PUBLIC LAW 94-460—OCT. 8, 1976
90 STAT. 1947
For the purpose of determining the total net increase in enrollment in a health maintenance organization, there shall not be included any " ^ individual who is enrolled in the organization through a group which had a contract for health care services with the health maintenance organization at the time that such health maintenance organization was determined to be a qualified health maintenance organization under section 1310. 42 USC 300e-9. "(2) Notwithstanding the requirements of paragraph (1) a health maintenance organization shall not be required to enroll individuals who are confined to an institution because of chronic illness, permanent injury, or other infirmity which would cause economic impairment to the health maintenance organization if such individual were enrolled. "(3) A health maintenance organization may not be required to make the effective date of benefits for individuals enrolled under this subsection less than 90 days after the date of enrollment. "(4) The Secretary may waive the requirements of this subsection Waiver, for a health maintenance organization which demonstrates that compliance with the provisions of this subsection would jeopardize its economic viability in its service area.". DEriNITlON OF SERVICES
SEC. 104. (a)(1) Paragraph (1)(H) of section 1302 is amended to 42 USC 300e-l. read as follows: " (H) preventive health services (including (i) immunizations, (ii) well-child care from birth, (iii) periodic health evaluations for adults, (iv) voluntary family planning services, (v) infertility services, and (vi) children's eye and ear examinations conducted to determine the need for vision and hearing correction).". (2) Paragraph (1) of section 1302 is amended by striking out "or podiatrist" each place it occurs and substituting "podiatrist, or other health care personnel". (b) Paragraph (2) of such section is amended— (1) by striking out "under paragraph (1)(A) or (l)(H) " i n subparagraphs (B) and (C); (2) by striking out "and" at the end of subparagraph (E), by striking out the period at the end of subparagraph (F) and substituting "; and", and by adding after subparagraph (F) the following: "(G) other health services which are not included as basic health services and which have been approved by the Secretary for delivery as supplemental health services."; (3) by striking out "or podiatrist" each place it occurs and substituting "podiatrist, or other health care personnel". C O M M U N r i Y RATING
SEC. 105. (a)(1) Section 1301(b)(1) is amended by adding at the 42 USC 300e. end thereof the following new sentence: "In the case of an entity which before it became a qualified health maintenance organization (within the meaning of section 1310(d)) provided comprehensive health services on a prepaid basis, the requirement of clause (C) shall not apply to such entity until the expiration of the forty-eight month period beginning with the month following the month in which the entity became such a qualified health organization.".
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