Page:United States Statutes at Large Volume 111 Part 1.djvu/522

 Ill STAT. 498 PUBLIC LAW 105-33 —AUG. 5, 1997 be owed by the individual if the organization had directly provided the services. "(7) ANTIDISCRIMINATION. — A medicaid managed care organization shall not discriminate with respect to participation, reimbursement, or indemnification as to any provider who is acting within the scope of the provider's license or certification under applicable State law, solely on the basis of such license or certification. This paragraph shall not be construed to prohibit an organization from including providers only to the extent necessary to meet the needs of the organization's enrollees or from establishing any measure designed to maintain quality and control costs consistent with the responsibilities of the organization. "(8) COMPLIANCE WITH CERTAIN MATERNITY AND MENTAL HEALTH REQUIREMENTS.— Each medicaid managed care organization shall comply with the requirements of subpart 2 of part A of title XXVII of the Public Health Service Act insofar as such requirements apply and are effective with respect to a health insurance issuer that offers group health insurance coverage.". (b) PROTECTION OF ENROLLEES AGAINST BALANCE BILLING THROUGH SUBCONTRACTORS.—Section 1128B(d)(l) (42 U.S.C. 1320a-7b(d)(l)) is amended by inserting "(or, in the case of services provided to an individual enrolled with a medicaid managed care organization under title XIX under a contract under section 1903(m) or under a contractual, referral, or other arrangement under such contract, at a rate in excess of the rate permitted under such contract)" before the comma at the end. 42 USC 1396U-2. SEC. 4705. QUALITY ASSURANCE STANDARDS. (a) IN GENERAL.—Section 1932 is further amended by adding at the end the following: "(c) QUALITY ASSURANCE STANDARDS. — " (1) QUALITY ASSESSMENT AND IMPROVEMENT STRATEGY. — "(A) IN GENERAL.—If a State provides for contracts with medicaid managed care organizations under section 1903(m), the State shall develop and implement a quality assessment and improvement strategy consistent with this paragraph. Such strategy shall include the following: "(i) ACCESS STANDARDS.—Standards for access to care so that covered services are available within reasonable timeframes and in a manner that ensures continuity of care and adequate primary care and specialized services capacity. "(ii) OTHER MEASURES.— Examination of other aspects of care and service directly related to the improvement of quality of care (including grievance procedures and marketing and information standards), "(iii) MONITORING PROCEDURES. —Procedures for monitoring and evaluating the quality and appropriateness of care and services to enrollees that reflect the full spectrum of populations enrolled under the contract and that includes requirements for provision of quality assurance data to the State using the data and information set that the Secretary has specified for use under part C of title XVIII or such zdtemative

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