Ill STAT. 490 PUBLIC LAW 105-33—AUG. 5, 1997 "(B) EXEMPTION OF MEDICARE BENEFICIARIES.— A State may not require under paragraph (1) the enrollment in a managed care entity of an individual who is a qualified medicare beneficiary (as defined in section 1905(p)(l)) or an individual otherwise eligible for benefits under title XVIIL "(C) INDIAN ENROLLMENT.^A State may not require under paragraph (1) the enrollment in a managed care entity of an individual who is an Indian (as defined in section 4(c) of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603(c)) unless the entity is one of the following (and only if such entity is participating under the plan): "(i) The Indian Health Service. "(ii) An Indian health program operated by an Indian tribe or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self- Determination Act (25 U.S.C. 450 et seq.). "(iii) An urban Indian health program operated by an urban Indian organization pursuant to a grant or contract with the Indian Health Service pursuant to title V of the Indian Health Care Improvement Act(25 U.S.C. 1601et seq.). " (3) CHOICE OF COVERAGE. — "(A) IN GENERAL.— ^A State must permit an individual to choose a managed care entity from not less than two such entities that meet the applicable requirements of this section, and of section 1903(m) or section 1905(t). "(B) STATE OPTION. —At the option of the State, a State shall be considered to meet the requirements of subparagraph (A) in the case of an individual residing in a rural area, if the State requires the individual to enroll with a managed care entity if such entity— "(i) permits the individual to receive such assistance through not less than two physicians or case managers (to the extent that at least two physicians or case managers are available to provide such assistance in the area), and (ii) permits the individual to obtain such assistance from any other provider in appropriate circumstances (as established by the State under regulations of the Secretary). "(C) TREATMENT OF CERTAIN COUNTY-OPERATED HEALTH INSURING ORGANIZATIONS. —^A State shall be considered to meet the requirement of subparagraph (A) if— "(i) the managed care entity in which the individual is enrolled is a health-insuring organization which— "(I) first became operational prior to January 1, 1986, or "(II) is described in section 9517(c)(3) of the Omnibus Budget Reconciliation Act of 1985 (as added by section 4734(2) of the Omnibus Budget Reconciliation Act of 1990), and "(ii) the individual is given a choice between at least two providers within such entity.
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