‘‘(I) provides stop-loss protection
for the provider or group that is ade-
quate and appropriate, based on
standards developed by the Secretary
that take into account the number
(and type) of providers placed at such
substantial financial risk in the group
or under the plan and the number of
individuals enrolled with the organiza-
tion who receive services from the pro-
vider or the group, and
‘‘(II) conducts periodic surveys of
both individuals enrolled and individ-
uals previously enrolled with the orga-
nization to determine the degree of
access of such individuals to services
provided by the organization and sat-
isfaction with the quality of such serv-
ices.
‘‘(iii) The organization provides the
Secretary with descriptive information re-
garding the plan, sufficient to permit the
Secretary to determine whether the plan is
in compliance with the requirements of this
subparagraph.
‘‘(B) PROVIDER
INCENTIVE
PLAN
DE-
FINED.—In this paragraph, the term ‘provider
incentive plan’ means any compensation ar-
rangement between an eligible organization and
a provider or provider group that may directly
or indirectly have the effect of reducing or lim-
iting services provided with respect to individ-
uals enrolled with the organization.
‘‘(8) ADDITIONAL DEFINITIONS.—
‘‘(A) 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.
‘‘(B) 
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.
‘‘(C) 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.’’.
(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 contract years beginning at least
60 days after the date the Secretary establishes the cost-
sharing schedule for out-of-network services under section
1876(k)(2)(C) of the Social Security Act (as added by sub-
section (a)(2)).
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—
‘‘(i) meets the requirements of section
1876(k) with respect to individuals en-
rolled under the policy in the same manner
such requirements apply with respect to an
eligible organization under such section
with respect to individuals enrolled with
the organization under such section, and
‘‘(ii) discloses (in a form and manner
specified by the Secretary) the loss ratio
described in subsection (r)(1) most re-
cently calculated for purposes of such sub-
section.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to policies issued or renewed on
or after the effective date described in section 3(c).
Æ