new MA plan

(3) Qualifying plans and qualifying county defined; application of increases to low enrollment and new plans For purposes of this subsection: (A) Qualifying plan (i) In general The term “qualifying plan” means, for a year and subject to paragraph (4), a plan that had a quality rating under paragraph (4) of 4 stars or higher based on the most recent data available for such year. (ii) Application of increases to low enrollment plans (I) 2012 For 2012, the term “qualifying plan” includes an MA plan that the Secretary determines is not able to have a quality rating under paragraph (4) because of low enrollment. (II) 2013 and subsequent years For 2013 and subsequent years, for purposes of determining whether an MA plan with low enrollment (as defined by the Secretary) is included as a qualifying plan, the Secretary shall establish a method to apply to MA plans with low enrollment (as defined by the Secretary) the computation of quality rating and the rating system under paragraph (4). (iii) Application of increases to new plans (I) In general A new MA plan that meets criteria specified by the Secretary shall be treated as a qualifying plan, except that in applying paragraph (1), the applicable percentage under subsection (n)(2)(B) shall be increased— (aa) for 2012, by 1.5 percentage points; (bb) for 2013, by 2.5 percentage points; and (cc) for 2014 or a subsequent year, by 3.5 percentage points. (II) New MA plan defined The term “new MA plan” means, with respect to a year, a plan offered by an organization or sponsor that has not had a contract as a Medicare Advantage organization in the preceding 3-year period. (B) Qualifying county The term “qualifying county” means, for a year, a county— (i) that has an MA capitation rate that, in 2004, was based on the amount specified in subsection (c)(1)(B) for a Metropolitan Statistical Area with a population of more than 250,000; (ii) for which, as of December 2009, of the Medicare Advantage eligible individuals residing in the county at least 25 percent of such individuals were enrolled in Medicare Advantage plans; and (iii) that has per capita fee-for-service spending that is lower than the national monthly per capita cost for expenditures for individuals enrolled under the original medicare fee-for-service program for the year.


42 USC § 1395w-23(o)(3)

Scoping language

For purposes of this subsection
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