Page:United States Statutes at Large Volume 111 Part 1.djvu/321

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 297 compensation arrangement between a Medicare+Choice organization and a physician or physician group that may directly or indirectly have the effect of reducing or limiting services provided with respect to individuals enrolled with the organization under this part. "(5) LIMITATION ON PROVIDER INDEMNIFICATION. — A Medicare+Choice organization may not provide (directly or indirectly) for a health care professional, provider of services, or other entity providing health care services (or group of such professionals, providers, or entities) to indemnify the organization against any liability resulting from a civil action brought for any damage caused to an enrollee with a Medicare+Choice plan of the organization under this part by the organization's denial of medically necessary care. "(6) SPECIAL RULES FOR MEDICARE+CHOICE PRIVATE FEE- FOR-SERVICE PLANS.— For purposes of applying this part (including subsection (k)(l)) and section 1866(a)(l)(0), a hospital (or other provider of services), a physician or other health care professional, or other entity furnishing health care services is treated as having an agreement or contract in effect with a Medicare+Choice organization (with respect to an individual enrolled in a Medicare+Choice private fee-for-service plan it offers), if— "(A) the provider, professional, or other entity furnishes services that are covered under the plan to such an enrollee; and "(B) before providing such services, the provider, professional, or other entity — "(i) has been informed of the individual's enrollment under the plan, and " (ii) either— "(I) has been informed of the terms and conditions of payment for such services under the plan, or "(II) is given a reasonable opportunity to obtain information concerning such terms and conditions, in a manner reasonably designed to effect informed agreement by a provider. The previous sentence shall only apply in the absence of an explicit agreement between such a provider, professional, or other entity and the Medicare+Choice organization, "(k) TREATMENT OF SERVICES FURNISHED BY CERTAIN PROVID- ERS.— "(1) IN GENERAL.— Except as provided in paragraph (2), a physician or other entity (other than a provider of services) that does not have a contract establishing payment amounts for services furnished to an individual enrolled under this part with a Medicare+Choice organization described in section 1851(a)(2)(A) shall accept as payment in full for covered services under this title that are furnished to such an individual the amounts that the physician or other entity could collect if the individual were not so enrolled. Any penalty or other provision of law that applies to such a payment with respect to an individual entitled to benefits under this title (but not enrolled with a Medicare+Choice organization under this part) also applies with respect to an individual so enrolled. 39-194O-97-11:QL3Part1

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