Ill STAT. 440 PUBLIC LAW 105-33 —AUG. 5, 1997 "(i) the contract is in writing and is signed by the medicare beneficiary before any item or service is provided pursuant to the contract; "(ii) the contract contains the items described in subparagraph (B); and "(iii) the contract is not entered into at a time when the medicare beneficiary is facing an emergency or urgent health care situation. " (B) ITEMS REQUIRED TO BE INCLUDED IN CONTRACT. — Any contract to provide items and services to which paragraph (1) apphes shall clearly indicate to the medicare beneficiary that by signing such contract the beneficiary— "(i) agrees not to submit a claim (or to request that the physician or practitioner submit a claim) under this title for such items or services even if such items or services are otherwise covered by this title; "(ii) agrees to be responsible, whether through insurance or otherwise, for payment of such items or services and understands that no reimbursement will be provided under this title for such items or services; "(iii) acknowledges that no limits under this title (including the limits under section 1848(g)) apply to amounts that may be charged for such items or services; "(iv) acknowledges that Medigap plans under section 1882 do not, and other supplemental insurance plans may elect not to, make payments for such items and services because payment is not made under this title; and "(v) acknowledges that the medicare beneficiary has the right to have such items or services provided by other physicians or practitioners for whom payment would be made under this title. Such contract shall also clearly indicate whether the physician or practitioner is excluded from participation under the medicare program under section 1128. "(3) PHYSICIAN OR PRACTITIONER REQUIREMENTS.— " (A) IN GENERAL.— Paragraph (1) shall not apply to any contract entered into by a physician or practitioner unless an affidavit described in subparagraph (B) is in effect during the period any item or service is to be provided pursuant to the contract. "(B) AFFIDAVIT.— An affidavit is described in this subparagraph if— "(i) the affidavit identifies the physician or practitioner and is in writing and is signed by the physician or practitioner; "(ii) the affidavit provides that the physician or practitioner will not submit any claim under this title for any item or service provided to any medicare beneficiary (and will not receive any reimbursement or amount described in paragraph (1)(B) for any such item or service) during the 2-year period beginning on the date the affidavit is signed; and "(iii) a copy of the affidavit is filed with the Secretary no later than 10 days after the first contract to which such affidavit applies is entered into.
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