PUBLIC LAW 105-33—AUG. 5, 1997 Subtitle H—Medicaid 111 STAT. 489 CHAPTER 1—MANAGED CARE SEC. 4701. STATE OPTION OF USING MANAGED CABE; CHANGE IN TERMINOLOGY. (a) USE OF MANAGED CARE GENERALLY.Title XIX is amended by redesignating section 1932 as section 1933 and by inserting after section 1931 the following new section: "PROVISIONS RELATING TO MANAGED CARE "SEC. 1932. (a) STATE OPTION TO USE MANAGED CARE.— "(1) USE OF MEDICAID MANAGED CARE ORGANIZATIONS AND PRIMARY CARE CASE MANAGERS.— "(A) IN GENERAL.—Subject to the succeeding provisions of this section, and notwithstanding paragraph (1), (10)(B), or (23)(A) of section 1902(a), a State— "(i) may require an individual who is eligible for medical assistance under the State plan under this title to enroll with a managed care entity as a condition of receiving such assist£ince (and, with respect to assistance furnished by or under arrangements with such entity, to receive such assistance through the entity), if— "(I) the entity and the contract with the State meet the applicable requirements of this section and section 1903(m) or section 1905(t), and "(II) the requirements described in the succeeding paragraphs of this subsection are met; and "(ii) may restrict the number of provider agreements with managed care entities under the State plan if such restriction does not substantially impair access to services. "(B) DEFINITION OF MANAGED CARE ENTITY.— In this section, the term 'managed care entity' means— "(i) a medicaid managed care organization, as defined in section 1903(m)(l)(A), that provides or arranges for services for enrollees under a contract pursuant to section 1903(m); and "(ii) a primary care case manager, as defined in section 1905(t)(2). "(2) SPECIAL RULES.— "(A) EXEMPTION OF CERTAIN CHILDREN WITH SPECIAL NEEDS.— ^A state may not require under paragraph (1) the enrollment in a managed care entity of an individual under 19 years of age who— "(i) is eligible for supplemental security income under title XVI; "(ii) is described in section 501(a)(1)(D); "(iii) is described in section 1902(e)(3); "(iv) is receiving foster care or adoption assistance under part E of title IV; or "(v) is in foster care or otherwise in an out-of- home placement. 42 USC 1396v. 42 USC 1396U-2. 39-194O-97- 17:QL3Part1
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