Page:United States Statutes at Large Volume 111 Part 1.djvu/349

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 325 penalty procedures by the Secretary during which the deficiency that is the basis of a determination under subsection (c)(2) exists. "(C) Suspension of enrollment of individuals under this part after the date the Secretary notifies the organization of a determination under subsection (c)(2) and until the Secretary is satisfied that the deficiency that is the basis for the determination has been corrected and is not likely to recur. "(4) CIVIL MONEY PENALTIES.— The provisions of section Applicability. 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under paragraph (2) or (3) in the same manner as they apply to a civil money penalty or proceeding under section 1128A(a). " (h) PROCEDURES FOR TERMINATION. — "(1) IN GENERAL.— The Secretary may terminate a contract with a Medicare+Choice organization under this section in accordance with formal investigation and compliance procedures established by the Secretary under which— "(A) the Secretary provides the organization with the reasonable opportunity to develop and implement a corrective action plan to correct the deficiencies that were the basis of the Secretary's determination under subsection (c)(2); and "(B) the Secretary provides the organization with reasonable notice and opportunity for hearing (including the right to appeal an initial decision) before terminating the contract. "(2) EXCEPTION FOR IMMINENT AND SERIOUS RISK TO HEALTH.— Paragraph (1) shall not apply if the Secretary determines that a delay in termination, resulting from compliance with the procedures specified in such paragraph prior to termination, would pose an imminent and serious risk to the health of individuals enrolled under this part with the organization. " DEFINITIONS; MISCELLANEOUS PROVISIONS " SEC. 1859. (a) DEFINITIONS RELATING TO MEDICARE+CHOICE 42 USC ORGANIZATIONS.— In this part— i395w-28. "(1) MEDICARE+CHOICE ORGANIZATION.—The term that is certified under section 1856 as meeting the requirements and standards of this part for such an organization. "(2) PROVIDER-SPONSORED ORGANIZATION. — The term 'provider-sponsored organization' is defined in section 1855(d)(1). "(b) DEFINITIONS RELATING TO MEDICARE-HCHOICE PLANS.— "(1) MEDICARE+CHOICE PLAN. — The term 'Medicare+Choice plan' means health benefits coverage offered under a policy, contract, or plan by a Medicare+Choice organization pursuant to and in accordance with a contract under section 1857. "(2) MEDICARE+CHOICE PRIVATE FEE-FOR-SERVICE PLAN.— The term 'Medicare+Choice private fee-for-service plan' means a Medicare+Choice plan that— "(A) reimburses hospitals, physicians, and other providers at a rate determined by the plan on a fee-for-service basis without placing the provider at financial risk; "(B) does not vary such rates for such a provider based on utilization relating to such provider; and
 * Medicare-i -Choice organization' means a public or private entity

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