benefits under the original medicare fee-for-service program option

(i)For purposes of this part, the term “benefits under the original medicare fee-for-service program option” means, subject to subsection (m), those items and services (other than hospice care or coverage for organ acquisitions for kidney transplants, including as covered under) for which benefits are available under parts A and B to individuals entitled to benefits under part A and enrolled under part B, with cost-sharing for those services as required under parts A and B or, subject to clause (iii), an actuarially equivalent level of cost-sharing as determined in this part. (ii)In the case of an MA regional plan in determining an actuarially equivalent level of cost-sharing with respect to benefits under the original medicare fee-for-service program option, there shall only be taken into account, with respect to the application of, such expenses only with respect to subparagraph (A) of such section. (iii)Subject to clause (v), cost-sharing for services described in clause (iv) shall not exceed the cost-sharing required for those services under parts A and B. (iv)The following services are described in this clause: (I)Chemotherapy administration services. (II)Renal dialysis services (as defined insection 1395rr(b)(14)(B) of this title). (III)Skilled nursing care. (IV)Such other services that the Secretary determines appropriate (including services that the Secretary determines require a high level of predictability and transparency for beneficiaries). (v)In the case of services described in clause (iv) for which there is no cost-sharing required under parts A and B, cost-sharing may be required for those services in accordance with clause (i).

Source

42 USC § 1395w-22(a)(1)(B)(i)


Scoping language

For purposes of this part
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