BENEFICIARIES.—In 
the 
case 
of 
a 
specialized
Medicare+Choice plan (as defined in subsection (b)(4)),
notwithstanding any other provision of this part and in
accordance with regulations of the Secretary and for peri-
ods before January 1, 2007, the plan may restrict the en-
rollment of individuals under the plan to individuals who
are within one or more classes of special needs bene-
ficiaries.’’.
(d) REPORT TO CONGRESS.—Not later than Decem-
ber 31, 2005, the Medicare Benefits Administrator shall
submit to Congress a report that assesses the impact of
specialized Medicare+Choice plans for special needs bene-
ficiaries on the cost and quality of services provided to
enrollees. Such report shall include an assessment of the
costs and savings to the medicare program as a result of
amendments made by subsections (a), (b), and (c).
(e) EFFECTIVE DATES.—
(1) IN GENERAL.—The amendments made by
subsections (a), (b), and (c) shall take effect upon
the date of the enactment of this Act.
(2) DEADLINE
FOR
ISSUANCE
OF
REQUIRE-
MENTS FOR SPECIAL NEEDS BENEFICIARIES; TRAN-
SITION.—No later than 6 months after the date of
the enactment of this Act, the Secretary of Health
and Human Services shall issue final regulations to
establish requirements for special needs beneficiaries
under section 1859(b)(4)(B)(iii) of the Social Secu-
rity Act, as added by subsection (b).
SEC. 205. MEDICARE MSAS.
(a) EXEMPTION FROM QUALITY ASSURANCE PRO-
GRAM REQUIREMENT.—
(1) IN
GENERAL.—Section 1852(e)(1) (42
U.S.C. 1395w–22(e)(1)) is amended by inserting
‘‘(other than MSA plans)’’ after ‘‘Medicare+Choice
plans’’.
(2) CONFORMING AMENDMENTS.—Section 1852
(42 U.S.C. 1395w–22) is amended—
(A) in subsection (c)(1)(I), by inserting be-
fore the period at the end the following: ‘‘if re-
quired under such section’’; and
(B) in subparagraphs (A) and (B) of sub-
section (e)(2), by striking ‘‘, a non-network
MSA 
plan,’’ 
and 
‘‘, 
NON-NETWORK
MSA
PLANS,’’ each place it appears.
(b) MAKING PROGRAM PERMANENT
AND ELIMI-
NATING CAP.—Section 1851(b)(4) (42 U.S.C. 1395w–
21(b)(4)) is amended—
(1) in the heading of subparagraph (A), by
striking ‘‘ON A DEMONSTRATION BASIS’’;
(2) by striking the first sentence of subpara-
graph (A); and
(3) by striking the second sentence of subpara-
graph (C).
(c) APPLYING LIMITATIONS
ON BALANCE BILL-
ING.—Section 1852(k)(1) (42 U.S.C. 1395w–22(k)(1)) is
amended by inserting ‘‘or with an organization offering
a MSA plan’’ after ‘‘section 1851(a)(2)(A)’’.
(d) 
ADDITIONAL
AMENDMENT.—Section
1851(e)(5)(A) 
(42 
U.S.C. 
1395w–21(e)(5)(A)) 
is
amended—
(1) by adding ‘‘or’’ at the end of clause (i);
(2) by striking ‘‘, or’’ at the end of clause (ii)
and inserting a semicolon; and
(3) by striking clause (iii).
SEC. 206. EXTENSION OF REASONABLE COST AND SHMO
CONTRACTS.
(a) REASONABLE COST CONTRACTS.—
(1) IN GENERAL.—Section 1876(h)(5)(C) (42
U.S.C. 1395mm(h)(5)(C)) is amended—
(A) by inserting ‘‘(i)’’ after ‘‘(C)’’;
(B) by inserting before the period the fol-
lowing: ‘‘, except (subject to clause (ii)) in the
case of a contract for an area which is not cov-
ered in the service area of 1 or more coordi-
nated care Medicare+Choice plans under part
C’’; and
(C) by adding at the end the following new
clause:
‘‘(ii) In the case in which—
‘‘(I) a reasonable cost reimbursement contract
includes an area in its service area as of a date that
is after December 31, 2003;
‘‘(II) such area is no longer included in such
service area after such date by reason of the oper-
ation of clause (i) because of the inclusion of such
area within the service area of a Medicare+Choice
plan; and
‘‘(III) all Medicare+Choice plans subsequently
terminate coverage in such area;
such reasonable cost reimbursement contract may be ex-
tended and renewed to cover such area (so long as it is
not included in the service area of any Medicare+Choice
plan).’’.
