837
Advantage 
organizations 
under 
this 
part.’’. 
(b) EFFECTIVE
DATE.—The amendment 
made by subsection (a) shall take effect on the 
date of the enactment of this Act. 
SEC. 233. SPECIALIZED MEDICARE ADVANTAGE PLANS FOR 
SPECIAL NEEDS BENEFICIARIES. 
(a) TREATMENT
AS
COORDINATED
CARE 
PLAN.—Section 1851(a)(2)(A) (42 U.S.C. 1395w–
21(a)(2)(A)) is amended by adding at the end 
the following new sentence: ‘‘Specialized 
Medicare Advantage plans for special needs 
beneficiaries (as defined in section 1859(b)(4)) 
may be any type of coordinated care plan.’’. 
(b) 
SPECIALIZED
MEDICARE
ADVANTAGE 
PLAN FOR SPECIAL NEEDS BENEFICIARIES DE-
FINED.—Section 1859(b) (42 U.S.C. 1395w–
29(b)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(4) SPECIALIZED MEDICARE ADVANTAGE 
PLANS FOR SPECIAL NEEDS BENEFICIARIES.—
‘‘(A) IN GENERAL.—The term ‘spe-
cialized Medicare Advantage plan for 
special needs beneficiaries’ means a 
Medicare Advantage plan that exclu-
838
sively serves special needs bene-
ficiaries (as defined in subparagraph 
(B)). 
‘‘(B) SPECIAL NEEDS BENEFICIARY.—
The term ‘special needs beneficiary’ 
means a Medicare Advantage eligible 
individual who—
‘‘(i) is institutionalized (as de-
fined by the Secretary); 
‘‘(ii) is entitled to medical as-
sistance under a State plan under 
title XIX; or 
‘‘(iii) meets such requirements 
as the Secretary may determine 
would benefit from enrollment in 
such a specialized Medicare Ad-
vantage plan described in sub-
paragraph 
(A) 
for 
individuals 
with severe or disabling chronic 
conditions.’’. 
(c) RESTRICTION
ON
ENROLLMENT
PER-
MITTED.—Section 1859 (42 U.S.C. 1395w–29) is 
amended by adding at the end the following 
new subsection:
839
‘‘(f) RESTRICTION ON ENROLLMENT FOR SPE-
CIALIZED MEDICARE ADVANTAGE PLANS FOR SPE-
CIAL NEEDS BENEFICIARIES.—In the case of a 
specialized Medicare Advantage plan (as de-
fined in subsection (b)(4)), notwithstanding 
any other provision of this part and in accord-
ance with regulations of the Secretary and for 
periods before January 1, 2007, the plan may 
restrict the enrollment of individuals under 
the plan to individuals who are within one or 
more classes of special needs beneficiaries.’’. 
(d) REPORT TO CONGRESS.—Not later than 
December 31, 2005, the Medicare Benefits Ad-
ministrator shall submit to Congress a report 
that assesses the impact of specialized Medi-
care Advantage plans for special needs bene-
ficiaries on the cost and quality of services 
provided to enrollees. Such report shall in-
clude an assessment of the costs and savings 
to the medicare program as a result of amend-
ments made by subsections (a), (b), and (c). 
(e) EFFECTIVE DATES.—
(1) IN
GENERAL.—The amendments 
made by subsections (a), (b), and (c) shall
840
take effect upon the date of the enact-
ment of this Act. 
(2) DEADLINE
FOR
ISSUANCE
OF
RE-
QUIREMENTS
FOR
SPECIAL
NEEDS
BENE-
FICIARIES; TRANSITION.—No later than 6 
months after the date of the enactment of 
this Act, the Secretary shall issue interim 
final regulations to establish require-
ments for special needs beneficiaries 
under section 1859(b)(4)(B)(iii) of the So-
cial Security Act, as added by subsection 
(b). 
SEC. 234. MEDICARE MSAS. 
(a) EXEMPTION FROM REPORTING ENROLLEE 
ENCOUNTER DATA.—
(1) IN GENERAL.—Section 1852(e)(1) (42 
U.S.C. 1395w–22(e)(1)) is amended by in-
serting ‘‘(other than MSA plans)’’ after 
‘‘plans’’. 
(2) 
CONFORMING
AMENDMENTS.—Sec-
tion 1852 (42 U.S.C. 1395w–22) is amend-
ed—
(A) in subsection (c)(1)(I), by in-
serting before the period at the end
841
the following: ‘‘if required under such 
section’’; and 
(B) in subparagraphs (A) and (B) 
of subsection (e)(2), by striking ‘‘, a 
non-network MSA plan,’’ and ‘‘, NON-
NETWORK MSA PLANS,’’ each place it ap-
pears. 
(b) MAKING
PROGRAM
PERMANENT
AND 
ELIMINATING
CAP.—Section 
1851(b)(4) 
(42 
U.S.C. 1395w–21(b)(4)) is amended—
(1) in the heading, by striking ‘‘ON A 
DEMONSTRATION BASIS’’; 
(2) by striking the first sentence of 
subparagraph (A); and 
(3) by striking the second sentence of 
subparagraph (C). 
(c) APPLYING
LIMITATIONS
ON
BALANCE 
BILLING.—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 ‘‘sec-
tion 1851(a)(2)(A)’’. 
(d) 
ADDITIONAL
AMENDMENT.—Section 
1851(e)(5)(A) (42 U.S.C. 1395w–21(e)(5)(A)) is 
amended—