101 STAT. 1330-60
PUBLIC LAW 100-203—DEC. 22, 1987
P A R T 2 — PROVISIONS R E L A T I N G TO P A R T S A ANDB •^'l!
Subpart A—Health Maintenance Organization Reforms
SEC. 4011. BENEFICIARY PROTECTION. (a) POST-CONTRACT PROTECTION FOR ENROLLEES WITH ELIGIBLE ORGANIZATIONS UNDER ^e THE MEDICARE PROGRAM.—
42 USC 1395mm note.
(1) Section 1876(c)(3) of such Act (42 U.S.C. 1395mm(b)(2)) is amended by adding at the end the following new subparagraph: "(F) Each eligible organization that provides items and services pursuant to a contract under this section shall provide assurances to the Secretary that in the event the organization ceases to provide such items and services, the organization shall provide or arrange for supplemental coverage of benefits under this title related to a pre-existing Bi'f'i condition with respect to any exclusion period, to all individuals enrolled with the entity who receive benefits under this title, for the lesser of six months or the duration of such period.". (2) The amendment made by paragraph (1) shall apply with respect to contracts entered into or renewed on or after the date of enactment of this Act. (b) NOTIFICATION OF TERMINATION OF RISK-SHARING CONTRACT.—
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42 USC 1395mm note.
(1) Section 1876(c)(3) of such Act, as amended by subsection (a)(1), is further amended by adding at the end the following new subparagraph: "(G)(i) Each eligible organization having a risk-sharing contract under this section shall notify individuals eligible to enroll with the organization under this section and individuals enrolled with the organization under this section that— "(I) the organization is authorized by law to terminate or refuse to renew the contract, and "(II) termination or nonrenewal of the contract may result in termination of the enrollments of individuals enrolled with the organization under this section. "(ii) The notice required by clause (i) shall be included in— "(I) any marketing materials described in subparagraph (C) that are distributed by an eligible organization to individuals eligible to enroll under this section with the organization, and "(II) any explanation provided to enrollees by the organization pursuant to subparagraph (E).". (2) The amendment made by paragraph (1) shall apply to contracts entered into or renewed on or after the date of the enactment of this Act. SEC. 4012. PAYMENTS FOR HOSPITAL SERVICES.
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contracts.
(a) IN GENERAL.—Section 1866(a)(l) of such Act (42 U.S.C. 1395cc(a)(l)) is amended by inserting immediately after subparagraph (N) the following new subparagraph: "(O) in the cgise of hospitals and skilled nursing facilities, to accept as payment in full for inpatient hospital and extended
- Copy read "UNDER".
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