(2) STUDY.—The Medicare Benefits Adminis-
trator shall conduct a study of an appropriate tran-
sition for plans offered under reasonable cost con-
tracts under section 1876 of the Social Security Act
on and after January 1, 2005. Such a transition
may take into account whether there are one or
more coordinated care Medicare+Choice plans being
offered in the areas involved. Not later than Feb-
ruary 1, 2004, the Administrator shall submit to
Congress a report on such study and shall include
recommendations regarding any changes in the
amendment made by paragraph (1) as the Adminis-
trator determines to be appropriate.
(b) EXTENSION OF SOCIAL HEALTH MAINTENANCE
ORGANIZATION (SHMO) DEMONSTRATION PROJECT.—
(1) IN GENERAL.—Section 4018(b)(1) of the
Omnibus Budget Reconciliation Act of 1987 is
amended by striking ‘‘the date that is 30 months
after the date that the Secretary submits to Con-
gress the report described in section 4014(c) of the
Balanced Budget Act of 1997’’ and inserting ‘‘De-
cember 31, 2004’’.
(2) SHMOS
OFFERING
MEDICARE+CHOICE
PLANS.—Nothing in such section 4018 shall be con-
strued as preventing a social health maintenance or-
ganization from offering a Medicare+Choice plan
under part C of title XVIII of the Social Security
Act.
Subtitle B—Medicare+Choice
Competition Program
SEC. 211. MEDICARE+CHOICE COMPETITION PROGRAM.
(a) SUBMISSION OF BID AMOUNTS.—Section 1854
(42 U.S.C. 1395w–24) is amended—
(1) by amending the heading to read as follows:
‘‘SUBMISSION OF BID AMOUNTS’’;
(2) in subsection (a)(1)(A)—
(A) by striking ‘‘(A)’’ and inserting ‘‘(A)(i)
if the following year is before 2005,’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘ or (ii) if the following
year is 2005 or later, the information described
in paragraph (6)(A)’’; and
(3) by adding at the end of subsection (a) the
following:
‘‘(6) 
SUBMISSION
OF
BID
AMOUNTS
BY
MEDICARE+CHOICE ORGANIZATIONS.—
‘‘(A) INFORMATION TO BE SUBMITTED.—
The information described in this subparagraph
is as follows:
‘‘(i) 
The 
monthly 
aggregate 
bid
amount for provision of all items and serv-
ices under this part and the actuarial basis
for determining such amount.
‘‘(ii) The proportions of such bid
amount that are attributable to—
‘‘(I) the provision of statutory
non-drug benefits (such portion re-
ferred 
to 
in 
this 
part 
as 
the
‘unadjusted non-drug monthly bid
amount’);
‘‘(II) the provision of statutory
prescription drug benefits; and
‘‘(III) the provision of non-statu-
tory benefits;
and the actuarial basis for determining
such proportions.
‘‘(iii) Such additional information as
the Administrator may require to verify
the actuarial bases described in clauses (i)
and (ii).
‘‘(B) STATUTORY
BENEFITS
DEFINED.—
For purposes of this part:
‘‘(i) The term ‘statutory non-drug
benefits’ means benefits under parts A and
B.
‘‘(ii) The term ‘statutory prescription
drug benefits’ means benefits under part
D.
‘‘(iii) The term ‘statutory benefits’
means statutory prescription drug benefits
and statutory non-drug benefits.
‘‘(C) ACCEPTANCE AND NEGOTIATION OF
BID AMOUNTS.—The Administrator has the au-
thority to negotiate regarding monthly bid
amounts submitted under subparagraph (A)
(and the proportion described in subparagraph
(A)(ii)). The Administrator may reject such a
bid amount or proportion if the Administrator
determines that such amount or proportion is
not supported by the actuarial bases provided
under subparagraph (A).’’.
(b) PROVIDING
FOR BENEFICIARY SAVINGS
FOR
CERTAIN PLANS.—
(1) IN GENERAL.—Section 1854(b) (42 U.S.C.
