Page:United States Statutes at Large Volume 101 Part 2.djvu/857

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-63

(A) may retain the surplus, but not to exceed 5 percent of the average adjusted per capita cost determined in accordance with paragraph (3)(A), and (B) with respect to any additional surplus not retained by the project, shall apply such surplus to additional benefite for individuals served by the project or return such surplus to the Secretary. (5) Enrollment under the project shall be voluntary. Individuals enrolled with the project may terminate such enrollment as of the beginning of the first calendar month following the date on which the request is made for such termination. Upon such termination, such individuals shall retain the same rights to other health benefits that such individuals would have had if they had never enrolled with the project without any exclusion or waiting period for pre-existing conditions. (6) The requirements of— (A) subsection (c)(3)(C) (relating to dissemination of information), (B) subsection (c)(3)(E) (annual statement of rights), (C) subsection (c)(5) (grievance procedures), (D) subsection (c)(6) (on-going quality), (E) subsection (g)(6) (relating to prompt payment of claims), (F) subsection (i)(3)(A) and (B) (relating to access to information and termination notices), (G) subsection (i)(6) (relating to providing necessary services), and (H) subsection (i)(7) (relating to agreements with peer Contracts. review organizations), of section 1876 of the Social Security Act shall apply to a project in the same manner as they apply to eligible organizations with risk-sharing contracts under such section, (7) The benefits provided under a project must be at least actuarially equivalent to the combination of the benefits available under title XVIII of the Social Security Act and the benefits available through any alternative plans in which the individual can enroll through the the employer. The project shall guarantee the actuarial value of benefits available under the employer plan for the duration of the project. (8) A project shall comply with all applicable State laws. (9) The Secretary may not authorize a project unless the entity offering the project demonstrates to the satisfaction of the Secretary that it has the necessary financial reserves to pay for any liability for benefits under the project (including those liabilities for health benefits under medicare and any supplemental benefits). (10) The Comptroller General shall monitor projects under Reports. this subsection and shall report periodically (not less often than once every year) to the (Dommittee on Finance of the Senate and the Committee on Energy and Commerce and Committee on Ways and Means of the House of Representatives on the status of such projects and the affect on such projects of the requirements of this section and shall submit a final report to each such committee on the results of such projects. (b) PAYMENT METHODOLOGY REFORM DEMONSTRATIONS PROJECTS.—

(1) The Secretary of Health and Human Services (in this subsection referred to as the "Secretary") is specifically au-

