Page:United States Statutes at Large Volume 110 Part 3.djvu/865

 PUBLIC LAW 104-201—SEPT. 23, 1996 110 STAT. 2595 SEC. 724. ENROLLMENT OF COVERED BENEFICIARIES. (a) FISCAL YEAR 1997 LIMITATION. — (1) During fiscal year 1997, the number of covered beneficiaries who are enrolled in managed care plans offered by designated providers may not exceed the number of such enrollees as of October 1, 1995. (2) The Secretary may waive the limitation under paragraph (1) if the Secretary determines that additional enrollment authority for a designated provider is required to accommodate covered beneficiaries who are dependents of members of the uniformed services entitled to health care under section 1074(a) of title 10, United States Code. (b) PERMANENT LIMITATION. — For each fiscal year beginning Eifter September 30, 1997, the number of enrollees in managed care plans offered by designated providers may not exceed 110 percent of the number of such enrollees as of the first day of the immediately preceding fiscal year. The Secretary may waive this limitation as provided in subsection (a)(2). (c) RETENTION OF CURRENT ENROLLEES. —An enrollee in the managed care plan of a designated provider as of September 30, 1997, or such earlier date as the designated provider and the Secretary may agree upon, shall continue receiving services from the designated provider pursuant to the agreement entered into under section 722 unless the enrollee disenrolls from the designated provider. Except as provided in subsection (e), the administering Secretaries may not disenroll such an enrollee unless the disenrollment is agreed to by the Secretary and the designated provider. (d) ADDITIONAL ENROLLMENT AUTHORITY. — Other covered beneficiaries may also receive health care services from a designated provider, except that the designated provider may market such services to, and enroll, only those covered beneficiaries who— (1) do not have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; or (2) are enrolled in the direct care system under the TRICARE program, regardless of whether the covered beneficiaries were users of the hesilth care delivery system of the uniformed services in prior years. (e) SPECIAL RULE FOR MEDICARE-ELIGIBLE BENEFICIARIES.— If a covered beneficiary who desires to enroll in the managed care program of a designated provider is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.), the covered beneficiary shall elect whether to receive health care services as an enrollee or under part A of title XVIII of the Social Security Act. The Secretary may disenroll an enrollee who subsequently violates the election made under this subsection and receives benefits under part A of title XVIII of the Social Security Act. (f) INFORMATION REGARDING ELIGIBLE COVERED BENE- FICIARIES. — The Secretary shall provide, in a timely manner, a designated provider with an accurate list of covered beneficiaries within the marketing area of the designated provider to whom the designated provider may offer enrollment. SEC. 725. APPLICATION OF CHAMPUS PAYMENT RULES. (a) APPLICATION OF PAYMENT RULES. — Subject to subsection (b), the Secretary shall require a private facility or health care 2&-194O-96 - 28:QL3Part3

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