Page:United States Statutes at Large Volume 111 Part 1.djvu/519

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 495 "(D) prohibits discrimination on the basis of health status or requirements for health care services in enrollment, disenrollment, or reenrollment of individuals eligible for medical assistance under this title; "(E) provides for a right for an enrollee to terminate enrollment in accordance with section 1932(a)(4); and "(F) complies with the other applicable provisions of section 1932. "(4) For purposes of this subsection, the term 'primary care' includes all health care services customarily provided in accordance with State licensure and certification laws and regulations, and all laboratory services customarily provided by or through, a general practitioner, family medicine physician, internal medicine physician, obstetrician/gynecologist, or pediatrician.". (b) CONFORMING AMENDMENTS.— (1) APPLICATION OF REENROLLMENT PROVISIONS TO PCCMS.— Section 1903(m)(2)(H) (42 U.S.C. 1396b(m)(2)(H)) is amended— (A) in clause (i), by inserting before the comma the following: "or with a primary care case manager with a contract described in section 1905(t)(3)"; and (B) by inserting before the period at the end the following: "or with the manager described in such clause if the manager continues to have a contract described in section 1905(t)(3) with the State". (2) CONFORMING CROSS-REFERENCE. —Section 1902(j) (42 U.S.C. 1396a(j)) is amended by striking "paragraphs (1) through (25)" and inserting "a numbered paragraph of. SEC. 4703. ELIMINATION OF 75:25 RESTRICTION ON RISK CONTRACTS. (a) IN GENERAL.—Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)) is amended by striking clause (ii). (b) CONFORMING AMENDMENTS.— (1) Section 1903(m)(2) (42 U.S.C. 1396b(m)(2)) is amended— (A) by striking subparagraphs (C), (D), and (E); and (B) in subparagraph (G), by striking "clauses (i) and (ii)" and inserting "clause (i)". (2) Section 1925(b)(4)(D)(iv) (42 U.S.C. 1396r-6(b)(4)(D)(iv)) is amended by striking "less than 50 percent" and all that follows up to the period at the end. SEC. 4704. INCREASED BENEFICIARY PROTECTIONS. (a) IN GENERAL.—Section 1932, as added by section 4701(a), is amended by adding at the end the following: "(b) BENEFICIARY PROTECTIONS.— "(1) SPECIFICATION OF BENEFITS. — Each contract with a managed care entity under section 1903(m) or under section 1905(t)(3) shall specify the benefits the provision (or arrangement) for which the entity is responsible. " (2) ASSURING COVERAGE TO EMERGENCY SERVICES.— "(A) IN GENERAL. — Each contract with a medicaid managed care organization under section 1903(m) and each contract with a primary care case manager under section 1905(t)(3) shall require the organization or manager— "(i) to provide coverage for emergency services (as defined in subparagraph (B)) without regard to prior

