Page:United States Statutes at Large Volume 111 Part 1.djvu/527

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 503 1903(m) unless the State has in effect conflict-of-interest safeguards with respect to officers and employees of the State with responsibilities relating to contracts with such organizations or to the default enrollment process described in subsection (a)(4)(C)(ii) that are at least as effective as the Federal safeguards provided under section 27 of the Office of Federal Procurement Policy Act (41 U.S.C. 423), against conflicts of interest that apply with respect to Federal procurement officials with comparable responsibilities with respect to such contracts. " (4) USE OF UNIQUE PHYSICIAN IDENTIFIER FOR PARTICIPAT- ING PHYSICIANS. —Each medicaid managed care organization shall require each physician providing services to enrollees eligible for medical assistance under the State plan under this title to have a unique identifier in accordance with the system established under section 1173(b). "(e) SANCTIONS FOR NONCOMPLIANCE.— " (1) USE OF INTERMEDIATE SANCTIONS BY THE STATE TO ENFORCE REQUIREMENTS.— "(A) IN GENERAL. —^A State may not enter into or renew a contract under section 1903(m) unless the State has established intermediate sanctions, which may include any of the types described in paragraph (2), other than the termination of a contract with a medicaid managed care organization, which the State may impose against a medicaid managed care organization with such a contract, if the organization— "(i) fails substantially to provide medically necessary items and services that are required (under law or under such organization's contract with the State) to be provided to an enrollee covered under the contract; "(ii) imposes premiums or charges on enrollees in excess of the premiums or charges permitted under this title; "(iii) acts to discriminate among enrollees on the basis of their health status or requirements for health care services, including expulsion or refusal to reenroU an individusil, except as permitted by this title, or engaging in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment with the organization by eligible individuals whose medical condition or history indicates a need for substantial future medical services; "(iv) misrepresents or falsifies information that is furnished— "(I) to the Secretary or the State under this title; or "(II) to an enrollee, potential enrollee, or a health care provider under such title; or "(v) fails to comply with the applicable requirements of section 1903(m)(2)(A)(x). The State may also impose such intermediate sanction against a managed care entity if the State determines that the entity distributed directly or through any agent or independent contractor marketing materials in violation of subsection (d)(2)(A)(i)(II).

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