFICIARIES.—In the case of a specialized 

16 Medicare+Choice plan (as defined in subsection (b)(4)), 

17 notwithstanding any other provision of this part and in 

18 accordance with regulations of the Secretary and for peri19 ods before January 1, 2008, the plan may restrict the en20 rollment of individuals under the plan to individuals who 

21 are within one or more classes of special needs bene22 ficiaries.’’. 

23 (d) REPORT TO CONGRESS.—Not later than Decem24 ber 31, 2006, the Secretary of Health and Human Serv25 ices shall submit to Congress a report that assesses the 
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1 impact of specialized Medicare+Choice plans for special 

2 needs beneficiaries on the cost and quality of services pro3 vided to enrollees. Such report shall include an assessment 

4 of the costs and savings to the medicare program as a 

5 result of amendments made by subsections (a), (b), and 

6 (c). 

7 (e) EFFECTIVE DATES.—

8 (1) IN GENERAL.—The amendments made by 

9 subsections (a), (b), and (c) shall take effect upon 

10 the date of the enactment of this Act. 

11 (2) DEADLINE FOR ISSUANCE OF REQUIRE12 MENTS FOR SPECIAL NEEDS BENEFICIARIES; TRAN13 SITION.—No later than 1 year after the date of the 

14 enactment of this Act, the Secretary of Health and 

15 Human Services shall issue final regulations to es16 tablish requirements for special needs beneficiaries 

17 under section 1859(b)(4)(B)(iii) of the Social Secu18 rity Act, as added by subsection (b).

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