Page:United States Statutes at Large Volume 101 Part 2.djvu/856

 101 STAT. 1330-62

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42 USC 1395mm

PUBLIC LAW 100-203—DEC. 22, 1987

"(B) The remedies described in this subparagraph are— "(i) civil money penalties of not more than $25,000 for each "' determination under subparagraph (A) or, with respect to a determination under clause (iv) or (v)(I), of not more than $100,000 for each such determination, "(ii) suspension of enrollment of individuals under this section ' after the date the Secretary notifies the organization of a determination under subparagraph (A) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur, or "(iii) suspension of payment to the organization under this section for individuals enrolled after the date the Secretary notifies the organization of a determination under subparagraph (A) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as they apply to a civil money penalty under that section.", SEC. 4015. MEDICARE PAYMENT DEMONSTRATION PROJECTS. (a) MEDICARE INSURED GROUP DEMONSTRATION PROJECTS.—

Contracts.

(1) The Secretary of Health and Human Services (in this subsection referred to as the "Secretary") may provide for capitation demonstration projects (in this subsection referred to as "projects") with an entity which is an eligible organization with a contract with the Secretary under section 1876 of the Social Security Act or which meets the restrictions and requirements of this subsection. The Secretary may not approve a project unless it meets the requirements of this subsection. (2) The Secretary may not conduct more than 3 projects and may not expend, from funds under title XVIII of the Social Security Act, more than $600,000,000 in any fiscal year for all such projects. (3) The per capita rate of payment under a project— (A) may be based on the adjusted average per capita cost (as defined in section 1876(a)(4) of the Social Security Act) determined only with respect to the group of individuals involved (rather than with respect to medicare beneficiaries generally), but \ *' ""'

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(B) the r a t e of payment may not exceed the lesser of— (i) 95 percent of the adjusted average per capita cost described in subparagraph (A), or (iiXD in the 4th year or 5th year of a project, 115 percent of the adjusted average per capita cost (as defined in section 1876(a)(4) of such Act) for classes of individuals described in section 1876(a)(l)(B) of that Act, or (II) in any subsequent year of a project, 95 percent of the adjusted average per capita cost (as defined in section 1876(a)(4)) for such cleisses.

(4) If the payment amounts made to a project are greater than the costs of the project (as determined by the Secretary or, if applicable, on the basis of adjusted community rates described in section 1876(e)(3) of the Social Security Act), the project—

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