2010 US Code
Title 42 - THE PUBLIC HEALTH AND WELFARE
CHAPTER 7 - SOCIAL SECURITY
SUBCHAPTER XVIII - HEALTH INSURANCE FOR AGED AND DISABLED
Part D - Voluntary Prescription Drug Benefit Program
subpart 5 - definitions and miscellaneous provisions
Sec. 1395w-151 - Definitions; treatment of references to provisions in part C
View MetadataPublication Title | United States Code, 2006 Edition, Supplement 4, Title 42 - THE PUBLIC HEALTH AND WELFARE |
Category | Bills and Statutes |
Collection | United States Code |
SuDoc Class Number | Y 1.2/5: |
Contained Within | Title 42 - THE PUBLIC HEALTH AND WELFARE CHAPTER 7 - SOCIAL SECURITY SUBCHAPTER XVIII - HEALTH INSURANCE FOR AGED AND DISABLED Part D - Voluntary Prescription Drug Benefit Program subpart 5 - definitions and miscellaneous provisions Sec. 1395w-151 - Definitions; treatment of references to provisions in part C |
Contains | section 1395w-151 |
Date | 2010 |
Laws in Effect as of Date | January 7, 2011 |
Positive Law | No |
Disposition | standard |
Source Credit | Aug. 14, 1935, ch. 531, title XVIII, §1860D-41, as added Pub. L. 108-173, title I, §101(a)(2), Dec. 8, 2003, 117 Stat. 2148. |
Statutes at Large Reference | 117 Stat. 2148 |
Public Law Reference | Public Law 108-173 |
§1395w–151. Definitions; treatment of references to provisions in part C (a) Definitions
For purposes of this part:
(1) Basic prescription drug coverageThe term “basic prescription drug coverage” is defined in section 1395w–102(a)(3) of this title.
(2) Covered part D drugThe term “covered part D drug” is defined in section 1395w–102(e) of this title.
(3) Creditable prescription drug coverageThe term “creditable prescription drug coverage” has the meaning given such term in section 1395w–113(b)(4) of this title.
(4) Part D eligible individualThe term “part D eligible individual” has the meaning given such term in section 1395w–101(a)(3)(A) of this title.1
(5) Fallback prescription drug planThe term “fallback prescription drug plan” has the meaning given such term in section 1395w–111(g)(4) of this title.
(6) Initial coverage limitThe term “initial coverage limit” means such limit as established under section 1395w–102(b)(3) of this title, or, in the case of coverage that is not standard prescription drug coverage, the comparable limit (if any) established under the coverage.
(7) Insurance riskThe term “insurance risk” means, with respect to a participating pharmacy, risk of the type commonly assumed only by insurers licensed by a State and does not include payment variations designed to reflect performance-based measures of activities within the control of the pharmacy, such as formulary compliance and generic drug substitution.
(8) MA planThe term “MA plan” has the meaning given such term in section 1395w–101(a)(3)(B) of this title.1
(9) MA–PD planThe term “MA–PD plan” has the meaning given such term in section 1395w–101(a)(3)(C) of this title.1
(10) Medicare Prescription Drug AccountThe term “Medicare Prescription Drug Account” means the Account created under section 1395w–116(a) of this title.
(11) PDP approved bidThe term “PDP approved bid” has the meaning given such term in section 1395w–113(a)(6) of this title.
(12) PDP regionThe term “PDP region” means such a region as provided under section 1395w–111(a)(2) of this title.
(13) PDP sponsorThe term “PDP sponsor” means a nongovernmental entity that is certified under this part as meeting the requirements and standards of this part for such a sponsor.
(14) Prescription drug planThe term “prescription drug plan” means prescription drug coverage that is offered—
(A) under a policy, contract, or plan that has been approved under section 1395w–111(e) of this title; and
(B) by a PDP sponsor pursuant to, and in accordance with, a contract between the Secretary and the sponsor under section 1395w–112(b) of this title.
(15) Qualified prescription drug coverageThe term “qualified prescription drug coverage” is defined in section 1395w–102(a)(1) of this title.
(16) Standard prescription drug coverageThe term “standard prescription drug coverage” is defined in section 1395w–102(b) of this title.
(17) State Pharmaceutical Assistance ProgramThe term “State Pharmaceutical Assistance Program” has the meaning given such term in section 1395w–133(b) of this title.
(18) Subsidy eligible individualThe term “subsidy eligible individual” has the meaning given such term in section 1395w–114(a)(3)(A) of this title.
(b) Application of part C provisions under this partFor purposes of applying provisions of part C of this subchapter under this part with respect to a prescription drug plan and a PDP sponsor, unless otherwise provided in this part such provisions shall be applied as if—
(1) any reference to an MA plan included a reference to a prescription drug plan;
(2) any reference to an MA organization or a provider-sponsored organization included a reference to a PDP sponsor;
(3) any reference to a contract under section 1395w–27 of this title included a reference to a contract under section 1395w–112(b) of this title;
(4) any reference to part C of this subchapter included a reference to this part; and
(5) any reference to an election period under section 1395w–21 of this title were a reference to an enrollment period under section 1395w–101 of this title.
(Aug. 14, 1935, ch. 531, title XVIII, §1860D–41, as added Pub. L. 108–173, title I, §101(a)(2), Dec. 8, 2003, 117 Stat. 2148.)
References in TextPart C of this subchapter, referred to in subsec. (b), is classified to section 1395w–21 et seq. of this title.
Section 1395w–101(a)(3) of this title, referred to in subsec. (a)(4), (8), (9), was in the original “section 1860D–1(a)(4)”, and was translated as meaning section 1860D–1(a)(3) of act Aug. 14, 1935, which is classified to section 1395w–101(a)(3) of this title, to reflect the probable intent of Congress, because section 1395w–101(a) of this title does not contain a par. (4) and par. (3) defines terms for purposes of this part.
1 See References in Text note below.
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