{"identifier":"/us/usc/t42/s1395w\u2013131","title":42,"num":"\u00a7\u202f1395w\u2013131.","heading":"Application to Medicare Advantage program and related managed care programs","text":"\u00a7\u202f1395w\u2013131.\nApplication to Medicare Advantage program and related managed care programs\n(a)\nSpecial rules relating to offering of qualified prescription drug coverage\n(1)\nIn general\nAn MA organization on and after\n(A) may not offer an MA plan described in\nsection 1395w\u201321(a)(2)(A) of this title\n(B) may not offer prescription drug coverage (other than that required under parts A and B) to an enrollee\u2014\n(i) under an MSA plan; or\n(ii) under another MA plan unless such drug coverage under such other plan provides qualified prescription drug coverage and unless the requirements of this section with respect to such coverage are met.\n(2)\nQualifying coverage\nFor purposes of paragraph (1)(A), the term \u201crequired coverage\u201d means with respect to an MA\u2013PD plan\u2014\n(A) basic prescription drug coverage; or\n(B) qualified prescription drug coverage that provides supplemental prescription drug coverage, so long as there is no MA monthly supplemental beneficiary premium applied under the plan (due to the application of a credit against such premium of a rebate under\nsection 1395w\u201324(b)(1)(C) of this title\n(b)\nApplication of default enrollment rules\n(1)\nSeamless continuation\nIn applying\nsection 1395w\u201321(c)(3)(A)(ii) of this title\n(2)\nMA continuation\nIn applying\n(A) for purposes of the election as of\nJanuary 1, 2006\nDecember 31, 2005\n(B) for periods after\nJanuary 1, 2006\n(3)\nDiscontinuance of MA\u2013PD election during first year of eligibility\nIn applying the second sentence of\nsection 1395w\u201321(e)(4) of this title\n(4)\nRules regarding enrollees in MA plans not providing qualified prescription drug coverage\nIn the case of an individual who is enrolled in an MA plan (other than an MSA plan) that does not provide qualified prescription drug coverage, if the organization offering such coverage discontinues the offering with respect to the individual of all MA plans that do not provide such coverage\u2014\n(i) the individual is deemed to have elected the original medicare fee-for-service program option, unless the individual affirmatively elects to enroll in an MA\u2013PD plan; and\n(ii) in the case of such a deemed election, the disenrollment shall be treated as an involuntary termination of the MA plan described in subparagraph (B)(ii) of\nsection 1395ss(s)(3) of this title\nThe information disclosed under\nsection 1395w\u201322(c)(1) of this title\n(c)\nApplication of part D rules for prescription drug coverage\nWith respect to the offering of qualified prescription drug coverage by an MA organization under this part on and after\n(1)\nIn general\nExcept as otherwise provided, the provisions of this part shall apply under part C with respect to prescription drug coverage provided under MA\u2013PD plans in lieu of the other provisions of part C that would apply to such coverage under such plans.\n(2)\nWaiver\nThe Secretary shall waive the provisions referred to in paragraph (1) to the extent the Secretary determines that such provisions duplicate, or are in conflict with, provisions otherwise applicable to the organization or plan under part C or as may be necessary in order to improve coordination of this part with the benefits under this part.\n(3)\nTreatment of MA owned and operated pharmacies\nThe Secretary may waive the requirement of\nsection 1395w\u2013104(b)(1)(C) of this title\n(d)\nSpecial rules for private fee-for-service plans that offer prescription drug coverage\nWith respect to an MA plan described in\n(1)\nRequirements regarding negotiated prices\nSubsections (a)(1) and (d)(1) of\nsection 1395w\u2013102 of this title\nsection 1395w\u2013104(b)(2)(A) of this title\n(2)\nModification of pharmacy access standard and disclosure requirement\nIf the plan provides coverage for drugs purchased from all pharmacies, without charging additional cost-sharing, and without regard to whether they are participating pharmacies in a network or have entered into contracts or agreements with pharmacies to provide drugs to enrollees covered by the plan, subsections (b)(1)(C) and (k) of\nsection 1395w\u2013104 of this title\n(3)\nDrug utilization management program and medication therapy management program not required\nThe requirements of subparagraphs (A) and (C) of\nsection 1395w\u2013104(c)(1) of this title\n(4)\nApplication of reinsurance\nThe Secretary shall determine the amount of reinsurance payments under\n(A) bases such amount on the Secretary\u2019s estimate of the amount of such payments that would be payable if the plan were an MA\u2013PD plan described in\nsection 1395w\u201321(a)(2)(A)(i) of this title\n(B) takes into account the average reinsurance payments made under\nsection 1395w\u2013115(b) of this title\n(5)\nExemption from risk