1395w–24(b)) is amended—
(A) by adding at the end of paragraph (1)
the following new subparagraph:
‘‘(C) BENEFICIARY REBATE RULE.—
‘‘(i) 
REQUIREMENT.—The
Medicare+Choice plan shall provide to the
enrollee a monthly rebate equal to 75
percent of the average per capita savings
(if any) described in paragraph (3) appli-
cable to the plan and year involved.
‘‘(iii) FORM
OF
REBATE.—A rebate
required under this subparagraph shall be
provided—
‘‘(I) through the crediting of the
amount of the rebate towards the
Medicare+Choice 
monthly 
supple-
mentary beneficiary premium or the
premium imposed for prescription
drug coverage under part D;
‘‘(II) through a direct monthly
payment (through electronic funds
transfer or otherwise); or
‘‘(III) through other means ap-
proved by the Medicare Benefits Ad-
ministrator,
or any combination thereof.’’; and
(B) by adding at the end the following new
paragraph:
‘‘(3) COMPUTATION OF AVERAGE PER CAPITA
MONTHLY
SAVINGS.—For purposes of paragraph
(1)(C)(i), the average per capita monthly savings re-
ferred to in such paragraph for a Medicare+Choice
plan and year is computed as follows:
‘‘(A) DETERMINATION OF STATE-WIDE AV-
ERAGE RISK ADJUSTMENT.—
‘‘(i) IN
GENERAL.—The Medicare
Benefits Administrator shall determine, at
the same time rates are promulgated under
section 1853(b)(1) (beginning with 2005),
for each State the average of the risk ad-
justment factors to be applied to enrollees
under section 1853(a)(1)(A) in that State.
In the case of a State in which a
Medicare+Choice plan was offered in the
previous year, the Administrator may com-
pute such average based upon risk adjust-
ment factors applied in that State in a pre-
vious year.
‘‘(ii) TREATMENT OF NEW STATES.—
In the case of a State in which no
Medicare+Choice plan was offered in the
previous year, the Administrator shall esti-
mate such average. In making such esti-
mate, the Administrator may use average
risk adjustment factors applied to com-
parable States or applied on a national
basis.
‘‘(B) DETERMINATION OF RISK ADJUSTED
BENCHMARK
AND
RISK-ADJUSTED
BID.—For
each Medicare+Choice plan offered in a State,
the Administrator shall—
‘‘(i) adjust the fee-for-service area-
specific non-drug benchmark amount by
the applicable average risk adjustment fac-
tor computed under subparagraph (A); and
‘‘(ii) adjust the unadjusted non-drug
monthly bid amount by such applicable av-
erage risk adjustment factor.
‘‘(C) DETERMINATION
OF
AVERAGE
PER
CAPITA MONTHLY SAVINGS.—The average per
capita monthly savings described in this sub-
paragraph is equal to the amount (if any) by
which—
‘‘(i) 
the 
risk-adjusted 
benchmark
amount computed under subparagraph
(B)(i), exceeds
‘‘(ii) the risk-adjusted bid computed
under subparagraph (B)(ii).
‘‘(D) AUTHORITY TO DETERMINE RISK AD-
JUSTMENT FOR AREAS OTHER THAN STATES.—
The Administrator may provide for the deter-
mination and application of risk adjustment
factors under this paragraph on the basis of
areas other than States.’’.
(2) COMPUTATION OF FEE-FOR-SERVICE AREA-
SPECIFIC
NON-DRUG
BENCHMARK.—Section 1853
(42 U.S.C. 1395w–23) is amended by adding at the
end the following new subsection:
‘‘(j) COMPUTATION OF FEE-FOR-SERVICE AREA-SPE-
CIFIC NON-DRUG BENCHMARK AMOUNT.—For purposes
of this part, the term ‘fee-for-service area-specific non-
drug benchmark amount’ means, with respect to a
Medicare+Choice payment area for a month in a year,
an amount equal to the greater of the following (but in
no case less than 1⁄12 of the rate computed under sub-
section (c)(1), without regard to subparagraph (A), for the
year):
‘‘(1) BASED
ON
100
PERCENT
OF
FEE-FOR-
SERVICE COSTS IN THE AREA.—An amount equal to
1⁄12 of 100 percent (for 2005 through 2007, or 95
percent for 2008 and years thereafter) of the ad-
justed average per capita cost for the year involved,
determined under section 1876(a)(4) for the
Medicare+Choice payment area, for the area and
the year involved, for services covered under parts A
and B for individuals entitled to benefits under part
A and enrolled under part B who are not enrolled
in a Medicare+Choice plan under this part for the
year, and adjusted to exclude from such cost the
amount the Medicare Benefits Administrator esti-
mates is payable for costs described in subclauses (I)
and (II) of subsection (c)(3)(C)(i) for the year in-
volved and also adjusted in the manner described in
subsection (c)(1)(D)(ii) (relating to inclusion of
costs of VA and DOD military facility services to
medicare-eligible beneficiaries).
