Page:United States Statutes at Large Volume 111 Part 1.djvu/313

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 289 equivalent in emergency situations and an explanation of what constitutes an emergency situation; "(ii) the process and procedures of the plan for obtaining emergency services; and "(iii) the locations of (I) emergency departments, and (II) other settings, in which plan physicians and hospitals provide emergency services and post-stabilization care. "(F) SUPPLEMENTAL BENEFITS. — Supplemental benefits available from the organization offering the plan, including— "(i) whether the supplemental benefits are optional, "(ii) the supplemental benefits covered, and "(iii) the Medicare+Choice monthly supplemental beneficiary premium for the supplemental benefits. " (G) PRIOR AUTHORIZATION RULES.— Rules regarding prior authorization or other review requirements that could result in nonpayment. " (H) PLAN GRIEVANCE AND APPEALS PROCEDURES.—A ll plan appeal or grievance rights and procedures. "(I) QUALITY ASSURANCE PROGRAM. —A description of the organization's quality assurance program under subsection (e). " (2) DISCLOSURE UPON REQUEST.— Upon request of a Medicare+Choice eligible individual, a Medicare+Choice organization must provide the following information to such individual: "(A) The general coverage information and general comparative plan information made available under clauses (i) and (ii) of section 1851(d)(2)(A). "(B) Information on procedures used by the organization to control utilization of services and expenditures. "(C) Information on the number of grievances, redeterminations, and appeals and on the disposition in the aggregate of such matters. "(D) An overall summary description as to the method of compensation of participating physicians. " (d) ACCESS TO SERVICES. — "(1) IN GENERAL.— ^A Medicare+Choice organization offering a Medicare+Choice plan may select the providers from whom the benefits under the plan are provided so long as— "(A) the organization makes such benefits available and accessible to each individual electing the plan within the plan service area with reasonable promptness and in a manner which assures continuity in the provision of benefits; "(B) when medically necessary the organization makes such benefits available and: accessible 24 hours a day and 7 days a week; "(C) the plan provides for reimbursement with respect to services which are covered under subparagraphs (A) and (B) and which are provided to such an individual other than through the organization, if— "(i) the services were not emergency services (as defined in paragraph (3)), but (I) the services were medically necessary and immediately required because