corridor provisions\nThe provisions of\nsection 1395w\u2013115(e) of this title\n(6)\nExemption from negotiations\nSubsections (d) and (e)(2)(C) of\nsection 1395w\u2013111 of this title\nsection 1395w\u201324(a)(5)(B) of this title\nsection 1395w\u2013111(d) of this title\n(7)\nTreatment of incurred costs without regard to formulary\nThe exclusion of costs incurred for covered part D drugs which are not included (or treated as being included) in a plan\u2019s formulary under\nsection 1395w\u2013102(b)(4)(C)(i) of this title\n(e)\nApplication to reasonable cost reimbursement contractors\n(1)\nIn general\nSubject to paragraphs (2) and (3) and rules established by the Secretary, in the case of an organization that is providing benefits under a reasonable cost reimbursement contract under\nsection 1395mm(h) of this title\nsection 1395\u201321(a)(2)(A)(i) of this title\n(2)\nLimitation on enrollment\nIn applying paragraph (1), the organization may not enroll part D eligible individuals who are not enrolled under the reasonable cost reimbursement contract involved.\n(3)\nBids not included in determining national average monthly bid amount\nThe bid of an organization offering prescription drug coverage under this subsection shall not be taken into account in computing the national average monthly bid amount and low-income benchmark premium amount under this part.\n(f)\nApplication to PACE\n(1)\nIn general\nSubject to paragraphs (2) and (3) and rules established by the Secretary, in the case of a PACE program under\nsection 1395eee of this title\nsection 1395w\u201321(a)(2)(A)(ii) of this title\n(2)\nLimitation on enrollment\nIn applying paragraph (1), the organization may not enroll part D eligible individuals who are not enrolled under the PACE program involved.\n(3)\nBids not included in determining standardized bid amount\nThe bid of an organization offering prescription drug coverage under this subsection is not be taken into account in computing any average benchmark bid amount and low-income benchmark premium amount under this part.","url":"https://projectusc.org/usc/t42/s1395w\u2013131.html","content":[{"t":"sec","id":"/us/usc/t42/s1395w\u2013131","children":[{"t":"num","text":"\u00a7\u202f1395w\u2013131."},{"t":"heading","text":"Application to Medicare Advantage program and related managed care programs"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013131/a","children":[{"t":"num","text":"(a)"},{"t":"heading","text":"Special rules relating to offering of qualified prescription drug coverage"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/a/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"chapeau","text":"An MA organization on and after ","children":[{"t":"text","text":"January 1, 2006","tail":"\u2014"}]},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/a/1/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" may not offer an MA plan described in ","children":[{"t":"ref","text":"section 1395w\u201321(a)(2)(A) of this title","href":"/us/usc/t42/s1395w\u201321/a/2/A","tail":" in an area unless either that plan (or another MA plan offered by the organization in that same service area) includes required prescription drug coverage (as defined in paragraph (2)); and"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/a/1/B","children":[{"t":"num","text":"(B)"},{"t":"chapeau","text":" may not offer prescription drug coverage (other than that required under parts A and B) to an enrollee\u2014"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013131/a/1/B/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" under an MSA plan; or","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013131/a/1/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" under another MA plan unless such drug coverage under such other plan provides qualified prescription drug coverage and unless the requirements of this section with respect to such coverage are met.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/a/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Qualifying coverage"},{"t":"chapeau","text":"For purposes of paragraph (1)(A), the term \u201crequired coverage\u201d means with respect to an MA\u2013PD plan\u2014"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/a/2/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" basic prescription drug coverage; or","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/a/2/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" qualified prescription drug coverage that provides supplemental prescription drug coverage, so long as there is no MA monthly supplemental beneficiary premium applied under the plan (due to the application of a credit against such premium of a rebate under ","children":[{"t":"ref","text":"section 1395w\u201324(b)(1)(C) of this title","href":"/us/usc/t42/s1395w\u201324/b/1/C","tail":")."