104 STAT. 1388-130 PUBLIC LAW 101-508—NOV. 5, 1990 policy, in violation of this paragraph is subject to a civil money penalty of not to exceed $25,000 for each such violation. The provisions of section 1128A (other than the first sentence of subsection (a) and other than subsection (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).". (b) PERIODIC REVIEW OF STATE REGULATORY PROGRAMS.— Section 42 USC 1395S8. 1882(b) is amended— (1) in paragraph (1), by striking "Supplemental Health Insurance Panel (established under paragraph (2))" and inserting "the Secretary", (2) in paragraph (1), by striking "the Panel" and inserting "the Secretary", (3) in subparagraphs (A) and (D) of paragraph (1), by inserting "and enforcement" after "application, and (4) by amending paragraph (2) to read as follows: "(2) The Secretary periodically shall review State regulatory programs to determine if they continue to meet the standards and requirements specified in paragraph (1). If the Secretary finds that a State regulatory program no longer meets the standards and requirements, before making a final determination, the Secretary shall provide the State an opportunity to adopt such a plan of correction as would permit the State regulatory program to continue to meet such standards and requirements. If the Secretary makes a final determination that the State regulatory program, after such an opportunity, fails to meet such standards and requirements, the program shall no longer be considered to have in operation a program meeting such standards and requirements.". (c) ENFORCEMENT BY STATES.— Section 1882a))(l) (42 U.S.C. 1395ss(b)(l)) is amended— (1) by striking "and" at the end of subparagraph (D); (2) by inserting "and" at the end of subparagraph (E); (3) by inserting after subparagraph (E) the following: "(F) reports to the Secretary on the implementation and enforcement of standards and requirements of this paragraph at intervals established by the Secretary,"; and (5) by adding at the end the following new sentence: "The report required under subsection (F) shall include information on loss ratios of policies sold in the State, frequency and types of instances in which policies approved by the State fail to meet the standards of this paragraph, actions taken by the State to bring such policies into compliance, and information regarding State programs implementing consumer protection provisions, and such further information as the Secretary in consultation with the National Association of Insurance Commissioners, may specify.". (d) REQUIRING APPROVAL OF STATE FOR SALE IN THE STATE.— (1) IN GENERAL.— Section 1882(d)(4)(B) (42 U.S.C. 1395ss(d)(4)(B)) is amended by striking the second sentence. 42 USC 1395SS (2) EFFECTIVE DATE.— The amendment made by paragraph (1) note. shall apply to policies mailed, or caused to be mailed, on and after July 1, 1991. SEC. 4354. PREVENTING DUPLICATION. (a) IN GENERAL.—Subsection (d)(3) of section 1882 (42 U.S.C. 1395ss) is amended— (1) in subparagraph (A)—
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