Page:United States Statutes at Large Volume 111 Part 1.djvu/347

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 323 year under this paragraph shall be deposited and credited as offsetting collections. "(D) LIMITATION,—In any fiscal year the fees collected by the Secretary under subparagraph (B) shall not exceed the lesser of— "(i) the estimated costs to be incurred by the Secretary in the fiscal year in carrying out the activities described in section 1851 and section 4360 of the Omnibus Budget Reconciliation Act of 1990; or "(ii)(I) $200,000,000 in fiscal year 1998; " (II) $150,000,000 in fiscal year 1999; and " (III) $100,000,000 in fiscal year 2000 and each subsequent fiscal year. "(f) PROMPT PAYMENT BY MEDICARE+CHOICE ORGANIZATION. — "(1) REQUIREMENT. —^A contract under this part shall require a Medicare+Choice organization to provide prompt pay- ment (consistent with the provisions of sections 1816(c)(2) and 1842(c)(2)) of claims submitted for services and supplies furnished to enrollees pursuant to the contract, if the services or supplies are not fiimished under a contract between the organization and the provider or supplier (or in the case of a Medicare+Choice private fee-for-service plan, if a claim is submitted to such organization by an enrollee). " (2) SECRETARY'S OPTION TO BYPASS NONCOMPLYING ORGANIZATION. —In the case of a Medicare+Choice eligible organization which the Secretary determines, after notice and opportunity for a hearing, has failed to make payments of amounts in compliance with paragraph (1), the Secretary may provide for direct payment of the amounts owed to providers and suppliers (or, in the case of a Medicare+Choice private fee-for-service plan, amounts owed to the enrollees) for covered services and supplies fiimished to individuals enrolled under this part under the contract. If the Secretary provides for the direct payments, the Secretary shall provide for an appropriate reduction in the amount of payments otherwise made to the organization under this part to reflect the amount of the Secretary payments (and the Secretary's costs in making the payments). " (g) INTERMEDIATE SANCTIONS.— "(1) IN GENERAL.— I f the Secretary determines that a Medicare+Choice organization with a contract under this section— "(A) fails substantially to provide medically necessary items and services that are required (under law or under the contract) to be provided to an individual covered under the contract, if the failure has adversely affected (or has substantial likelihood of adversely affecting) the individual; "(B) imposes premiums on individuals enrolled under this part in excess of the amount of the Medicare+Choice monthly basic and supplemental beneficiary premiums permitted under section 1854; "(C) acts to expel or to refuse to re-enroll an individual in violation of the provisions of this part; "(D) engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment (except as permitted by this part) by eligible individuals with the organization whose medical condition

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