Page:United States Statutes at Large Volume 101 Part 2.djvu/946

 101 STAT. 1330-152

PUBLIC LAW 100-203—DEC. 22, 1987

(b) MEDICAID MATCHING RATE FOR QUALITY REVIEW OF SERVICES.—

HMO

(1) Section 1902(a)(30)(C) of such Act (42 U.S.C. 1396a(a)(30)(C)) is amended by inserting ", an entity which meets the requirements of section 1152, as determined by the Secretary," after "title XI)". (2) Section 1902(d) of such Act (42 U.S.C. 1396a(d)) is amended— (i) by inserting after "contracts with" the following: "an entity which meets the requirements of section 1152, as determined by the Secretary, for the performance of the ^ g^ quality review functions described in subsection (a)(30)(C), or", and (ii) by striking "organization (or organizations)" each place it appears and inserting "such an entity or organization". (3) Section 1903(a)(3)(C) of such Act (42 U.S.C. 1396b(a)(3)(C)) is amended by inserting "or by an entity which meets the requirements "of section 1152, as determined by the Secretary," after "utilization and quality control peer review organization".

Contracts.

(c) FREEDOM OF CHOICE.— .aJos-f^ri':

l'v>

Effective date. 42 USC 1396a note.

(1) Section 1902(a)(23) of such Act (42 U.S.C. 1396a(a)(23)) is amended— (A) by inserting "(A)" after "Guam, provide that", and (B) by inserting before the semicolon at the end the following: ", and (B) an enrollment of an individual eligible for medical assistance in a primary care case-management system (described in section 1915(b)(l)), a health maintenance organization, or a similar entity shall not restrict the choice of the qualified person from whom the individual may receive services under section 1905(a)(4)(C)". (2) Section 1902(e)(2)(A) of such Act (42 U.S.C. 1396a(e)(2)(A)) is amended by striking "but only" and inserting "but, except for benefits furnished under section 1905(a)(4)(C), only". (3) The amendments made by this subsection shall apply to services furnished on and after July 1, 1988. (d) TECHNICAL AMENDMENTS.—

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(1) Section 1903(m)(2)(F) of such Act (42 U.S.C. 1396b(m)(2)(F)) is amended by striking "subparagraph (G)" and inserting "subparagraphs (E) or (G)". (2) Section 1902(e)(2)(A) of such Act (42 U.S.C. 1396a(e)(2)(A)) is amended by striking "section 1903(m)(2)(G)" and inserting "subparagraph (B)(iii), (E), or (G) of section 1903(m)(2)".

(e) CONTINUED ELIGIBILITY AND RESTRICTION ON DISENROLLMENT WITHOUT CAUSE FOR METROPOUTAN HEALTH PLAN HMO.—For pur-

poses of sections 1902(e)(2)(A) and 1903(m)(2)(F) of the Social Security Act, the Metropolitan Health Plan HMO operated by the New York City public hospitals shall be treated in the same manner as a qualiHed health maintenance organization (as defined in section 1310(d) of the Public Health Service Act). SEC. 4114. MEDICAID WAIVER FOR HOSPICE CARE FOR AIDS PATIENTS.

Section 1905(o)(l) of the Social Security Act (42 U.S.C. 1396d(o)(l)) is amended— (1) by inserting "(A)" after "(1)"; (2) by striking "The" and inserting "Subject to subparagraph (B), the"; and

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