‘‘(2) MINIMUM MONTHLY AMOUNT.—The min-
imum amount specified in this paragraph is the
amount specified in subsection (c)(1)(B)(iv) for the
year involved.’’.
(c) PAYMENT OF PLANS BASED ON BID AMOUNTS.—
(1) IN GENERAL.—Section 1853(a)(1)(A) (42
U.S.C. 1395w–23) is amended by striking ‘‘in an
amount’’ and all that follows and inserting the fol-
lowing: ‘‘in an amount determined as follows:
‘‘(i) PAYMENT
BEFORE
2005.—For
years before 2005, the payment amount
shall be equal to 
1⁄12
of the annual
Medicare+Choice capitation rate (as cal-
culated under subsection (c)) with respect
to that individual for that area, reduced by
the amount of any reduction elected under
section 1854(f )(1)(E) and adjusted under
clause (iii).
‘‘(ii) PAYMENT FOR STATUTORY NON-
DRUG BENEFITS BEGINNING WITH 2005.—
For years beginning with 2005—
‘‘(I) PLANS
WITH
BIDS
BELOW
BENCHMARK.—In the case of a plan
for which there are average per capita
monthly savings described in section
1854(b)(3)(C), the payment under
this 
subsection 
is 
equal 
to 
the
unadjusted non-drug monthly bid
amount, adjusted under clause (iii),
plus the amount of the monthly rebate
computed 
under 
section
1854(b)(1)(C)(i) for that plan and
year.
‘‘(II) PLANS WITH BIDS AT OR
ABOVE BENCHMARK.—In the case of a
plan for which there are no average
per capita monthly savings described
in section 1854(b)(3)(C), the payment
amount under this subsection is equal
to the fee-for-service area-specific non-
drug benchmark amount, adjusted
under clause (iii).
‘‘(iii) DEMOGRAPHIC
ADJUSTMENT,
INCLUDING
ADJUSTMENT
FOR
HEALTH
STATUS.—The Administrator shall adjust
the payment amount under clause (i), the
unadjusted non-drug monthly bid amount
under clause (ii)(I), and the fee-for-service
area-specific non-drug benchmark amount
under clause (ii)(II) for such risk factors
as age, disability status, gender, institu-
tional status, and such other factors as the
Administrator determines to be appro-
priate, including adjustment for health sta-
tus under paragraph (3), so as to ensure
actuarial equivalence. The Administrator
may add to, modify, or substitute for such
adjustment factors if such changes will im-
prove 
the 
determination 
of 
actuarial
equivalence.
‘‘(iv) REFERENCE TO SUBSIDY PAY-
MENT FOR STATUTORY DRUG BENEFITS.—
In the case in which an enrollee is enrolled
under part D, the Medicare+Choice orga-
nization also is entitled to a subsidy pay-
ment amount under section 1860H.’’.
(d) CONFORMING AMENDMENTS.—
(1) PROTECTION AGAINST BENEFICIARY SELEC-
TION.—Section 1852(b)(1)(A) (42 U.S.C. 1395w–
22(b)(1)(A)) is amended by adding at the end the
following: ‘‘The Administrator shall not approve a
plan of an organization if the Administrator deter-
mines that the benefits are designed to substantially
discourage enrollment by certain Medicare+Choice
eligible individuals with the organization.’’.
