Page:United States Statutes at Large Volume 111 Part 1.djvu/319

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 295 records or other health information regarding enrollees under this part, the Medicare+Choice organization shall establish procedures— "(1) to safeguard the privacy of any individually identifiable enrollee information; "(2) to maintain such records and information in a mginner that is accurate and timely, and "(3) to assure timely access of enrollees to such records and information. "(i) INFORMATION ON ADVANCE DIRECTIVES.— Each Medicare+Choice organization shall meet the requirement of section 1866(f) (relating to maintaining written policies and procedures respecting advance directives). " (j) RULES REGARDING PROVIDER PARTICIPATION.— "(1) PROCEDURES.— Insofar as a Medicare+Choice organization offers benefits under a Medicare+Choice plan through agreements with physicians, the organization shall establish reasonable procedures relating to the participation (under an agreement between a physician and the organization) of physicians under such a plan. Such procedures shall include— "(A) providing notice of the rules regarding participation, "(B) providing written notice of participation decisions that are adverse to physicians, and "(C) providing a process within the organization for appealing such adverse decisions, including the presentation of information and views of the physicisui regarding such decision. " (2) CONSULTATION IN MEDICAL POLICIES.— A Medicare+Choice organization shall consult with physicians who have entered into participation agreements with the organization regarding the organization's medical policy, quality, and medical management procedures. " (3) PROHIBITING INTERFERENCE WITH PROVIDER ADVICE TO ENROLLEES.— "(A) IN GENERAL.— Subject to subparagraphs (B) and (C), a Medicare+Choice organization (in relation to an individual enrolled under a Medicare+Choice plan offered by the organization under this part) shall not prohibit or otherwise restrict a covered health care professional (as defined in subparagraph (D)) from advising such an individual who is a patient of the professional about the health status of the individual or medical care or treatment for the individual's condition or disease, regardless of whether benefits for such care or treatment are provided under the plan, if the professional is acting within the lawful scope of practice. "(B) CONSCIENCE PROTECTION.— Subparagraph (A) shall not be construed as requiring a Medicare+Choice plan to provide, reimburse for, or provide coverage of a counseling or referral service if the Medicare+Choice organization offering the plan— "(i) objects to the provision of such service on moral or religious grounds; and "(ii) in the manner and through the written instrumentalities such Medicare+Choice organization deems appropriate, makes available information on its policies regarding such service to prospective enrollees

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