Page:United States Statutes at Large Volume 90 Part 2.djvu/490

 90 STAT. 1958 "Basic health services." 42 USC 300e.

PUBLIC LAW 94-460—OCT. 8, 1976

"(ii) provides such services and benefits in the manner prescribed in section 1301(b) of the Public Health Service Act (except that, solely for purposes of this paragraph, the term 'basic health services' and references thereto, when employed in such section, shall be deemed to refer to the services and benefits described in paragraphs (1), (2), (3), (4)(C),and (5) of section 42 USC 1396d. 1905(a), and, to the extent required by section 1902(a) (13)(A) 42 USC 1396a. (ii) to be provided under a State plan for medical assistance, the services and benefits described in paragraph (7) of section 1905 (a)); and "(iii) is organized and operated in the manner prescribed by section 1301(c) of the Public Health Service Act (except that solely for purposes of this paragraph, the term 'basic health services' and references thereto, when employed in such section shall be deemed to refer to the services and benefits described in section 1905 (a)(1), (2), (3), (4)(C),and (5), 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)). Administration. "(B) 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 subparagraph (A), shall be administered through the Assistant Secretary for Health and in the Office of the Assistant Secretary for Health, and the administration of such duties and functions shall be integrated with the administration of section 1312(a) and (b) of the Public Health 42 USC 300e- Service Act. IL "(2)(A) Except as provided in subparagraphs (B) and (C), no payment shall be made under this title to a State with respect to expenditures incurred by it for payment for services provided by any entity— " (i) which is responsible for the provision of— " (I) inpatient hospital services and any other service described in paragraph (2), (3), (4), (5), or (7) of section 1905(a), or " ( II) any three or more of the services described in such paragraphs, when payment for such services is determined under a prepaid capitation risk basis or under any other risk basis; "(ii) which the Secretary (or the State as authorized by paragraph (3)) has not determined to be a health maintenance organization as defined in paragraph (1); and "(iii) more than one-half of the membership of which consists of individuals who are insured under parts A and B of title X V H I or recipients of benefits under this title. "(B) Subparagraph (A) does not apply with respect to payments under this title to a State with respect to expenditures incurred by it for payment for services provided by an entity which— "(i)(I) received a grant of at least $100,000 in the fiscal year ending June 30, 1976, under section 319(d)(1)(A) or 330(d)(1) 42 USC 247d, of the Public Health Service Act, and (II) for the period begin254c. ning July 1, 1976, and ending on the expiration of the peroid for which payments are to be made under this title has been the recipient of a grant under either such section; and

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