(2) CONFORMING
AMENDMENT
TO
PREMIUM
TERMINOLOGY.—Subparagraphs (A) and (B) of sec-
tion 1854(b)(2) (42 U.S.C. 1395w–24(b)(2)) are
amended to read as follows:
‘‘(A) MEDICARE+CHOICE MONTHLY BASIC
BENEFICIARY
PREMIUM.—The 
term
‘Medicare+Choice monthly basic beneficiary
premium’ 
means, 
with 
respect 
to 
a
Medicare+Choice plan—
‘‘(i) 
described 
in 
section
1853(a)(1)(A)(ii)(I) (relating to plans pro-
viding rebates), zero; or
‘‘(ii) 
described 
in 
section
1853(a)(1)(A)(ii)(II), the amount (if any)
by which the unadjusted non-drug monthly
bid amount exceeds the fee-for-service
area-specific non-drug benchmark amount.
‘‘(B) MEDICARE+CHOICE MONTHLY SUP-
PLEMENTAL
BENEFICIARY
PREMIUM.—The
term ‘Medicare+Choice monthly supplemental
beneficiary premium’ means, with respect to a
Medicare+Choice plan, the portion of the ag-
gregate monthly bid amount submitted under
clause (i) of subsection (a)(6)(A) for the year
that is attributable under such section to the
provision of nonstatutory benefits.’’.
(3) 
REQUIREMENT
FOR
UNIFORM
BID
AMOUNTS.—Section 1854(c) (42 U.S.C. 1395w–
24(c)) is amended to read as follows:
‘‘(c) 
UNIFORM
BID
AMOUNTS.—The
Medicare+Choice monthly bid amount submitted under
subsection (a)(6) of a Medicare+Choice organization
under this part may not vary among individuals enrolled
in the plan.’’.
(4) PERMITTING BENEFICIARY REBATES.—
(A) Section 1851(h)(4)(A) (42 U.S.C.
1395w–21(h)(4)(A)) is amended by inserting
‘‘except 
as 
provided 
under 
section
1854(b)(1)(C)’’ after ‘‘or otherwise’’.
(B) Section 1854(d) (42 U.S.C. 1395w–
24(d)) is amended by inserting ‘‘, except as pro-
vided under subsection (b)(1)(C),’’ after ‘‘and
may not provide’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply to payments and premiums for
months beginning with January 2005.
SEC. 212. DEMONSTRATION PROGRAM FOR COMPETITIVE-
DEMONSTRATION AREAS.
(a) IDENTIFICATION OF COMPETITIVE-DEMONSTRA-
TION AREAS FOR DEMONSTRATION PROGRAM; COMPUTA-
TION
OF CHOICE NON-DRUG BENCHMARKS.—Section
1853, as amended by section 211(b)(2), is amended by
adding at the end the following new subsection:
‘‘(k) ESTABLISHMENT
OF
COMPETITIVE
DEM-
ONSTRATION PROGRAM.—
‘‘(1) 
DESIGNATION
OF
COMPETITIVE-DEM-
ONSTRATION AREAS AS PART OF PROGRAM.—
‘‘(A) IN GENERAL.—For purposes of this
part, the Administrator shall establish a dem-
onstration program under which the Adminis-
trator designates Medicare+Choice areas as
competitive-demonstration areas consistent with
the following limitations:
‘‘(i) LIMITATION
ON
NUMBER
OF
AREAS THAT MAY BE DESIGNATED.—The
Administrator may not designate more
than 4 areas as competitive-demonstration
areas.
‘‘(ii) LIMITATION ON PERIOD OF DES-
IGNATION
OF
ANY
AREA.—The Adminis-
trator may not designate any area as a
competitive-demonstration area for a pe-
riod of more than 2 years.
The Administrator has the discretion to decide
whether or not to designate as a competitive-
demonstration area an area that qualifies for
such designation.
‘‘(B) 
QUALIFICATIONS
FOR
DESIGNA-
TION.—For 
purposes 
of 
this 
title, 
a
Medicare+Choice area (which is a metropolitan
statistical area or other area with a substantial
number of Medicare+Choice enrollees) may not
be designated as a ‘competitive-demonstration
area’ for a 2-year period beginning with a year
unless the Administrator determines, by such
date before the beginning of the year as the Ad-
ministrator determines appropriate, that—
‘‘(i) there will be offered during the
open enrollment period under this part be-
fore the beginning of the year at least 2
Medicare+Choice plans (in addition to the
fee-for-service program under parts A and
B), 
each 
offered 
by 
a 
different
Medicare+Choice organization; and
‘‘(ii) during March of the previous
year at least 50 percent of the number of
Medicare+Choice eligible individuals who
reside in the area were enrolled in a
Medicare+Choice plan.
