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uals an option to decline the coverage) supple-
mental health care benefits that the Secretary
may approve. The Secretary shall approve any
such supplemental benefits unless the Secretary
determines that including such supplemental
benefits would substantially discourage enroll-
ment by Medicare Choice eligible individuals
with the organization.
‘‘(B) AT ENROLLEES’ OPTION.—A Medicare
Choice organization may provide to individuals
enrolled under this part (other than under an
MSA plan) supplemental health care benefits
that the individuals may elect, at their option,
to have covered.
‘‘(3) ORGANIZATION
AS
SECONDARY
PAYER.—
Notwithstanding any other provision of law, a Medi-
care Choice organization may (in the case of the pro-
vision of items and services to an individual under
a Medicare Choice plan under circumstances in which
payment under this title is made secondary pursuant
to section 1862(b)(2)) charge or authorize the provider
of such services to charge, in accordance with the
charges allowed under a law, plan, or policy described
in such section—
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‘‘(A) the insurance carrier, employer, or
other entity which under such law, plan, or pol-
icy is to pay for the provision of such services,
or
‘‘(B) such individual to the extent that the
individual has been paid under such law, plan,
or policy for such services.
‘‘(4) NATIONAL COVERAGE DETERMINATIONS.—If
there is a national coverage determination made in
the period beginning on the date of an announcement
under section 1853(b) and ending on the date of the
next announcement under such section and the Sec-
retary projects that the determination will result in
a significant change in the costs to a Medicare Choice
organization of providing the benefits that are the
subject of such national coverage determination and
that such change in costs was not incorporated in the
determination of the annual Medicare Choice capita-
tion rate under section 1853 included in the an-
nouncement made at the beginning of such period,
then, unless otherwise required by law—
‘‘(A) such determination shall not apply to
contracts under this part until the first contract
year that begins after the end of such period, and
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‘‘(A) redetermine the amount under para-
graph (1)(C) for such year by substituting ‘100
percent’ for ‘101 percent’ each place it appears,
and
‘‘(B) increase the minimum amount under
paragraph (1)(B) to an amount equal to the less-
er of—
‘‘(i) the amount the Secretary esti-
mates will result in increased payments
under such paragraph equal to the decrease
in payments by reason of the redetermina-
tion under subparagraph (A), or
‘‘(ii) an amount equal to 85 percent of
the annual national Medicare Choice capi-
tation rate determined under paragraph
(4).
‘‘(9) STUDY OF LOCAL PRICE INDICATORS.—The
Secretary and the Medicare Payment Advisory Com-
mission shall each conduct a study with respect to ap-
propriate measures for adjusting the annual Medicare
Choice capitation rates determined under this section
to reflect local price indicators, including the medi-
care hospital wage index and the case-mix of a geo-
graphic region. The Secretary and the Advisory Com-
mission shall report the results of such study to the
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rience to determine an average of the capitation pay-
ments to be made under this part at the beginning of
a contract period, the Secretary may determine such
an average based on the enrollment experience of other
contracts entered into under this part.
‘‘(4) ADJUSTED COMMUNITY RATE.—
‘‘(A) IN
GENERAL.—For purposes of this
subsection, subject to subparagraph (B), the term
‘adjusted community rate’ for a service or serv-
ices means, at the election of a Medicare Choice
organization, either—
‘‘(i) the rate of payment for that serv-
ice or services which the Secretary annually
determines would apply to an individual
electing a Medicare Choice plan under this
part if the rate of payment were determined
under a ‘community rating system’ (as de-
fined in section 1302(8) of the Public
Health Service Act, other than subpara-
graph (C)), or
‘‘(ii) such portion of the weighted ag-
gregate premium, which the Secretary an-
nually estimates would apply to such an in-
dividual, as the Secretary annually esti-