Page:United States Statutes at Large Volume 104 Part 2.djvu/603

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PUBLIC LAW 101-508 —NOV. 5, 1990 104 STAT. 1388-195 ness is made by the Social Security Administration with respect to such an individual. In making such determinations, the State must apply the definitions of disability and blindness found in section 1614(a) of the Social Security Act. ". Subpart C—Health Maintenance Organizations SEC. 4731. REGULATION OP INCENTIVE PAYMENTS TO PHYSICIANS. (a) PHYSICIAN PAYMENT PLAN. —Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)) as amended by this title is further amended— (1) by striking ", and" at the end of clause (viii) and inserting a semicolon; (2) by striking the period at the end of clause (ix) and inserting "; and"; and (3) by adding at the end the following new clause: "(x) any physician incentive plan that it operates meets the requirements described in section 1876(i)(8).". (b) REPEAL OF PROHIBITION AGAINST PHYSICIAN INCENTIVE PAY- MENTS.—Section 1128A(b)(l) (42 U.S.C. 1320a-7a(b)(l)) is— (1) REPEAL OF PROHIBITION. —Section 1128A(b)(l) (42 U.S.C. 1320a-7a(b)(l)) is amended by striking "or an entity with a contract under section 1903(m)". (2) PENALTIES.— Section 1903(m)(5)(A) (42 U.S.C. 1396b(m)(5)(A)) is amended— (A) by striking "or" at the end of clause (iii); (B) by adding "or" at the end of clause (iv); and (C) by adding at the end the following new clause: "(v) fails to comply with the requirements of section 1876(1)(8),". (c) EFFECTIVE DATE.—The amendments made by subsections (a) 42 USC 1396b and (b)(2) shall apply with respect to contract years beginning on or ^°^- after January 1, 1992, and the amendments made by subsection (b)(1) shall take effect on the date of the enactment of this Act. SEC. 4732. SPECIAL RULES. (a) WAIVER OF 75 PERCENT RULE FOR PUBLIC ENTITIES, — Section 1903(m)(2)(D) (42 U.S.C. 1396b(m)(2)(D)) is amended by striking "(i) special circumstances warrant such modification or waiver, and (ii)". (b) EXTENDING SPECIAL TREATMENT TO MEDICARE COMPETITIVE MEDICAL PLANS.— (1) 6-MONTH MINIMUM ENROLLMENT PERIOD OPTION.— Section 1902(e)(2)(A) (42 U.S.C. 1396a(e)(2)(A)) is amended by inserting "or with an eligible organization with a contract under section 1876" after "1903(m)(2)(A)". (2) ENROLLMENT LOCK-IN. —Section 1903(m)(2)(F)(i) (42 U.S.C. 1396b(m)(2)(F)(i)) is amended— (A) by striking "(G) or" and inserting "(G),", and (B) adding at the end the following: "or with an eligible organization with a contract under section 1876 which meets the requirement of subparagraph (A)(ii), or". (c) AUTOMATIC 1-MONTH REENROLLMENT FOR SHORT PERIODS OF INELIGIBILITY. — Section 1903(m)(2) is amended by adding at the end the following new subparagraph: "(H) In the case of an individual who— "(i) in a month is eligible for benefits under this title and enrolled with a health maintenance organization with a contract under this paragraph,