Section 1 Short title
This Act may be cited as the “Addressing Social Determinants in Medicare Advantage Act of 2021”.
Addressing Social Determinants in Medicare Advantage Act of 2021
A BILL
To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees.
Sec. 2 Expanding the availability of supplemental benefits to certain Medicare Advantage enrollees
In general— Section 1852(a)(3)(D) of the Social Security Act (42 U.S.C. 1395w–22(a)(3)(D)) is amended—
in the header, by striking “chronically ill” and inserting “certain”;
in clauses (i) and (ii), by striking “chronically ill” each place such term appears and inserting “specified” in each such place; and
in clause (iii), by amending such clause to read as follows:
“(iii) Specified enrollee defined—In this subparagraph, the term “specified enrollee” means an enrollee in an MA plan that—
“(I) the Secretary determines—
“(aa) has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee;
“(bb) has a high risk of hospitalization or other adverse health outcomes; and
“(cc) requires intensive care coordination;
“(II) is a low-income enrollee (as specified by the Secretary); or
“(III) meets any other criterion determined appropriate by the Secretary, such as criteria relating to social and socioeconomic risk.”
Effective date— The amendments made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2023.