‘‘(ii) Utilization review procedures.
‘‘(iii) The basis for specific utilization
review decisions.
‘‘(iv) Whether a specific prescription
drug or biological is included in the for-
mulary.
‘‘(v) How the eligible organization de-
cides whether a treatment or procedure is
experimental.
‘‘(vi) The patient’s physical or mental
condition or treatment options.
‘‘(C) CONSTRUCTION.—Nothing in this
paragraph shall be construed as preventing an
entity from—
‘‘(i) acting on information relating to
the provision of (or failure to provide)
treatment to a patient, or
‘‘(ii) restricting a medical communica-
tion that recommends one health plan over
another if the sole purpose of the commu-
nication is to secure financial gain for the
health care provider.
‘‘(7) ADDITIONAL DEFINITIONS.—For purposes
of this subsection:
‘‘(A) HEALTH CARE PROVIDER.—The term
‘health care provider’ means anyone licensed
under State law to provide health care services
under part A or part B.
‘‘(B) IN-NETWORK.—The term ‘in-network’
means services provided by health care provid-
ers who have entered into a contract or agree-
ment with the organization under which such
providers are obligated to provide items, treat-
ment, and services under this section to individ-
uals enrolled with the organization under this
section.
‘‘(C) 
NETWORK.—The 
term 
‘network’
means, with respect to an eligible organization,
the health care providers who have entered into
a contract or agreement with the organization
under which such providers are obligated to
provide items, treatment, and services under
this section to individuals enrolled with the or-
ganization under this section.
‘‘(D) OUT-OF-NETWORK.—The term ‘out-
of-network’ means services provided by health
care providers who have not entered into a con-
tract agreement with the organization under
which such providers are obligated to provide
items, treatment, and services under this sec-
tion to individuals enrolled with the organiza-
tion under this section.
‘‘(8) NON-PREEMPTION
OF
STATE
LAW.—A
State may establish or enforce requirements with re-
spect to the subject matter of this subsection, but
only if such requirements are more stringent than
the requirements established under this subsection.’’.
(b) CONFORMING AMENDMENTS.—Section 1876 of
such Act is further amended—
(1) by striking subparagraph (E) of subsection
(c)(3);
(2) by striking paragraphs (4) and (5) of sub-
section (c); and
(3) by striking paragraph (8) of subsection (i).
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to contracts entered into or re-
newed under section 1876 of the Social Security Act after
the expiration of the 1-year period which begins on the
date of the enactment of this Act.
SEC. 4. APPLICATION OF PROTECTIONS TO MEDICARE SE-
LECT POLICIES.
(a) IN GENERAL.—Section 1882(t)(1) of the Social
Security Act (42 U.S.C. 1395ss(t)(1)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (E);
(2) by striking the period at the end of sub-
paragraph (F) and inserting a semicolon; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(G) notwithstanding any other provision
of this section to the contrary, if the issuer of
the policy meets the requirements of section
1876(k) with respect to individuals enrolled
under the policy in the same manner such re-
quirements apply with respect to an eligible or-
ganization under such section with respect to
individuals enrolled with the organization under
such section.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to policies issued or renewed on
or after the expiration of the 1-year period which begins
on the date of the enactment of this Act.
Æ