‘‘(2) 
CHOICE
NON-DRUG
BENCHMARK
AMOUNT.—For purposes of this part, the term
‘choice non-drug benchmark amount’ means, with
respect to a Medicare+Choice payment area for a
month in a year, the sum of the 2 components de-
scribed in paragraph (3) for the area and year. The
Administrator 
shall 
compute 
such 
benchmark
amount for each competitive-demonstration area be-
fore the beginning of each annual, coordinated elec-
tion period under section 1851(e)(3)(B) for each
year (beginning with 2005) in which it is designated
as such an area.
‘‘(3) 2 COMPONENTS.—For purposes of para-
graph (2), the 2 components described in this para-
graph for an area and a year are the following:
‘‘(A) 
FEE-FOR-SERVICE
COMPONENT
WEIGHTED
BY
NATIONAL
FEE-FOR-SERVICE
MARKET SHARE.—The product of the following:
‘‘(i) 
NATIONAL
FEE-FOR-SERVICE
MARKET
SHARE.—The national fee-for-
service market share percentage (deter-
mined under paragraph (5)) for the year.
‘‘(ii) 
FEE-FOR-SERVICE
AREA-SPE-
CIFIC NON-DRUG BID.—The fee-for-service
area-specific non-drug bid (as defined in
paragraph (6)) for the area and year.
‘‘(B) M+C COMPONENT WEIGHTED BY NA-
TIONAL MEDICARE+CHOICE MARKET SHARE.—
The product of the following:
‘‘(i) NATIONAL
MEDICARE+CHOICE
MARKET
SHARE.—1 minus the national
fee-for-service market share percentage for
the year.
‘‘(ii) WEIGHTED
AVERAGE
OF
PLAN
BIDS IN AREA.—The weighted average of
the plan bids for the area and year (as de-
termined under paragraph (4)(A)).
‘‘(4) DETERMINATION OF WEIGHTED AVERAGE
BIDS FOR AN AREA.—
‘‘(A) IN GENERAL.—For purposes of para-
graph (3)(B)(ii), the weighted average of plan
bids for an area and a year is the sum of the
following products for Medicare+Choice plans
described in subparagraph (C) in the area and
year:
‘‘(i) PROPORTION
OF
EACH
PLAN’S
ENROLLEES IN THE AREA.—The number
of individuals described in subparagraph
(B), divided by the total number of such
individuals for all Medicare+Choice plans
described in subparagraph (C) for that
area and year.
‘‘(ii) 
MONTHLY
NON-DRUG
BID
AMOUNT.—The 
unadjusted 
non-drug
monthly bid amount.
‘‘(B) COUNTING
OF
INDIVIDUALS.—The
Administrator 
shall 
count, 
for 
each
Medicare+Choice plan described in subpara-
graph (C) for an area and year, the number of
individuals who reside in the area and who were
enrolled under such plan under this part during
March of the previous year.
‘‘(C) EXCLUSION OF PLANS NOT OFFERED
IN PREVIOUS YEAR.—For an area and year, the
Medicare+Choice plans described in this sub-
paragraph are plans that are offered in the area
and year and were offered in the area in March
of the previous year.
‘‘(5) COMPUTATION
OF
NATIONAL
FEE-FOR-
SERVICE
MARKET
SHARE
PERCENTAGE.—The Ad-
ministrator shall determine, for a year, the propor-
tion (in this subsection referred to as the ‘national
fee-for-service 
market 
share 
percentage’) 
of
Medicare+Choice eligible individuals who during
March of the previous year were not enrolled in a
Medicare+Choice plan.
‘‘(6) FEE-FOR-SERVICE
AREA-SPECIFIC
NON-
DRUG
BID.—For purposes of this part, the term
‘fee-for-service area-specific non-drug bid’ means, for
an area and year, the amount described in section
1853(j)(1) for the area and year, except that any
reference to a percent of less than 100 percent shall
be deemed a reference to 100 percent.’’.
(b) APPLICATION OF CHOICE NON-DRUG BENCH-
MARK IN COMPETITIVE-DEMONSTRATION AREAS.—
(1) IN GENERAL.—Section 1854 is amended—