Page:United States Statutes at Large Volume 90 Part 2.djvu/488

 90 STAT. 1956

PUBLIC LAW 94-460—OCT. 8, 1976

(7) The amendments made by paragraph s (3) and (4) of section 110 shall apply with respect to failures of employers to comply with 42 USC 300e-9. section 1310(a) of the Public Health Service Act after the date of the enactment of this Act. (8) The amendment made by section 111 shall apply with respect 42 USC 300eto determinations of the Secretary of Health, Education, and Welfare U. described in section 1312(a) of the Public Health Service Act and made after the date of the enactment of this Act. TITLE II—AMENDMENTS TO SOCIAL SECUEITY ACT MEDICARE AMENDMENTS

42 USC 1395mm. "Health maintenance organization.'

42 USC 1395x.

42 USC 300e. "Basic health

Administration.

SEC. 201. (a) Section 1876(b) of the Social Security Act is amended to read as follows: " (b)(1) The term 'health maintenance organization' means a legal entity which provides health services on a prepayment basis to individuals enrolled with such organizations and which— " (A) provides to its enrollees who are insured for benefits under part s A and B of this title or for benefits under part B alone, through institutions, entities, and persons meeting the applicable requirements of section 1861, all of the services and benefits covered under such part s (to the extent applicable under subparagraph (A) or (B) of subsection (a)(1)) which are available to individuals residing in the geographic area served by the organization; " (B) provides such services in the manner prescribed by section 1301(b) of the Public Health Service Act, except that solely for the purposes of this section— " (i) the term 'basic health services' and references thereto shall be deemed to refer to the services and benefits included under parts A and B of this title; " (ii) the organization shall not be required to fix the basic health services payment under a community r a t i n g system; " ( i i i) the additional nominal payments authorized by section 1301(b)(1)(D) of such Act shall not exceed the limits applicable under subsection (g) of this section; and " ( i v) payment for basic health services provided by the organization to its enrollees under this section or for services such enrollees receive other than through the organization shall be made as provided for by this title; " (C) is organized and operated in the manner prescribed by section 1301(c) of the Public Health Service Act, except that solely for the purposes of this section— " (i) the term 'basic health services' and references thereto shall i3e deemed to refer to the services and benefits included under part s A and B of this title; " ( i i) the organization shall not be reimbursed for the cost of reinsurance except as permitted by subsection (i) of this section; and " ( i i i) the organization shall have an open enrollment period as provided for in subsection (k) of this section. " (2)(A) The duties and functions of the Secretary, insofar as they involve making determinations as to whether an organization is a 'health maintenance organization' within the meaning of paragraph (1), shall be administered through the Assistant Secretary for Health and in the Office of the Assistant Secretary for Health, and the admin-

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