Page:United States Statutes at Large Volume 104 Part 2.djvu/519

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PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-111 (3) EFFECTIVE DATE. —The amendments made by this subsection shall apply with respect to national coverage determinations that are not incorporated in the determination of the per capita rate of payment for individuals enrolled for 1991 with an eligible organization which has entered into a risk-sharing contract under section 1876 of the Social Security Act. (d) PAYMENTS FOR SERVICES FURNISHED BY NON-CONTRACT PRO- VIDERS.— (1) IN GENERAL.— Section 1876(j) (42 U.S.C. 1395mm(j)) is amended— (A) in paragraph (1)(A)— (i) by striking "physician" each place it appears and inserting "physician or provider of services or renal dialysis facility", (ii) by striking "physicians' services" and inserting "physicians' services or renal dialysis services", and (iii) by striking "participation agreement under section 1842(h)(1)" and inserting "applicable participation agreement", (B) in paragraph (2)— (i) by striking "physicians' services" each place it appears and inserting "physicians' services or renal dialysis services", and (ii) by striking "which—" and all that follows and inserting "which are furnished to an enrollee of an eligible organization under this setion ^o by a physician, provider of services, or renal dialysis facility who is not under a contract with the organization.". (2) EFFECTIVE DATE. — The amendment made by paragraph (1) shall apply with respect to items and services furnished on or after January 1, 1991. (e) RETROACTIVE ENROLLMENT. — (1) IN GENERAL.—Section 1876(a)(1)(E) (42 U.S.C. 1395mm(a)(l)(E)) is amended— (A) by striking "(E)" and inserting "(E)(i)"; and (B) by adding at the end the following new clause: "(ii)(I) Subject to subclause (II), the Secretary may make retroactive adjustments under clause (i) to take into account individuals enrolled during the period beginning on the date on which the individual enrolls with an eligible organization (which has a risksharing contract under this section) under a health benefit plan operated, sponsored, or contributed to, by the individual's employer or former employer (or the employer or former employer of the individual's spouse) and ending on the date on which the individual is enrolled in the plan under this section, except that for purposes of making such retroactive adjustments under this clause, such period may not exceed 90 days. "(II) No adjustment may be made under subclause (I) with respect to any individual who does not certify that the organization provided the individual with the explanation described in subsection (c)(3)(E) at the time the individual enrolled with the organization.". (2) EFFECTIVE DATE. — The amendments made by paragraph (1) shall apply with respect to individuals enrolling with an eligible organization (which has a risk-sharing contract under section 1876 of the Social Security Act) under a health benefit plan operated, sponsored, or contributed to, by the individual's em- 42 USC 1395mm note. 42 USC 1395mm note. 42 USC 1395mm note. ^^ So in original. Probably should be "section".