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013131/b","children":[{"t":"num","text":"(b)"},{"t":"heading","text":"Application of default enrollment rules"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/b/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Seamless continuation"},{"t":"content","children":[{"t":"p","text":"In applying ","children":[{"t":"ref","text":"section 1395w\u201321(c)(3)(A)(ii) of this title","href":"/us/usc/t42/s1395w\u201321/c/3/A/ii","tail":", an individual who is enrolled in a health benefits plan shall not be considered to have been deemed to make an election into an MA\u2013PD plan unless such health benefits plan provides any prescription drug coverage."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/b/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"MA continuation"},{"t":"chapeau","text":"In applying ","children":[{"t":"ref","text":"section 1395w\u201321(c)(3)(B) of this title","href":"/us/usc/t42/s1395w\u201321/c/3/B","tail":", an individual who is enrolled in an MA plan shall not be considered to have been deemed to make an election into an MA\u2013PD plan unless\u2014"}]},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/b/2/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" for purposes of the election as of ","children":[{"t":"text","text":"January 1, 2006","tail":", the MA plan provided as of "},{"t":"text","text":"December 31, 2005","tail":", any prescription drug coverage; or"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/b/2/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" for periods after ","children":[{"t":"text","text":"January 1, 2006","tail":", such MA plan is an MA\u2013PD plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/b/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Discontinuance of MA\u2013PD election during first year of eligibility"},{"t":"content","children":[{"t":"p","text":"In applying the second sentence of ","children":[{"t":"ref","text":"section 1395w\u201321(e)(4) of this title","href":"/us/usc/t42/s1395w\u201321/e/4","tail":" in the case of an individual who is electing to discontinue enrollment in an MA\u2013PD plan, the individual shall be permitted to enroll in a prescription drug plan under part D at the time of the election of coverage under the original medicare fee-for-service program."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/b/4","children":[{"t":"num","text":"(4)"},{"t":"heading","text":"Rules regarding enrollees in MA plans not providing qualified prescription drug coverage"},{"t":"chapeau","text":"In the case of an individual who is enrolled in an MA plan (other than an MSA plan) that does not provide qualified prescription drug coverage, if the organization offering such coverage discontinues the offering with respect to the individual of all MA plans that do not provide such coverage\u2014"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013131/b/4/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" the individual is deemed to have elected the original medicare fee-for-service program option, unless the individual affirmatively elects to enroll in an MA\u2013PD plan; and","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013131/b/4/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" in the case of such a deemed election, the disenrollment shall be treated as an involuntary termination of the MA plan described in subparagraph (B)(ii) of ","children":[{"t":"ref","text":"section 1395ss(s)(3) of this title","href":"/us/usc/t42/s1395ss/s/3","tail":" for purposes of applying such section."}],"tail":"\n"}],"tail":"\n\n"},{"t":"continuation","text":"The information disclosed under ","children":[{"t":"ref","text":"section 1395w\u201322(c)(1) of this title","href":"/us/usc/t42/s1395w\u201322/c/1","tail":" for individuals who are enrolled in such an MA plan shall include information regarding such rules."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013131/c","children":[{"t":"num","text":"(c)"},{"t":"heading","text":"Application of part D rules for prescription drug coverage"},{"t":"chapeau","text":"With respect to the offering of qualified prescription drug coverage by an MA organization under this part on and after ","children":[{"t":"text","text":"January 1, 2006","tail":"\u2014"}]},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/c/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"Except as otherwise provided, the provisions of this part shall apply under part C with respect to prescription drug coverage provided under MA\u2013PD plans in lieu of the other provisions of part C that would apply to such coverage under such plans.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/c/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Waiver"},{"t":"content","children":[{"t":"p","text":"The Secretary shall waive the provisions referred to in paragraph (1) to the extent the Secretary determines that such provisions duplicate, or are in conflict with, provisions otherwise applicable to the organization or plan under part C or as may be necessary in order to improve coordination of this part with the benefits under this part.