Page:United States Statutes at Large Volume 98 Part 1.djvu/1155

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1107

"(vi) every 12 months thereafter. "(D) For purposes of determining compliance with the schedule established by this paragraph, a recertification shall be considered to have been done on a timely basis if it was performed not later than 10 days after the date the recertification was otherwise required and the State establishes good cause why the physician or other person making such recertification did not meet such schedule.". (b) Section 1903 of such Act is further amended by adding at the 42 USC 1396b. end the following new paragraph: "(7) It is the duty and responsibility of the Secretary to assure that standards which govern the provision of care in skilled nursing facilities and intermediate care facilities under plans approved under this title, and the enforcement of such standards, are adequate to protect the health and safety of residents and to promote the effective and efficient use of public moneys.". (c) The amendments made by subsection (a) apply to calendar Effective date. quarters beginning on or after the date of the enactment of this Act, 42 USC 1396b except that, in the case of individuals admitted to skilled nursing note. facilities before such date, the amendments made by such subsection shall not require recertifications sooner or more frequently than were required under the law in effect before such date. WAIVER OF CERTAIN MEMBERSHIP REQUIREMENTS FOR CERTAIN HEALTH MAINTENANCE ORGANIZATIONS

SEC. 2364. Section 1903(m)(2) of the Social Security Act is amended— (1) by inserting "except as provided under subparagraph (F)," in subparagraph (A)(vi) after "(I)", and (2) by adding at the end the following new subparagraphs: "(E) In the case of a health maintenance organization that— "(i) is a nonprofit organization with at least 25,000 members, "(ii) is and has been a qualified health maintenance organization (as defined in section 1310(d) of the Public Health Service Act) for a period of at least four years, "(iii) provides basic health services through members of the staff of the organization, "(iv) is located in an area designated as medically underserved under section 1302(7) of the Public Health Service Act, and "(v) previously received a waiver of the requirement described in subparagraph (A)(ii) under section 1115, the Secretary may modify or waive the requirement described in subparagraph (A)(ii) but only if the Secretary determines that special circumstances warrant such modification or waiver and that the organization has taken and is taking reasonable efforts to enroll individuals who are not entitled to benefits under the State plan approved under this title or under title XVIII. "(F)(i) In the case of a contract with a health maintenance organization described in clause (ii), a State plan may restrict the period in which requests for termination of enrollment without cause under subparagraph (A)(vi)(I) are permitted to the first month of each period of enrollment, each such period of enrollment not to exceed six months in duration, but only if the State provides notification, at least twice per year, to individuals enrolled with such organization of the right to terminate such enrollment and the restriction on the

42 USC 1396b.

42 USC 300e-9.

42 USC 300e-l. 42 USC 1315.

42 USC 1395.

