{"identifier":"/us/usc/t42/s1395w\u2013134","title":42,"num":"\u00a7\u202f1395w\u2013134.","heading":"Coordination requirements for plans providing prescription drug coverage","text":"\u00a7\u202f1395w\u2013134.\nCoordination requirements for plans providing prescription drug coverage\n(a)\nApplication of benefit coordination requirements to additional plans\n(1)\nIn general\nThe Secretary shall apply the coordination requirements established under\nsection 1395w\u2013133(a) of this title\n(2)\nApplication to treatment of certain out-of-pocket expenditures\nTo the extent specified by the Secretary, the requirements referred to in paragraph (1) shall apply to procedures established under\nsection 1395w\u2013102(b)(4)(D) of this title\n(3)\nUser fees\n(A)\nIn general\nThe Secretary may impose user fees for the transmittal of information necessary for benefit coordination under\nsection 1395w\u2013102(b)(4)(D) of this title\nsection 1395u(h)(3)(B) of this title\nsection 1395w\u2013102(b)(4)(D) of this title\n(B)\nApplication\nA user fee may not be imposed under subparagraph (A) with respect to a State Pharmaceutical Assistance Program.\n(b)\nRx Plan\nAn Rx plan described in this subsection is any of the following:\n(1)\nMedicaid programs\nA State plan under subchapter XIX, including such a plan operating under a waiver under\nsection 1315 of this title\nsection 1395w\u2013133(b)(2) of this title\n(2)\nGroup health plans\nAn employer group health plan.\n(3)\nFEHBP\nThe Federal employees health benefits plan under chapter 89 of title 5.\n(4)\nMilitary coverage (including TRICARE)\nCoverage under chapter 55 of title 10.\n(5)\nOther prescription drug coverage\nSuch other health benefit plans or programs that provide coverage or financial assistance for the purchase or provision of prescription drug coverage on behalf of part D eligible individuals as the Secretary may specify.\n(c)\nRelation to other provisions\n(1)\nUse of cost management tools\nThe requirements of this section shall not impair or prevent a PDP sponsor or MA organization from applying cost management tools (including differential payments) under all methods of operation.\n(2)\nNo affect\u202f11\u202fSo in original. Probably should be \u201ceffect\u201d. on treatment of certain out-of-pocket expenditures\nThe requirements of this section shall not affect the application of the procedures established under\nsection 1395w\u2013102(b)(4)(D) of this title","url":"https://projectusc.org/usc/t42/s1395w\u2013134.html","content":[{"t":"sec","id":"/us/usc/t42/s1395w\u2013134","children":[{"t":"num","text":"\u00a7\u202f1395w\u2013134."},{"t":"heading","text":"Coordination requirements for plans providing prescription drug coverage"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013134/a","children":[{"t":"num","text":"(a)"},{"t":"heading","text":"Application of benefit coordination requirements to additional plans"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/a/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"The Secretary shall apply the coordination requirements established under ","children":[{"t":"ref","text":"section 1395w\u2013133(a) of this title","href":"/us/usc/t42/s1395w\u2013133/a","tail":" to Rx plans described in subsection (b) in the same manner as such requirements apply to a State Pharmaceutical Assistance Program."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/a/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Application to treatment of certain out-of-pocket expenditures"},{"t":"content","children":[{"t":"p","text":"To the extent specified by the Secretary, the requirements referred to in paragraph (1) shall apply to procedures established under ","children":[{"t":"ref","text":"section 1395w\u2013102(b)(4)(D) of this title","href":"/us/usc/t42/s1395w\u2013102/b/4/D","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/a/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"User fees"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013134/a/3/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"The Secretary may impose user fees for the transmittal of information necessary for benefit coordination under ","children":[{"t":"ref","text":"section 1395w\u2013102(b)(4)(D) of this title","href":"/us/usc/t42/s1395w\u2013102/b/4/D","tail":" in a manner similar to the manner in which user fees are imposed under "},{"t":"ref","text":"section 1395u(h)(3)(B) of this title","href":"/us/usc/t42/s1395u/h/3/B","tail":", except that the Secretary may retain a portion of such fees to defray the Secretary\u2019s costs in carrying out procedures under "},{"t":"ref","text":"section 1395w\u2013102(b)(4)(D) of this title","href":"/us/usc/t42/s1395w\u2013102/b/4/D","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013134/a/3/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Application"},{"t":"content","children":[{"t":"p","text":"A user fee may not be imposed under subparagraph (A) with respect to a State Pharmaceutical Assistance Program.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013134/b","children":[{"t":"num","text":"(b)"},{"t":"heading","text":"Rx Plan"},{"t":"chapeau","text":"An Rx plan described in this subsection is any of the following:"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/b/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Medicaid programs"},{"t":"content","children":[{"t":"p","text":"A State plan under subchapter XIX, including such a plan operating under a waiver under ","children":[{"t":"ref","text":"section 1315 of this title","href":"/us/usc/t42/s1315","tail":", if it meets the requirements of "},{"t":"ref","text":"section 1395w\u2013133(b)(2) of this title","href":"/us/usc/t42/s1395w\u2013133/b/2","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/b/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Group health plans"},{"t":"content","children":[{"t":"p","text":"An employer group health plan.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/b/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"FEHBP"},{"t":"content","children":[{"t":"p","text":"The Federal employees health benefits plan under chapter 89 of title 5.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/b/4","children":[{"t":"num","text":"(4)"},{"t":"heading","text":"Military coverage (including TRICARE)"},{"t":"content","children":[{"t":"p","text":"Coverage under chapter 55 of title 10.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/b/5","children":[{"t":"num","text":"(5)"},{"t":"heading","text":"Other prescription drug coverage"},{"t":"content","children":[{"t":"p","text":"Such other health benefit plans or programs that provide coverage or financial assistance for the purchase or provision of prescription drug coverage on behalf of part D eligible individuals as the Secretary may specify.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013134/c","children":[{"t":"num","text":"(c)"},{"t":"heading","text":"Relation to other provisions"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/c/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Use of cost management tools"},{"t":"content","children":[{"t":"p","text":"The requirements of this section shall not impair or prevent a PDP sponsor or MA organization from applying cost management tools (including differential payments) under all methods of operation.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013134/c/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"No affect\u202f11\u202fSo in original. Probably should be \u201ceffect\u201d. on treatment of certain out-of-pocket expenditures"},{"t":"content","children":[{"t":"p","text":"The requirements of this section shall not affect the application of the procedures established under ","children":[{"t":"ref","text":"section 1395w\u2013102(b)(4)(D) of this title","href":"/us/usc/t42/s1395w\u2013102/b/4/D","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"}]}]}