United States. Congress

“ Limitation on cost-sharing for dual eligibles and qualified medicare beneficiaries.—In the case of a individual who is a full-benefit dual eligible individual (as defined in section 1935 (c) (6) ) or a qualified medicare beneficiary (as defined in section 1905 (p) (1) ) who is enrolled in a Medicare Advantage plan, the plan may not impose cost-sharing that exceeds the amount of cost-sharing that would be permitted with respect to the individual under this title and title XIX if the individual were not enrolled with such plan. ”

“ Use of standardized elements and definitions.—The data to be submitted under subparagraph (A) relating to medical loss ratio for a year, beginning with 2012, shall be submitted based on the standardized elements and definitions developed under paragraph (3) . `` (3) Development of data reporting standards.— `` (A) In general.—The Secretary shall develop and implement standardized data elements and definitions for reporting under this subsection, for contract years beginning with 2012, of data necessary for the calculation of the medical loss ratio for MA plans. ”

“ Consultation.—The Secretary shall consult with the Health Choices Commissioner, representatives of MA organizations, experts on health plan accounting systems, and representatives of the National Association of Insurance Commissioners, in the development of such data elements and definitions. ”