PUBLIC LAW 99-509—OCT. 21, 1986
100 STAT. 2001
(1) IN GENERAL.—Subsection (g) of such section is amended by adding at the end the following new paragraph: "(6)(A) A risk-sharing contract under this section shall require the eligible organization to provide prompt payment (consistent with the provisions of sections 1816(c)(2) and 1842(c)(2)) of claims submitted for services and supplies furnished to individuals pursuant to such contract, if the services or supplies are not furnished under a contract between the organization and the provider or supplier. "(B) In the case of an eligible organization which the Secretary determines, after notice and opportunity for a hearing, has failed to make payments of amounts in compliance with subparagraph (A), the Secretary may provide for direct payment of the amounts owed to providers and suppliers for such covered services furnished to individuals enrolled under this section under the contract. If the Secretary provides for such direct payments, the Secretary shall provide for an appropriate reduction in the amount of payments otherwise made to the organization under this section to reflect the amount of the Secretary's payments (and costs incurred by the Secretary in making such payments).". (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to risk-sharing contracts under section 1876 of the Social Security Act with respect to services furnished on or after January 1, 1987.
Contracts. Ante, pp. 1997, 1998.
Contracts. 42 USC 1395mm note.
(e) REQUIRING ACCESS TO FINANCIAL RECORDS AND DISCLOSURE OF INTERNAL LOANS.—
'
(1) IN GENERAL.—Subsection (i)(3)(C) of such section is amended— (A) by striking "and" at the end, (B) by inserting "(i)" after "(C)", and ^ (C) by adding at the end the following new clauses: "(ii) shall require the organization to provide and supply information (described in section 1866(b)(2)(C)(ii)) in the manner such information is required to be provided or supplied under that section; "(iii) shall require the organization to notify the Secretary of loans and other special financial arrangements which are made between the organization and subcontractors, affiliates, and related parties; and". (2) EFFECTIVE DATE.—The amendments made by paragraph (1) shall apply to contracts as of January 1, 1987. (f) AUTHORITY TO IMPOSE CIVIL MONEY PENALTIES.—Subsection (i)
42 USC 1395CC.
Loans.
Contracts. 42 USC 1395mm note.
of such section is amended by adding at the end the following new paragraph: "(6)(A) Any eligible organization with a risk-sharing contract Contracts. under this section that fails substantially to provide medically necessary items and services that are required (under law or such contract) to be provided to individuals covered under such contract, if the failure has adversely affected (or has a substantial likelihood of adversely affecting) these individuals, is subject to a civil money penalty of not more than $10,000 for each such failure. "(B) The provisions of section 1128A (other than subsection (a)) Post, pp. 2003, shall apply to a civil money penalty under subparagraph (A) in the 2008. same manner as they apply to a civil money penalty under that S6ct^ion
(g) STUDY OF A A P C C AND ACR.—The Secretary of Health and
Human Services shall provide, through contract with an appropriate organization, for a study of the methods by which—
Contracts. 42 USC 1395 mm note.
�
