Page:United States Statutes at Large Volume 90 Part 2.djvu/489

 PUBLIC LAW 9 4 - 4 6 0 ~ O C T. 8, 1976

90 STAT. 1957

istration of such duties and functions shall be integrated with the administration of section 1312(a) and (b) of the Public Health Service Act. " (B) Except as provided in subparagraph (A), the Secretary shall administer the provisions of this section through the Commissioner of Social Security.". (b) Section 1876(h) of such Act is amended to read as follows: " (h)(1) Except as provided in paragraph (2), each health maintenance organization with which the Secretary enters into a contract under this section shall have an enrolled membership at least half of which consists of individuals who have not attained age 65. " (2) The Secretary may waive the requirement imposed in paragraph (1) for a period of not more than three years from the date a health maintenance organization first enters into an agreement with the Secretary pursuant to subsection (i), but only for so long as such organization demonstrates to the satisfaction of the Secretary by the submission of its plan for each year that it is making continuous efforts and progress toward compliance with the provisions of paragraph (1) within such three-year period.". (c) Section 1876(i)(6)(B) of such Act is amended by striking out " ( other than those with respect to out-of-area services)" and inserting in lieu thereof " ( other than costs with respect to out-of-area services and, in the case of an organization which has entered into a risksharing contract with the Secretary pursuant to paragraph (2)(A), the cost of providing any member with basic health services the aggregate value of which exceeds $5,000 in any year) ". (d) Section 1876 is amended by adding at the end thereof the following— " (k) Each health maintenance organization with which the Secretary enters into a contract under this section shall have an open enrollment period at least every year under which it accepts u p to the limits of its capacity and without restrictions, except as may be authorized in reofulations, individuals who are eligible to enroll under subsection (d) in the order in which they apply for enrollment (unless to do so would result in failure to meet the requirements of subsection (h)) or would result in enrollment of enrollees substantially nonrepresentative, as determined in accordance with regulations of the Secretary, of the population in the geographic area served by such health maintenance organization.". (e) The amendments made by this section shall be effective with respect to contracts entered into between the Secretary and health maintenance organizations under section 1876 of the Social Security Act on and after the first day of the first calendar month which begins more than 30 days after the date of enactment of this Act.

42 USC 300e11.

42 USC 1395mm.

Waiver.

Open enrollment period.

Effective date.

42 USC 1395mm note.

MEDICAID AMENDMENTS

SEC. 202. (a) Section 1903 of the Social Security Act is amended by adding at the end thereof the following new subsection: " (m)(1)(A) The term 'health maintenance organization' means a legal entity which provides health services to individuals enrolled in such organization and which— " (i) provides to its enrollees who are eligible for benefits under this title the services and benefits described in paragraph s (1), (2), (3), (4)(C), and (5) of section 1905, and, to the extent required by section 1902(a) (13)(A) (ii) to be provided under a State plan for medical assistance, the services and benefits described in paragraph (7) of section 1905(a);

42 USC 1396b, "Health maintenance organization.'

42 USC 1396d,. 42 USC 1396a.

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