102 STAT. 2578
PUBLIC LAW 100-517—OCT. 24, 1988
Public Law 100-517 100th Congress Oct. 24, 1988 [H.R. 3235] Health Maintenance Organization Amendments of 1988 42 USC 201 note.
An Act To amend the Public Health Service Act to revise the program of assistance for health maintenance organizations.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE, REFERENCE. (a) SHORT TITLE.—This Act may be cited as the "Health Mainte-
nance Organization Amendments of 1988". (b) REFERENCE.—Whenever in this Act (other than in section 6(a)) an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act. SEC. 2. ORGANIZATIONAL STRUCTURE.
Section 1301(a) (42 U.S.C. 300e(a)) is amended by striking out "legal entity" and inserting in lieu thereof "public or private entity which is organized under the laws of any State and". SEC. 3. DEDUCTIBLES.
Section 1301(b)(l) (42 U.S.C. 300e(b)(l)) is amended by adding after the second sentence the following: "If a health maintenance organization offers to its members the opportunity to obtain basic health services through a physician not described in subsection (b)(3)(A), the organization may require, in addition to payments described in clause (D) of this paragraph, a reasonable deductible to be paid by a member when obtaining a basic health service from such a physician.". SEC. 4. PHYSICIAN SERVICES. (a) GENERAL RULE.—Section 1301(b)(3)(A) (42 U.S.C. 300e(b)(3)(A))
is amended by striking out "the services of a physician which are provided as basic health services shall be provided" and insert in lieu thereof "at least 90 percent of the services of a physician which are provided as basic health services shall be provided". flb) DUAL-CHOICE.—Section 1310(b) (42 U.S.C. 300e-9(b)) is amended— (1) in paragraph (1), by inserting before the comma at the end the following: "and provides at least 90 percent of such services through physicians described in section 13010t)X3XA)", and (2) in paragraph (2), by inserting before the comma at the end the following: "and provides no more than 10 percent of such services through physicians who are not described in section 1301(b)(3)(A)". SEC. 5. ORGANIZATION. (a) FISCAL OPERATION.—