Page:United States Statutes at Large Volume 111 Part 1.djvu/567

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 543 is related to a mental or physical condition of the individual. For purposes of the preceding sentence, the term 'noncompliemt behavior' includes repeated noncompliance with medical advice and repeated failure to appear for appointments. "(iii) TIMELY REVIEW OF PROPOSED NONVOLUNTARY DISENROLLMENT.—A proposed disenrollment, other than a voluntary disenrollment, shall be subject to timely review and final determination by the Secretary or by the State administering agency (as applicable), prior to the proposed disenrollment becoming effective. "(d) PAYMENTS TO PACE PROVIDERS ON A CAPITATED BASIS.— "(1) IN GENERAL.— In the case of a PACE provider with a PACE program agreement under this section, except as provided in this subsection or by regulations, the State shall make prospective monthly payments of a capitation amount for each PACE program eligible individual enrolled under the agreement under this section. "(2) CAPITATION AMOUNT. — The capitation amount to be applied under this subsection for a provider for a contract year shall be an amount specified in the PACE program agreement for the year. Such amount shall be an amount, specified under the PACE agreement, which is less than the amount that would otherwise have been made under the State plan if the individuals were not so enrolled and shall be adjusted to take into account the comparative frailty of PACE enrollees and such other factors as the Secretary determines to be appropriate. The payment under this section shall be in addition to any payment made under section 1894 for individuals who are enrolled in a PACE program under such section. "(e) PACE PROGRAM AGREEMENT. — " (1) REQUIREMENT. — "(A) IN GENERAL. —The Secretary, in close cooperation Procedures, with the State administering agency, shall establish procedures for entering into, extending, and terminating PACE program agreements for the operation of PACE programs by entities that meet the requirements for a PACE provider under this section, section 1894, and regulations. "(B) NUMERICAL LIMITATION. — "(i) IN GENERAL.— The Secretary shall not permit the number of PACE providers with which agreements are in effect under this section or under section 9412(b) of the Omnibus Budget Reconciliation Act of 1986 to exceed— "(I) 40 as of the date of the enactment of this section, or "(II) as of each succeeding anniversary of such date, the numerical limitation under this subparagraph for the preceding year plus 20. Subclause (II) shall apply without regard to the actual Applicability, number of agreements in effect as of a previous anniversary date. " (ii) TREATMENT OF CERTAIN PRIVATE, FOR-PROFIT PROVIDERS. —The numerical limitation in clause (i) shall not apply to a PACE provider that— "(I) is operating under a demonstration project waiver under subsection (h), or

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