Page:United States Statutes at Large Volume 111 Part 1.djvu/320

 Ill STAT. 296 PUBLIC LAW 105-33—AUG. 5, 1997 before or during enrollment and to enrollees within 90 days after the date that the organization or plan adopts a change in policy regarding such a counseling or referral service. "(C) CONSTRUCTION. —Nothing in subparagraph (B) shall be construed to affect disclosure requirements under State law or under the Employee Retirement Income Security Act of 1974. "(D) HEALTH CARE PROFESSIONAL DEFINED.— For purposes of this paragraph, the term 'health care professional' means a physician (as defined in section 186l(r)) or other health care professional if coverage for the professional's services is provided under the Medicare+Choice plan for the services of the professional. Such term includes a podiatrist, optometrist, chiropractor, psychologist, dentist, physician assistant, physical or occupational therapist and therapy assistant, speech-language pathologist, audiologist, registered or licensed practical nurse (including nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse-midwife), licensed certified social worker, registered respiratory therapist, and certified respiratory therapy technician. " (4) LIMITATIONS ON PHYSICIAN INCENTIVE PLANS.— "(A) IN GENERAL. —No Medicare-i -Choice organization may operate any physician incentive plan (as defined in subparagraph (B)) unless the following requirements are met: "(i) No specific payment is made directly or indirectly under the plan to a physician or physician group as an inducement to reduce or limit medically necessary services provided with respect to a specific individual enrolled with the orgsinization. "(ii) If the plan places a physician or physician group at substantial financial risk (as determined by the Secretary) for services not provided by the physician or physician group, the organization— "(I) provides stop-loss protection for the physician or group that is adequate and appropriate, based on standards developed by the Secretary that take into account the number of physicians placed at such substantial financial risk in the group or under the plan and the number of individuals enrolled with the organization who receive services from the physician or group, and "(II) conducts periodic surveys of both individuals enrolled and individuals previously enrolled with the organization to determine the degree of access of such individuals to services provided by the organization and satisfaction with the quality of such services. " (iii) The organization provides the Secretary with descriptive information regarding the plan, sufficient to permit the Secretary to determine whether the plan is in compliance with the requirements of this subparagraph. "(B) PHYSICIAN INCENTIVE PLAN DEFINED. —In this paragraph, the term 'physician incentive plan' means any

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