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(2) The need and feasibility of including further 
gradations of diseases and conditions (such as the 
degree of severity of congestive heart failure). 
(3) The feasibility of measuring difference in 
coding over time between Medicare part C plans and 
the medicare traditional fee-for-service program and, 
to the extent this difference exists, the options for 
addressing it. 
(4) The feasibility and value of including part 
D and other drug utilization data in the risk adjust-
ment model. 
SEC. 425. ELIMINATING SPECIAL TREATMENT OF PRIVATE 
FEE-FOR-SERVICE PLANS. 
(a) ELIMINATION OF EXTRA BILLING PROVISION.— 
Section 1852(k)(2) of the Social Security Act (42 U.S.C. 
1395w–22(k)(2)) is amended— 
(1) in subparagraph (A)(i), by striking ‘‘115 
percent’’ and inserting ‘‘100 percent’’; and 
(2) in subparagraph (C)(i), by striking ‘‘includ-
ing any liability for balance billing consistent with 
this subsection)’’. 
(b) 
REVIEW
OF
BID
INFORMATION.—Section 
1854(a)(6)(B) 
of 
such 
Act 
(42 
U.S.C. 
1395w– 
24(a)(6)(B)) is amended— 
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(1) in clause (i), by striking ‘‘clauses (iii) and 
(iv)’’ and inserting ‘‘clause (iii)’’; and 
(2) by striking clause (iv). 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to contract years beginning with 
2009. 
SEC. 426. RENAMING OF MEDICARE ADVANTAGE PROGRAM. 
(a) IN GENERAL.—The program under part C of title 
XVIII of the Social Security Act is henceforth to be known 
as the ‘‘Medicare Part C program’’. 
(b) CHANGE IN REFERENCES.— 
(1) AMENDING
SOCIAL
SECURITY
ACT.—The 
Social Security Act is amended by striking ‘‘Medi-
care Advantage’’, ‘‘MA’’, and ‘‘Medicare+Choice’’ 
and inserting ‘‘Medicare Part C’’ each place it ap-
pears, with the appropriate, respective typographic 
formatting, including typeface and capitalization. 
(2) 
ADDITIONAL
REFERENCES.—Notwith-
standing section 201(b) of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 
(Public Law 108–173), any reference to the pro-
gram under part C of title XVIII of the Social Secu-
rity Act shall be deemed a reference to the ‘‘Medi-
care Part C’’ program and, with respect to such 
part, any reference to ‘‘Medicare+Choice’’. ‘‘Medi-
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care Advantage’’, or ‘‘MA’’ is deemed a reference to 
the program under such part. 
Subtitle D—Extension of 
Authorities 
SEC. 431. EXTENSION AND REVISION OF AUTHORITY FOR 
SPECIAL NEEDS PLANS (SNPS). 
(a) EXTENDING RESTRICTION ON ENROLLMENT AU-
THORITY FOR SNPS FOR 3 YEARS.—Subsection (f) of sec-
tion 1859 of the Social Security Act (42 U.S.C. 1395w– 
28) is amended by striking ‘‘2009’’ and inserting ‘‘2012’’. 
(b) STRUCTURE OF AUTHORITY FOR SNPS.— 
(1) IN
GENERAL.—Such section is further 
amended— 
(A) in subsection (b)(6)(A), by striking all 
that follows ‘‘means’’ and inserting the fol-
lowing: ‘‘an MA plan— 
‘‘(i) that serves special needs individ-
uals (as defined in subparagraph (B)); 
‘‘(ii) as of January 1, 2009— 
‘‘(I) at least 90 percent of the 
enrollees which are described in sub-
paragraph 
(B)(i), 
as 
determined 
under regulations in effect as of July 
1, 2007; 
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‘‘(II) at least 90 percent of the 
enrollees in which are described in 
subparagraph (B)(ii) and are full-ben-
efit dual eligible individuals (as de-
fined in section 1935(c)(6)) or quali-
fied medicare beneficiaries (as defined 
in section 1905(p)(1)); or 
‘‘(III) at least 90 percent of the 
enrollees in which have a severe or 
disabling chronic condition of the type 
that the plan is committed to serve as 
indicated by the data submitted for 
the risk-adjustment of plan payments; 
and 
‘‘(iii) as of January 1, 2009, meets 
the applicable requirements of paragraph 
(2) or (3) of subsection (f), as the case 
may be.’’; and 
(B) in subsection (f)— 
(i) by amending the heading to read 
as follows: ‘‘REQUIREMENTS FOR ENROLL-
MENT
IN PART C PLANS
FOR SPECIAL 
NEEDS BENEFICIARIES’’; 
(ii) by designating the sentence begin-
ning ‘‘In the case of’’ as paragraph (1) 
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with the heading ‘‘REQUIREMENTS
FOR 
ENROLLMENT.—’’ and with appropriate in-
dentation; and 
(iii) by adding at the end the fol-
lowing new paragraphs: 
‘‘(2) ADDITIONAL REQUIREMENTS FOR INSTI-
TUTIONAL SNPS.—In the case of a specialized MA 
plan for special needs individuals described in sub-
section (b)(6)(A)(ii)(I), the applicable requirements 
of this subsection are as follows: 
‘‘(A) The plan has an agreement with the 
State that includes provisions regarding co-
operation on the coordination of care for such 
individuals. Such agreement shall include a de-
scription of the manner that the State Medicaid 
program under title XIX will pay for the costs 
of services for individuals eligible under such 
title for medical assistance for acute care and 
long-term care services. 
