Page:United States Statutes at Large Volume 106 Part 4.djvu/318

 106 STAT. 3054 PUBLIC LAW 102-486—OCT. 24, 1992 as to whether a network medical provider will be used. Migor elements of such rules may include, but are not limited to, elements described in paragraph (3). "(3) MAJOR ELEMENTS OF RULES.— Elements described in this parc^aph are— '^A) implementing formulary for drugs and subjecting the prescription program to a rigorous review of appropriate use, "(B) obtaining a unit price discount in exchange for patient volume and preferred provider status with the amount of the potential discount varying by geographic region, "(C) limiting benefit payments to physicians to the allowable charge under title XVIII of the Social Security Act, while protecting beneficiaries from balance billing by providers, "(D) utilizing, in the claims payment fimction 'appropriateness of service' protocols under title XVIII of the Social Security Act if more stringent, "(F) selecting the most efficient phvsicians and stateof-the-art utilization management techniques, including ambulatory care techniques, for medical services delivered by the managed care network, and "(G) utilizing a managed care network provider system, as practiced in the health care industry, at the time medical services are needed (point-of-service) in order to receive maximimi benefits available under this subsection. "(4) LAST SIGNATORY OPERATORS.— The board of trustees of the 1992 UMWA Benefit Plan shall permit any last signatory operator required to maintain an individual employer plan under section 9711 to utilize the managed care and cost containment rules and programs developed under this subsection if the ojperator elects to do so. (5) STANDARDS OF QUALITY. —Any managed care system or cost containment adopted by the board of trustees of the 1992 UMWA Benefit Plan or by a last signatory operator may not be implemented unless it is approved by, and meets the standards of quality adopted by, a medical peer review panel, which has been established— "(A) by the settlors, or "(B) by the United Mine Workers of America and a last signatory operator or group of operators. Standards of quality shall include accessibility to medical care, taking into account that accessibility requirements may differ depending on the nature of the medical need. " (d) GUARANTEE OF BENEFITS.- "(1) IN GENERAL. — All 1988 last signatory operators shall be responsible for financing the benefits described in subsection (c), in accordance with contribution requirements established in the 1992 UMWA Benefit Plan. Such contribution requirements, which shall be applied uniformly to each 1988 last signatory operator, on the basis of the number of eligible and potentially eligible beneficiaries attributable to each operator, shall include:
 * (£) creating mandatory utilization review (UR) procedures, but placing the responsibility to follow such procedures on the physician or hospital, not the beneficiaries,

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