Page:United States Statutes at Large Volume 101 Part 2.djvu/855

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-61

care services that are covered under this title and are furnished • to any individual enrolled with an eligible organization with a risk-sharing contract under section 1876 the amounts (in the case of hospitals) or limits (in the case of skilled nursing facilities) that would be made as a payment in full under this title if the individuals were not so enrolled.". (b) REPEAL.—Section 1876(g)(4) of the Social Security Act (42 U.S.C. 1395mm(g)(4)) is repealed. (c) IMPLEMENTATION.—The Secretary of Health and Human Services shall provide (in machine readable form) to eligible organizations under section 1876 of the Social Security Act medicare DRG rates for payments required by the amendment made by paragraph (2) and data on cost pass-through items for all inpatient services provided to medicare beneficiaries enrolled with such organizations. (d) EFFECTIVE DATE.—The amendments made by subsections (a) and (b) shall apply to admissions occurring on or after April 1, 1988, or, if later, the earliest date the Secretary can provide the information required under subsection (c) in machine readable form.

42 USC 1395mm note.

42 USC 1395mm note.

SEC. 40L3. TWO-YEAR EXTENSION ON PERIOD FOR BENEFIT STABILIZATION.

(a) IN GENERAL.—Section 1876(g)(5) of the Social Security Act (42 U.S.C. 1395mm(g)(5)), as added by the amendment made by section 2350(a)(2) of the Deficit Reduction Act of 1984, is amended by striking "four" and inserting "six". (b) EFFECTIVE DATE.—The amendment made by subsection (a) 42 USC 1395mm shall be effective as if included in the enactment of the amendment note. made by section 2350(a)(2) of the Deficit Reduction Act of 1984. SEC. 4014. CIVIL MONEY PENALTIES AND INTERMEDIATE SANCTIONS AGAINST HMOS/CMPS.

Section 1876(i)(6) of the Social Security Act (42 U.S.C. 1395mm) is amended to read as follows: "(6)(A) If the Secretary determines that an eligible organization Contracts. with a contract under this section— "(i) fails substantially to provide medically necessary items and services that are required (under law or under the contract) to be provided to an individual covered under the contract, if the failure has adversely affected (or has substantial likelihood of adversely affecting) the individual; "(ii) imposes premiums on individuals enrolled under this section in excess of the premiums permitted; "(iii) acts to expel or to refuse to re-enroll an individual in violation of the provisions of this section; Ii "(iv) engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment (except as permitted by this section) by eligible individuals with ., the organization whose medical condition or history indicates a need for substantial future medical services; "(v) misrepresents or falsifies information that is furnished— "(I) to the Secretary under this section, or "(II) to an individual or to any other entity under this section; or "(vi) fails to comply with the requirements of subsection (g)(e)(A); the Secretary may provide for any of the remedies described in subparagraph (B).

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