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/c/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Treatment of MA owned and operated pharmacies"},{"t":"content","children":[{"t":"p","text":"The Secretary may waive the requirement of ","children":[{"t":"ref","text":"section 1395w\u2013104(b)(1)(C) of this title","href":"/us/usc/t42/s1395w\u2013104/b/1/C","tail":" in the case of an MA\u2013PD plan that provides access (other than mail order) to qualified prescription drug coverage through pharmacies owned and operated by the MA organization, if the Secretary determines that the organization\u2019s pharmacy network is sufficient to provide comparable access for enrollees under the plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013131/d","children":[{"t":"num","text":"(d)"},{"t":"heading","text":"Special rules for private fee-for-service plans that offer prescription drug coverage"},{"t":"chapeau","text":"With respect to an MA plan described in ","children":[{"t":"ref","text":"section 1395w\u201321(a)(2)(C) of this title","href":"/us/usc/t42/s1395w\u201321/a/2/C","tail":" that offers qualified prescription drug coverage, on and after "},{"t":"text","text":"January 1, 2006","tail":", the following rules apply:"}]},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/d/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Requirements regarding negotiated prices"},{"t":"content","children":[{"t":"p","text":"Subsections (a)(1) and (d)(1) of ","children":[{"t":"ref","text":"section 1395w\u2013102 of this title","href":"/us/usc/t42/s1395w\u2013102","tail":" and "},{"t":"ref","text":"section 1395w\u2013104(b)(2)(A) of this title","href":"/us/usc/t42/s1395w\u2013104/b/2/A","tail":" shall not be construed to require the plan to provide negotiated prices (described in subsection (d)(1)(B) of such section), but shall apply to the extent the plan does so."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/d/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Modification of pharmacy access standard and disclosure requirement"},{"t":"content","children":[{"t":"p","text":"If the plan provides coverage for drugs purchased from all pharmacies, without charging additional cost-sharing, and without regard to whether they are participating pharmacies in a network or have entered into contracts or agreements with pharmacies to provide drugs to enrollees covered by the plan, subsections (b)(1)(C) and (k) of ","children":[{"t":"ref","text":"section 1395w\u2013104 of this title","href":"/us/usc/t42/s1395w\u2013104","tail":" shall not apply to the plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/d/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Drug utilization management program and medication therapy management program not required"},{"t":"content","children":[{"t":"p","text":"The requirements of subparagraphs (A) and (C) of ","children":[{"t":"ref","text":"section 1395w\u2013104(c)(1) of this title","href":"/us/usc/t42/s1395w\u2013104/c/1","tail":" shall not apply to the plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/d/4","children":[{"t":"num","text":"(4)"},{"t":"heading","text":"Application of reinsurance"},{"t":"chapeau","text":"The Secretary shall determine the amount of reinsurance payments under ","children":[{"t":"ref","text":"section 1395w\u2013115(b) of this title","href":"/us/usc/t42/s1395w\u2013115/b","tail":" using a methodology that\u2014"}]},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/d/4/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" bases such amount on the Secretary\u2019s estimate of the amount of such payments that would be payable if the plan were an MA\u2013PD plan described in ","children":[{"t":"ref","text":"section 1395w\u201321(a)(2)(A)(i) of this title","href":"/us/usc/t42/s1395w\u201321/a/2/A/i","tail":" and the previous provisions of this subsection did not apply; and"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013131/d/4/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" takes into account the average reinsurance payments made under ","children":[{"t":"ref","text":"section 1395w\u2013115(b) of this title","href":"/us/usc/t42/s1395w\u2013115/b","tail":" for populations of similar risk under MA\u2013PD plans described in such section."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/d/5","children":[{"t":"num","text":"(5)"},{"t":"heading","text":"Exemption from risk corridor provisions"},{"t":"content","children":[{"t":"p","text":"The provisions of ","children":[{"t":"ref","text":"section 1395w\u2013115(e) of this title","href":"/us/usc/t42/s1395w\u2013115/e","tail":" shall not apply."