Page:United States Statutes at Large Volume 111 Part 1.djvu/323

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 299 hospital imposes balance billing under subparagraph (A)- "(I) notice of the fact that balance billing is permitted under such subparagraph for such services, and "(11) a good faith estimate of the likely amount of such balance billing (if any), with respect to such services, based upon the presenting condition of theenrollee. "PAYMENTS TO MEDICARE+CHOICE ORGANIZATIONS 42 USC "(1) MONTHLY PAYMENTS.— i395w-23. "(A) IN GENERAL.—Under a contract under section 1857 and subject to subsections (e) and (f) and section 1859(e)(4), the Secretary shall make monthly payments under this section in advance to each Medicare+Choice organization, with respect to coverage of an individual under this part in a Medicare+Choice payment area for a month, in an amount equal to Vi2 of the annual Medicare+Choice capitation rate (as calculated under subsection (c)) with respect to that individual for that area, adjusted for such risk factors as age, disability status, gender, institutional status, and such other factors as the Secretary determines to be appropriate, so as to ensure actuarial equivalence. The Secretary may add to, modify, or substitute for such factors, if such changes will improve the determination of actuarial equivalence. " (B) SPECIAL RULE FOR END-STAGE RENAL DISEASE.— The Secretary shall establish separate rates of payment to a Medicare+Choice organization with respect to classes of individuals determined to have end-stage renal disease and enrolled in a Medicare+Choice plan of the organization. Such rates of payment shall be actuarially equivalent to rates paid to other enrollees in the Medicare+Choice pay- ment area (or such other area as specified by the Secretary). In accordance with regulations, the Secretary shall provide for the application of the seventh sentence of section 1881(b)(7) to pa3nnents under this section covering the provision of renal dialysis treatment in the same manner as such sentence applies to composite rate payments described in such sentence. " (2) ADJUSTMENT TO REFLECT NUMBER OF ENROLLEES.— "(A) IN GENERAL.— The amount of payment under this subsection may be retroactively adjusted to take into account any difference between the actual number of individuals enrolled with an organization under this part and the number of such individuals estimated to be so enrolled in determining the amount of the advance pay- ment. " (B) SPECL^L RULE FOR CERTAIN ENROLLEES. — "(i) IN GENERAL.— Subject to clause (ii), the Secretary may make retroactive adjustments under subparagraph (A) to take into account individuals enrolled during the period beginning on the date on which the individual enrolls with a Medicare+Choice organization under a plan operated, sponsored, or
 * SEC. 1853. (a) PAYMENTS TO ORGANIZATIONS.—

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