I 
110TH CONGRESS 
2D SESSION 
H. R. 6174 
To amend part C of title XVIII of the Social Security Act to reduce variation 
in Medicare Advantage payment rates among counties within the same 
State within certain very large metropolitan area. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 3, 2008 
Mr. WEXLER introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend part C of title XVIII of the Social Security Act 
to reduce variation in Medicare Advantage payment rates 
among counties within the same State within certain 
very large metropolitan area. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Equality in Medicare 
Advantage Payment Act of 2008’’. 
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SEC. 2. REDUCING VARIATION IN MEDICARE ADVANTAGE 
PAYMENT RATES AMONG COUNTIES IN THE 
SAME STATE WITHIN CERTAIN VERY LARGE 
METROPOLITAN AREAS. 
Section 1853(k) of the Social Security Act (42 U.S.C. 
1395w–23(k)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) BUDGET-NEUTRAL
ADJUSTMENT
TO
RE-
DUCE VARIATION IN APPLICABLE AMOUNTS AMONG 
MA LOCAL AREAS WITHIN SAME STATE IN A VERY 
LARGE METROPOLITAN AREA.— 
‘‘(A) IN GENERAL.—Beginning with 2009, 
the Secretary shall adjust the applicable 
amount so that, for MA local areas located 
within the same State within a very large met-
ropolitan area described in subparagraph (B), 
the lowest applicable amount for such an MA 
local area is not less than the applicable min-
imum percentage (specified in subparagraph 
(C)) of the highest applicable amount for such 
an MA local area. Such adjustment shall be 
made in a manner, as estimated by the Sec-
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retary, that does not result in any increase or 
decrease in aggregate payments under this title. 
‘‘(B) VERY
LARGE
METROPOLITAN
AREA 
DESCRIBED.—A very large metropolitan area 
described in this subparagraph is a metropoli-
tan statistical area which, based on the data 
from the 2000 Census, has a population of not 
less than 5,000,000, and which has, within such 
area, more than one MA local area (but not 
more than three MA local areas) within the 
same State. 
‘‘(C) APPLICABLE
MINIMUM
PERCENT-
AGE.—The applicable minimum percentage 
specified in this subparagraph— 
‘‘(i) for 2009 is 85 percent; 
‘‘(ii) for 2010 is 90 percent; 
‘‘(iii) for 2011 is 95 percent; and 
‘‘(iv) for a subsequent year is 97 per-
cent.’’. 
Æ 
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