metropolitan statistical area
(4) Geographic adjustment (A) In general Upon written request of the chief executive officer of a State for a contract year (beginning after 1998) made by not later than February 1 of the previous year, the Secretary shall make a geographic adjustment to a Medicare+Choice payment area in the State otherwise determined under paragraph (1) for MA local plans— (i) to a single statewide Medicare+Choice payment area, (ii) to the metropolitan based system described in subparagraph (C), or (iii) to consolidating into a single Medicare+Choice payment area noncontiguous counties (or equivalent areas described in paragraph (1)(A)) within a State. Such adjustment shall be effective for payments for months beginning with January of the year following the year in which the request is received. (B) Budget neutrality adjustment In the case of a State requesting an adjustment under this paragraph, the Secretary shall initially (and annually thereafter) adjust the payment rates otherwise established under this section with respect to MA local plans for Medicare+Choice payment areas in the State in a manner so that the aggregate of the payments under this section for such plans in the State shall not exceed the aggregate payments that would have been made under this section for such plans for Medicare+Choice payment areas in the State in the absence of the adjustment under this paragraph. (C) Metropolitan based system The metropolitan based system described in this subparagraph is one in which— (i) all the portions of each metropolitan statistical area in the State or in the case of a consolidated metropolitan statistical area, all of the portions of each primary metropolitan statistical area within the consolidated area within the State, are treated as a single Medicare+Choice payment area, and (ii) all areas in the State that do not fall within a metropolitan statistical area are treated as a single Medicare+Choice payment area. (D) Areas In subparagraph (C), the terms “metropolitan statistical area”, “consolidated metropolitan statistical area”, and “primary metropolitan statistical area” mean any area designated as such by the Secretary of Commerce.