Page:United States Statutes at Large Volume 111 Part 1.djvu/316

 Ill STAT. 292 PUBLIC LAW 105-33 —AUG. 5, 1997 "(xi) take action to improve quality and assesses the effectiveness of such action through systematic followup; and "(xii) make available information on quality and outcomes measures to facilitate beneficiary comparison and choice of health coverage options (in such form and on such quality and outcomes measures as the Secretary determines to be appropriate). " (B) ELEMENTS OF PROGRAM FOR ORGANIZATIONS OFFER- ING MEDICARE+CHOICE PRIVATE FEE-FOR-SERVICE PLANS AND NON-NETWORK MSA PLANS. — The quality assurance program of £m organization with respect to a Medicare+Choice private fee-for-service plan or a non-network MSA plan it offers shall— "(i) meet the requirements of clauses (i) through (vi) of subparagraph (A); "(ii) insofar as it provides for the establishment of written protocols for utilization review, base such protocols on current standards of medical practice; and "(iii) have mechanisms to evaluate utilization of services and inform providers and enrollees of the results of such evaluation. "(C) DEFINITION OF NON-NETWORK MSA PLAN. —In this subsection, the term 'non-network MSA plan' means an MSA plan offered by a Medicare+Choice organization that does not provide benefits required to be provided by this part, in whole or in part, through a defined set of providers under contract, or under another arrangement, with the organization. " (3) EXTERNAL REVIEW. — "(A) IN GENERAL.— Each Medicare+Choice organization shall, for each Medicare+Choice plan it operates, have an agreement with an independent quality review and improvement organization approved by the Secretary to perform functions of the type described in sections 1154(a)(4)(B) and 1154(a)(14) with respect to services furnished by Medicare+Choice plans for which payment is made under this title. The previous sentence shall not apply to a Medicare+Choice private fee-for-service plan or a non-network MSA plan that does not employ utilization review. "(B) NONDUPLICATION OF ACCREDITATION.— Except in the case of the review of quality complaints, and consistent with subparagraph (C), the Secretary shall ensure that the external review activities conducted under subparagraph (A) are not duplicative of review activities conducted as part of the accreditation process. "(C) WAIVER AUTHORITY.—The Secretary may waive the requirement described in subparagraph (A) in the case of an organization if the Secretary determines that the organization has consistently maintained an excellent record of quality assurance and compliance with other requirements under this part. "(4) TREATMENT OF ACCREDITATION. — The Secretary shall provide that a Medicare+Choice organization is deemed to meet requirements of paragraphs (1) and (2) of this subsection and subsection (h) (relating to confidentiality and accuracy of

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