Page:United States Statutes at Large Volume 90 Part 2.djvu/478

 90 STAT. 1946

PUBLIC LAW 94-460—OCT. 8, 1976

ing the month in which the organization becomes a qualified health 42 USC 300e-9. maintenance organization (within the meaning of section 1310(d)), provide basic and supplemental health services through an entity 42 USC 300e-l. which but for the requirement of section 1302(4)(C)(i) would be a medical group for purposes of this title. After the expiration of such period, the organization may provide basic or supplemental health , services through such an entity only if authorized by the Secretary in accordance with regulations which take into consideration the unusual circumstances of such entity. A health maintenance organization may not, in any of its fiscal years, enter into contracts with health professionals or entities other than medical groups or individual practice '• associations if the amounts paid under such contracts for basic and supplemental health services exceed fifteen percent of the total amount to be paid in such fiscal year by the health maintenance organization to physicians for the provision of basic and supplemental health services, or, if the health maintenance organization principally serves a rural area, thirty percent of such amount, except that this sentence does not apply to the entering into of contracts for the purchase of basic and supplemental health services through an entity which but for the ., requirements of section 1302(4)(C)(i) would be a medical group for purposes of this title. Contracts between a health maintenance organization and health professionals for the provision of basic and supplemental health services shall include such provisions as the Secretary may require (including provisions requiring appropriate continuing education).". 42 USC 300e-l. (b)(1) Section 1302(4)(C) is amended (A) by striking out clause (iv), (B) by redesignating clause (v) as clause (iv), and (C) by inserting "and" at the end of clause (iii). (2) Section 1302(5)(B) is amended (A) by striking out clause (i), and (B) by redesignating clauses (ii) and (iii) as clauses (i) and (ii), respectively. OPEN

42 USC SOOe.

ENROLLMENT

SEC. 103. (a) Section 1301(c) is amended by amending paragraph (4) to read as follows: "(4) have an open enrollment period in accordance with the provisions of subsection (d);". (b) Section 1301 is amended by adding at the end thereof the following: ' "(d)(1)(A) A health maintenance organization which— "(i) has for at least 5 years provided comprehensive health services on a prepaid basis, or . j. ^ ^ •::-! '••• "(ii) has an enrollment of at least 50,000 members, shall have at least once during each fiscal year next following a fiscal year in which it did not have a financial deficit an open enrollment period (determined under subparagraph (B)) during which it shall accept individuals for membership in the order in which they apply for enrollment and, except as provided in paragraph (2). without, regard to preexisting illness, medical condition, or degree of disability. "(B) An open enrollment period for a health maintenance organization shall be the lesser of— "(i) 30 days, or ,, "(ii) the number of days in which the organization enrolls a number of individuals at least equal to 3 percent of its total net increase in enrollment (if any) in the fiscal year preceding the fiscal year in which such period is held.

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