HEALTH MAINTENANCE ORGANIZATIONS AND COMPETITIVE MEDICAL PLANS.

SEC. 6212. HEALTH MAINTENANCE ORGANIZATIONS AND COMPETITIVE MEDICAL PLANS. (a) Temporary Waiver for Watts Health Foundation.—Section 9312(c)(3)(D) of the Omnibus Budget Reconciliation Act of 1986, as added by section 4018(d) of the Omnibus Budget Reconciliation Act of 1987, is amended— (1) in clause (i), by striking “January 1, 1990” and inserting “January 1, 1994”; and (2) by amending clauses (ii) and (iii) to read as follows: “(ii) beginning on January 1, 1990, the Secretary of Health and Human Services shall conduct an annual review of the organization to determine the organization’s compliance with the quality assurance requirements of section 1876(c)(6) of such Act; and “(iii) after January 1, 1990, if the organization receives an unfavorable review under clause (ii), the Secretary, after notice to the organization of the unfavorable review and an opportunity to correct any deficiencies identified during the review, may provide for the sanction described in section 1876(f)(3) of such Act effective with respect to individuals enrolling with the organization after the date the Secretary notifies the organization that the organization is not in compliance with the requirements of section 1876(c)(6) of such Act.”. 103 STAT. 2250 (b) Limit on Charges for Emergency Services and Out-of-Area Coverage.— (1) In general.—Section 1876 of the Social Security Act (42 U.S.C. 1395mm) is amended by adding at the end the following new subsection: “(j)(1)(A) In the case of physicians’ services described in paragraph (2) which are furnished by a participating physician to an individual enrolled with an eligible organization under this section and enrolled under part B, the participation agreement under section 1842(h)(1) is deemed to provide that the physician will accept as payment in full from the eligible organization the amount that would be payable to the physician under part B and from the individual under such part, if the individual were not enrolled with an eligible organization under this section. “(B) In the case of physicians’ services described in paragraph (2) which are furnished by a nonparticipating physician, the limitations on actual charges for such services otherwise applicable under part B (to services furnished by individuals not enrolled with an eligible organization under this section) shall apply in the same manner as such limitations apply to services furnished to individuals not enrolled with such an organization. “(2) The physicians’ services described in this paragraph are physicians’ services which— “(A) are emergency services or out-of-area coverage (described in clauses (iii) and (iv) of subsection (b)(2)(A)), and “(B) are furnished to an enrollee of an eligible organization under this section by a person who is not under a contract with the organization.”. (2) Effective date.—The amendment made by paragraph (1) shall apply to services furnished on or after April 1, 1990. (c) Making Authority for Benefit Stabilization Fund Permanent.— (1) Repeal on limitation on establishment of a fund.—Section 2350(b) of the Deficit Reduction Act of 1984 (Public Law 98–369) is amended by striking paragraphs (3) and (4). (2) Repeal on limiting period of use.—Section 1876(g)(5) of the Social Security Act (42 U.S.C. 1395mm(g)(5)) is amended by striking “and during a period of not longer than four years”. (3) Effective date.—The amendments made by this subsection shall take effect on the date of the enactment of this Act.