Page:United States Statutes at Large Volume 111 Part 1.djvu/315

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 291 to provide services under the terms of the plan. The Secretary shall find that an organization has met such requirement with respect to any category of health care professional or provider if, with respect to that category of provider— "(A) the plan has established payment rates for covered services furnished by that category of provider that are not less than the payment rates provided for under part A, part B, or both, for such services, or "(B) the plan has contracts or agreements with a sufficient number and range of providers within such category to provide covered services under the terms of the plan, or a combination of both. The previous sentence shall not be construed as restricting the persons from whom enrollees under such a plan may obtain covered benefits. " (e) QUALITY ASSURANCE PROGRAM.— "(1) IN GENERAL.— Each Medicare-f -Choice organization must have arrangements, consistent with any regulation, for an ongoing quality assurance program for health care services it provides to individuals enrolled with Medicare-i-Choice plans of the organization. " (2) ELEMENTS OF PROGRAM. — "(A) IN GENERAL. —The quality assurance program of an organization with respect to a Medicare+Choice plan (other than a Medicare+Choice private fee-for-service plan or a non-network MSA plan) it offers shall— "(i) stress health outcomes and provide for the collection, analysis, and reporting of data (in accordance with a quality measurement system that the Secretary recognizes) that will permit measurement of outcomes and other indices of the quality of Medicare+Choice plans and organizations; "(ii) monitor and evaluate high volume and high risk services and the care of acute and chronic conditions; "(iii) evaluate the continuity and coordination of care that enrollees receive; "(iv) be evaluated on an ongoing basis as to its effectiveness; "(v) include measures of consumer satisfaction; "(vi) provide the Secretary with such access to information collected as may be appropriate to monitor and ensure the quality of care provided under this part; "(vii) provide review by physicians and other health care professionals of the process followed in the provision of such health care services; "(viii) provide for the establishment of written protocols for utilization review, based on current standards of medical practice; "(ix) have mechanisms to detect both underutilization and overutilization of services; "(x) after identifying areas for improvement, establish or alter practice parameters;

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