Page:United States Statutes at Large Volume 111 Part 1.djvu/515

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 491 "(4) PROCESS FOR ENROLLMENT AND TERMINATION AND CHANGE OF ENROLLMENT. —As conditions under paragraph (I)(A)- "(A) IN GENERAL.—The State, enrollment broker (if any), and managed care entity shall permit an individual eligible for medical assistance under the State plan under this title who is enrolled with the entity under this title to terminate (or change) such enrollment— "(i) for cause at any time (consistent with section 1903(m)(2)(A)(vi)), and "(ii) without cause— "(I) during the 90-day period beginning on the date the individual receives notice of such enrollment, and "(II) at least every 12 months thereafter. "(B) NOTICE OF TERMINATION RIGHTS.— The State shall provide for notice to each such individual of the opportunity to terminate (or change) enrollment under such conditions. Such notice shall be provided at least 60 days before each annual enrollment opportunity described in subparagraph (A)(ii)(II). "(C) ENROLLMENT PRIORITIES.— In carrying out paragraph (1)(A), the State shall establish a method for establishing enrollment priorities in the case of a managed care entity that does not have sufficient capacity to enroll all such individuals seeking enrollment under which individuals already enrolled with the entity are given priority in continuing enrollment with the entity. "(D) DEFAULT ENROLLMENT PROCESS. —In carrying out paragraph (1)(A), the State shall establish a default enrollment process— "(i) under which any such individual who does not enroll with a managed care entity during the enrollment period specified by the State shall be enrolled by the State with such an entity which has not been found to be out of substantial compliance with the applicable requirements of this section and of section 1903(m) or section 1905(t); and "(ii) that takes into consideration— "(I) maintaining existing provider-individual relationships or relationships with providers that have traditionally served beneficiaries under this title; and "(II) if maintaining such provider relationships is not possible, the equitable distribution of such individuals among qualified managed care entities available to enroll such individuals, consistent with the enrollment capacities of the entities. " (5) PROVISION OF INFORMATION. — " (A) INFORMATION IN EASILY UNDERSTOOD FORM.— Each State, enrollment broker, or managed care entity shall provide all enrollment notices and informational and instructional materials relating to such an entity under this title in a manner and form which may be easily understood by enrollees and potential enrollees of the entity who are eligible for medical assistance under the State plan under this title.

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