I 
109TH CONGRESS 
1ST SESSION H. R. 4050 
To amend title XVIII of the Social Security Act to extend reasonable cost 
contracts under Medicare. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 7, 2005 
Mr. RAMSTAD (for himself, Mr. PETERSON of Minnesota, Mr. OBERSTAR, Mr. 
UDALL of Colorado, Mr. BEAUPREZ, Ms. MCCOLLUM of Minnesota, Mr. 
HEFLEY, and Mr. TANCREDO) 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 de-
termined 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 extend 
reasonable cost contracts under Medicare. 
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 ‘‘Medicare Cost Con-
tract Extension and Refinement Act of 2005’’. 
SEC. 2. EXTENSION OF REASONABLE COST CONTRACTS. 
(a) EXTENSION
OF PERIOD REASONABLE COST 
PLANS
CAN
REMAIN
IN
THE
MARKET.—Section
1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 
1395mm(h)(5)(C)(ii)) is amended— 
(1) in the matter preceding subclause (I)— 
(A) by striking ‘‘January 1, 2008’’ and in-
serting ‘‘January 1, 2012’’; 
(B) by striking ‘‘year’’ and inserting ‘‘two 
years’’; and 
(C) by inserting ‘‘entirely’’ after ‘‘was’’; 
(2) in subclause (I), by inserting ‘‘offered by 
more than one Medicare Advantage organization’’ 
before the semicolon at the end; and 
(3) in subclause (II), by inserting ‘‘offered by 
more than one Medicare Advantage organization’’ 
before the period at the end. 
(b) EXTENSION
OF PERIOD REASONABLE COST 
PLANS CAN EXPAND THEIR SERVICE AREA.—Section 
1876(h)(5)(B)(i) of the Social Security Act (42 U.S.C. 
1395mm(h)(5)(B)(i)) is amended to read as follows: 
‘‘(i) the conditions for prohibiting an extension 
or renewal of a contract under subparagraph (C)(ii) 
are not applicable to such service area at the time 
of the application; and’’.
SEC. 3. APPLICATION OF CERTAIN MEDICARE ADVANTAGE 
REQUIREMENTS TO COST CONTRACTS EX-
TENDED OR RENEWED AFTER 2003. 
Section 1876(h) of the Social Security Act (42 U.S.C. 
1395mm(h)), as amended by section 2, is amended— 
(1) by redesignating paragraph (5) as para-
graph (6); and 
(2) by inserting after paragraph (4) the fol-
lowing new paragraph: 
‘‘(5)(A) Any reasonable cost reimbursement contract 
with an eligible organization under this subsection that is 
extended or renewed on or after the date of enactment 
of the Medicare Cost Contract Extension and Refinement 
Act of 2005 shall provide that the provisions of the Medi-
care Advantage program under part C described in sub-
paragraph (B) shall apply to such organization and such 
contract in a substantially similar manner as such provi-
sions apply to Medicare Advantage organizations and 
Medicare Advantage plans under such part. 
‘‘(B) The provisions described in this subparagraph 
are as follows: 
‘‘(i) Section 1851(d) (relating to the provision 
of information to promote informed choice). 
‘‘(ii) Section 1851(h) (relating to the approval 
of marketing material and application forms).
‘‘(iii) Section 1852(a)(3)(A) (regarding the au-
thority of organizations to include mandatory sup-
plemental health care benefits under the plan subject 
to the approval of the Secretary). 
‘‘(iv) Section 1852(e) (relating to the require-
ment of having an ongoing quality improvement pro-
gram and treatment of accreditation in the same 
manner as such provisions apply to Medicare Advan-
tage local plans that are preferred provider organiza-
tion plans). 
‘‘(v) Section 1852(j)(4) (relating to limitations 
on physician incentive plans). 
‘‘(vi) Section 1854(c) (relating to the require-
ment of uniform premiums among individuals en-
rolled in the plan). 
‘‘(vii) Section 1854(g) (relating to restrictions 
on imposition of premium taxes with respect to pay-
ments to organizations). 
‘‘(viii) Section 1856(b)(3) (relating to relation 
to State laws). 
‘‘(ix) Section 1857(i) (relating to Medicare Ad-
vantage program compatibility with employer or 
union group health plans).
‘‘(x) The provisions of part C relating to 
timelines for contract renewal and beneficiary notifi-
cation.’’. 
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