259 
costs for beneficiaries with co-morbid conditions and 
associated cognitive impairments. 
(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 ‘‘ (in-
cluding any liability for balance billing consistent 
with this subsection)’’. 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00259
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
260 
(b) 
REVIEW
OF
BID
INFORMATION.—Section 
1854(a)(6)(B) 
of 
such 
Act 
(42 
U.S.C. 
1395w– 
24(a)(6)(B)) is amended— 
(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-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00260
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
261 
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-
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, either— 
‘‘(I) at least 90 percent of the 
enrollees in which are described in 
subparagraph (B)(i), as determined 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00261
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
262 
under regulations in effect as of July 
1, 2007; or 
‘‘(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)); and 
‘‘(iii) as of January 1, 2009, meets 
the applicable requirements of paragraph 
(2) or (3) of subsection (f), as the case 
may be.’’; 
(B) in subsection (b)(6)(B)(iii), by insert-
ing ‘‘only for contract years beginning before 
January 1, 2009,’’ after ‘‘(iii)’’; 
(C) 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) 
with the heading ‘‘REQUIREMENTS
FOR 
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00262
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS
263 
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-
VerDate Aug 31 2005 
05:18 Jul 25, 2007
Jkt 059200
PO 00000
Frm 00263
Fmt 6652
Sfmt 6201
E:\BILLS\H3162.IH
H3162
bajohnson on PROD1PC77 with BILLS