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/d/6","children":[{"t":"num","text":"(6)"},{"t":"heading","text":"Exemption from negotiations"},{"t":"content","children":[{"t":"p","text":"Subsections (d) and (e)(2)(C) of ","children":[{"t":"ref","text":"section 1395w\u2013111 of this title","href":"/us/usc/t42/s1395w\u2013111","tail":" shall not apply and the provisions of "},{"t":"ref","text":"section 1395w\u201324(a)(5)(B) of this title","href":"/us/usc/t42/s1395w\u201324/a/5/B","tail":" prohibiting the review, approval, or disapproval of amounts described in such section shall apply to the proposed bid and terms and conditions described in "},{"t":"ref","text":"section 1395w\u2013111(d) of this title","href":"/us/usc/t42/s1395w\u2013111/d","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/d/7","children":[{"t":"num","text":"(7)"},{"t":"heading","text":"Treatment of incurred costs without regard to formulary"},{"t":"content","children":[{"t":"p","text":"The exclusion of costs incurred for covered part D drugs which are not included (or treated as being included) in a plan\u2019s formulary under ","children":[{"t":"ref","text":"section 1395w\u2013102(b)(4)(C)(i) of this title","href":"/us/usc/t42/s1395w\u2013102/b/4/C/i","tail":" shall not apply insofar as the plan does not utilize a formulary."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013131/e","children":[{"t":"num","text":"(e)"},{"t":"heading","text":"Application to reasonable cost reimbursement contractors"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/e/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"Subject to paragraphs (2) and (3) and rules established by the Secretary, in the case of an organization that is providing benefits under a reasonable cost reimbursement contract under ","children":[{"t":"ref","text":"section 1395mm(h) of this title","href":"/us/usc/t42/s1395mm/h","tail":" and that elects to provide qualified prescription drug coverage to a part D eligible individual who is enrolled under such a contract, the provisions of this part (and related provisions of part C) shall apply to the provision of such coverage to such enrollee in the same manner as such provisions apply to the provision of such coverage under an MA\u2013PD local plan described in "},{"t":"ref","text":"section 1395\u201321(a)(2)(A)(i) of this title","href":"/us/usc/t42/s1395\u201321/a/2/A/i","tail":" and coverage under such a contract that so provides qualified prescription drug coverage shall be deemed to be an MA\u2013PD local plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/e/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Limitation on enrollment"},{"t":"content","children":[{"t":"p","text":"In applying paragraph (1), the organization may not enroll part D eligible individuals who are not enrolled under the reasonable cost reimbursement contract involved.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/e/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Bids not included in determining national average monthly bid amount"},{"t":"content","children":[{"t":"p","text":"The bid of an organization offering prescription drug coverage under this subsection shall not be taken into account in computing the national average monthly bid amount and low-income benchmark premium amount under this part.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013131/f","children":[{"t":"num","text":"(f)"},{"t":"heading","text":"Application to PACE"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/f/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"Subject to paragraphs (2) and (3) and rules established by the Secretary, in the case of a PACE program under ","children":[{"t":"ref","text":"section 1395eee of this title","href":"/us/usc/t42/s1395eee","tail":" that elects to provide qualified prescription drug coverage to a part D eligible individual who is enrolled under such program, the provisions of this part (and related provisions of part C) shall apply to the provision of such coverage to such enrollee in a manner that is similar to the manner in which such provisions apply to the provision of such coverage under an MA\u2013PD local plan described in "},{"t":"ref","text":"section 1395w\u201321(a)(2)(A)(ii) of this title","href":"/us/usc/t42/s1395w\u201321/a/2/A/ii","tail":" and a PACE program that so provides such coverage may be deemed to be an MA\u2013PD local plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/f/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Limitation on enrollment"},{"t":"content","children":[{"t":"p","text":"In applying paragraph (1), the organization may not enroll part D eligible individuals who are not enrolled under the PACE program involved.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013131/f/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Bids not included in determining standardized bid amount"},{"t":"content","children":[{"t":"p","text":"The bid of an organization offering prescription drug coverage under this subsection is not be taken into account in computing any average benchmark bid amount and low-income benchmark premium amount under this part.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"},{"t":"text","text":"\n"}]}]}