‘‘(B) The plan has a contract with long- 
term care facilities and other providers in the 
area sufficient to provide care for enrollees de-
scribed in subsection (b)(6)(B)(i). 
‘‘(C) The plan reports to the Secretary in-
formation on additional quality measures speci-
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fied 
by 
the 
Secretary 
under 
section 
1852(e)(3)(D)(iv)(I) for such plans. 
‘‘(3) ADDITIONAL
REQUIREMENTS
FOR
DUAL 
SNPS.—In the case of a specialized MA plan for spe-
cial needs individuals described in subsection 
(b)(6)(A)(ii)(II), the applicable requirements of this 
subsection are as follows: 
‘‘(A) The plan has an agreement with the 
State Medicaid agency that— 
‘‘(i) includes provisions regarding co-
operation on the coordination of the fi-
nancing of care for such individuals; 
‘‘(ii) includes a description of the 
manner that the State Medicaid program 
under title XIX will pay for the costs of 
cost-sharing and supplemental services for 
individuals enrolled in the plan eligible 
under such title for medical assistance for 
acute and long-term care services; and 
‘‘(iii) effective January 1, 2011, pro-
vides for capitation payments to cover 
costs of supplemental benefits for individ-
uals 
described 
in 
subsection 
(b)(6)(A)(ii)(II). 
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‘‘(B) The out-of-pocket costs for services 
under parts A and B that are charged to enroll-
ees may not exceed the out-of-pocket costs for 
same services permitted for such individuals 
under title XIX. 
‘‘(C) The plan reports to the Secretary in-
formation on additional quality measures speci-
fied 
by 
the 
Secretary 
under 
section 
1852(e)(3)(D)(iv)(II) for such plans. 
‘‘(4) ADDITIONAL REQUIREMENTS FOR SEVERE 
OR DISABLING CHRONIC CONDITION SNPS.—In the 
case of a specialized MA plan for special needs indi-
viduals described in subsection (b)(6)(A)(ii)(III), the 
applicable requirements of this subsection are as fol-
lows: 
‘‘(A) The plan is designated to serve, and 
serves, Medicare beneficiaries with one or more 
of the following specific severe or disabling 
chronic conditions: 
‘‘(i) Cardiovascular. 
‘‘(ii) Cerebrovascular. 
‘‘(iii) Congestive health failure. 
‘‘(iv) Diabetes. 
‘‘(v) Chronic obstructive pulmonary 
disease. 
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‘‘(vi) HIV/AIDS. 
‘‘(B) The plan has an average risk score 
under section 1853(a)(1)(C) of 1.35 or greater. 
‘‘(C) The plan has established and actively 
manages a chronic care improvement program 
under section 1852(e)(2) for each of the condi-
tions that it serves under subparagraph (A) 
that significantly exceeds the features and re-
sults of such programs established and man-
aged by Medicare Part C plans that are not 
specialized Medicare Part C plans for special 
needs individuals of the type described in this 
paragraph. 
‘‘(D) The plan has a network of a suffi-
cient number of primary care and specialty phy-
sicians, hospitals, and other health care pro-
viders under contract to the plan so that the 
plan can clearly meet the routine and specialty 
needs of the severely ill and disabled enrollees 
of the plan throughout the service area of the 
plan. 
‘‘(E) The plan reports to the Secretary in-
formation on additional quality measures speci-
fied 
by 
the 
Secretary 
under 
section 
1852(e)(3)(D)(iv)(III) for such plans.’’. 
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