PRIMARY CARE CASE MANAGEMENT SERVICES AS STATE OPTION WITHOUT NEED FOR WAIVER.

SEC. 4702. PRIMARY CARE CASE MANAGEMENT SERVICES AS STATE OPTION WITHOUT NEED FOR WAIVER. (a) In General.—Section 1905 (42 U.S.C. 1396d) is amended— (1) in subsection (a)— (A) by striking “and” at the end of paragraph (24); (B) by redesignating paragraph (25) as paragraph (26) and by striking the period at the end of such paragraph and inserting a comma; and (C) by inserting after paragraph (24) the following new paragraph: “(25) primary care case management services (as defined in subsection (t)); and”; and (2) by adding at the end the following new subsection: “(t)(1) The term ‘primary care case management services’ means case-management related services (including locating, coordinating, and monitoring of health care services) provided by a primary care case manager under a primary care case management contract. “(2) The term ‘primary care case manager’ means any of the following that provides services of the type described in paragraph (1) under a contract referred to in such paragraph: “(A) A physician, a physician group practice, or an entity employing or having other arrangements with physicians to provide such services. “(B) At State option— “(i) a nurse practitioner (as described in section 1905(a)(21)); “(ii) a certified nurse-midwife (as defined in section 1861(gg)); or “(iii) a physician assistant (as defined in section 1861(aa)(5)). “(3) The term ‘primary care case management contract’ means a contract between a primary care case manager and a State under which the manager undertakes to locate, coordinate, and monitor covered primary care (and such other covered services as may be specified under the contract) to all individuals enrolled with the manager, and which— “(A) provides for reasonable and adequate hours of operation, including 24-hour availability of information, referral, and treatment with respect to medical emergencies; “(B) restricts enrollment to individuals residing sufficiently near a service delivery site of the manager to be able to reach that site within a reasonable time using available and affordable modes of transportation; “(C) provides for arrangements with, or referrals to, sufficient numbers of physicians and other appropriate health care professionals to ensure that services under the contract can be furnished to enrollees promptly and without compromise to quality of care;111 STAT. 495 “(D) prohibits discrimination on the basis of health status or requirements for health care services in enrollment, disenrollment, or reenrollment of individuals eligible for medical assistance under this title; “(E) provides for a right for an enrollee to terminate enrollment in accordance with section 1932(a)(4); and “(F) complies with the other applicable provisions of section 1932. “(4) For purposes of this subsection, the term ‘primary care’ includes all health care services customarily provided in accordance with State licensure and certification laws and regulations, and all laboratory services customarily provided by or through, a general practitioner, family medicine physician, internal medicine physician, obstetrician/gynecologist, or pediatrician.”. (b) Conforming Amendments.— (1) Application of reenrollment provisions to pccms.—Section 1903(m)(2)(H) (42 U.S.C. 1396b(m)(2)(H)) is amended— (A) in clause (i), by inserting before the comma the following: “or with a primary care case manager with a contract described in section 1905(t)(3)”; and (B) by inserting before the period at the end the following: “or with the manager described in such clause if the manager continues to have a contract described in section 1905(t)(3) with the State”. (2) Conforming cross-reference.—Section 1902(j) (42 U.S.C. 1396a(j)) is amended by striking “paragraphs (1) through (25)” and inserting “a numbered paragraph of”.