Page:United States Statutes at Large Volume 92 Part 2.djvu/857

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PUBLIC LAW 95-000—MMMM. DD, 1978

PUBLIC LAW 95-559—NOV. 1, 1978

92 STAT. 2137

"(2) an assessment of the degree of conformity or noncon- Conformity, or formity of each health maintenance organization evaluated by nonconformity. the Secretary mider subsection (d) with such standards and norms; "(3) what action, if any, the Secretary considers necessary under section 1312 with respect to health maintenance organi- 42 USC 300e-ll. zations evaluated under subsection (d). "(f) Nothing in this section shall be construed to confer upon the Rates. Secretary any authority to approve or disapprove the rates charged by any health maintenance organization. "(g) Any health maintenance organization failing to file with the Annual financial Secretary the annual financial statement required in subsection (a) statement, filing. shall be ineligible for any Federal assistance under this title until such time as such statement is received by the Secretary and shall not be a qualified health maintenance organization for purposes of 42 USC 300e-9. section 1310. "(h) Whoever knowingly and willfully makes or causes to be made False statement any false statement or representation of a material fact in any or representation statement filed pursuant to this section shall be guilty of a felony of material fact, and upon conviction thereof shall be fined not more than $25,000 or penalty. imprisoned for not more than five years, or both.". (b) Section 1301(c)(3) is amended (1) by inserting " (A) " after 42 USC 300e. "(3)", and (2) by inserting before the semicolon a comma and the following: "and (B) carry out enrollment of members who are entitled to medical assistance under a State plan approved under title X IX of the Social Security Act in accordance with procedures 42 USC 1396. approved under regulations promulgated by the Secretary". ORGANIZATION REQUIREMENTS

SEC. 10. (a) Section 1301(b) is amended (1) by inserting "except in 42 USC 300e. the case of basic health services provided a member who is a full-time student (as defined by the Secretary) at an accredited institution of higher education," after " (C) " in paragraph (1), and (2) by inserting "unless the supplemental health services payment is for a supplemental health service provided a member who is a full-time student (as defined by the Secretary) at an accredited institution of higher education," after "community rating system" in the second sentence of paragraph (2). (b) Section 1301(c)(1) is amended (1) by inserting " (A) " after "(1)", and (2) by inserting before the semicolon a comma and the following: "and (B) have administrative and managerial arrangements satisfactory to the Secretary". (c) Section 1301(c)(6) is amended (1) by striking out " (6) " and inserting in lieu thereof "(6)(A) in the case of a private health maintenance organization,", (2) by redesignating clauses (A) and (B) as subclauses (i) and (ii), respectively, and (3) by inserting before the semicolon a comma and the following: "and (B) in the case of a public health maintenance organization, have an advisory board to the policymaking body of the public entity operating the organization which board meets the requirements of clause (A) of this paragraph and to which may be delegated policymaking authority for the organization."