Page:United States Statutes at Large Volume 100 Part 3.djvu/191

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 1999

calendar days with respect to claims submitted by participating physicians), "(C) If payment is not issued, mailed, or otherwise transmitted Claims. within the applicable number of calendar days (as defined in clause (ii) of subparagraph (B)) after a clean claim (as defined in clause (i) of such subparagraph) is received, interest shall be paid at the rate used for purposes of section 3902(a) of title 31, United States Code (relating to interest penalties for failure to make prompt payments) for the period beginning on the day after the required payment date and ending on the date on which payment is made.". (d) EFFECTIVE DATES.—

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42 USC 1395h note. Claims.

(1) Except as provided in paragraph (2), the amendments made by subsections (b) and (c) shall apply to claims received on or after November 1, 1986. (2) Sections 1816(c)(2)(C)) and 1842(c)(2)(C) of the Social Secu- Ante, pp. 1997, rity Act, as added by such amendments, shall apply to claims 1998. Claims. received on or after April 1, 1987. (3) The Secretary of Health and Human Services shall provide Contracts. for such timely amendments to agreements under section 1816 of the Social Security Act and contracts under section 1842 of such Act, and regulations, to such extent as may be necessary to implement the provisions of this Act on a timely basis.

SEC. 9312. HEALTH MAINTENANCE ORGANIZATIONS AND COMPETITIVE MEDICAL PLANS. (a) REPEAL OF "2 FOR 1" CONVERSION REQUIREMENT FOR CERTAIN

HEALTH MAINTENANCE ORGANIZATIONS.—Section 114(c)(2) of the Tax

42 USC 1395mm note.

Equity and Fiscal Responsibility Act of 1982 is amended by adding at the end the following new subparagraph: "(E) The preceding provisions of this paragraph shall not to apply to payments made for current, nonrisk medicare enrollees for months beginning with April 1987.". (b) REQUIRING THE PROVISION OF AN EXPLANATION OF ENROLLEE RIGHTS.—

(1) IN GENERAL.—Subsection (c)(3) of section 1876 of the Social J Security Act (42 U.S.C. 1395mm) is amended by adding at the ^ end the following new subparagraph: "(E) Each eligible organization shall provide each enrollee, at the time of enrollment and not less frequently than annually thereafter, an explanation of the enrollee's rights under this section, including an explanation of— "(i) the enrollee's rights to benefits from the organization, f "(ii) the restrictions on payments under this title for services ii furnished other than by or through the organization, t "(iii) out-of-area coverage provided by the organization, J "(iv) the organization's coverage of emergency services and urgently needed care, and "(v) appeal rights of enrollees.". ':• (2) EFFECTIVE DATE.—The amendment made by paragraph (1) 42 USC 1395mm •; shall take effect on January 1, 1987, and shall apply to enroll- note. ments effected on or after such date. (c) RESTRICTING WAIVER OF REQUIREMENT OF 50 PERCENT NONMEDICARE ENROLLMENT.—

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(1) RESTRICTION ON NEW WAIVERS.—Paragraph (2) of subsec-

tion (f) of such section is amended by striking all that follows "only" and inserting a dash and the following:

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