SEC. 215. INTERMEDIATE SANCTIONS FOR MEDICARE HEALTH MAINTENANCE ORGANIZATIONS.
Title[ Title II\Subtitle B Contents
(a) Application of Intermediate Sanctions for any Program
Violations.--
(1) In general.--Section 1876(i)(1) (42 U.S.C. 1395mm(i)(1))
is amended by striking ``the Secretary may terminate'' and all
that follows and inserting ``in accordance with procedures
established under paragraph (9), the Secretary may at any time
terminate any such contract or may impose the intermediate
sanctions described in paragraph (6)(B) or (6)(C) (whichever is
applicable) on the eligible organization if the Secretary
determines that the organization--
``(A) has failed substantially to carry out the contract;
``(B) is carrying out the contract in a manner substantially
inconsistent with the efficient and effective administration of
this section; or
``(C) no longer substantially meets the applicable
conditions of subsections (b), (c), (e), and (f).''.
(2) Other intermediate sanctions for miscellaneous program
violations.--Section 1876(i)(6) (42 U.S.C. 1395mm(i)(6)) is
amended by adding at the end the following new subparagraph:
``(C) In the case of an eligible organization for which the
Secretary makes a determination under paragraph (1), the basis of which
is not described in subparagraph (A), the Secretary may apply the
following intermediate sanctions:
``(i) Civil money penalties of not more than $25,000 for
each determination under paragraph (1) if the deficiency that is
the basis of the determination has directly adversely affected
(or has the substantial likelihood of adversely affecting) an
individual covered under the organization's contract.
``(ii) Civil money penalties of not more than $10,000 for
each week beginning after the initiation of procedures by the
Secretary under paragraph (9) during which the deficiency that
is the basis of a determination under paragraph (1) exists.
``(iii) Suspension of enrollment of individuals under this
section after the date the Secretary notifies the organization
of a determination under paragraph (1) and until the Secretary
is satisfied that the deficiency that is the basis for the
determination has been corrected and is not likely to recur.''.
(3) Procedures for imposing sanctions.--Section 1876(i) (42
U.S.C. 1395mm(i)) is amended by adding at the end the following
new paragraph:
``(9) The Secretary may terminate a contract with an eligible
organization under this section or may impose the intermediate sanctions
described in paragraph (6) on the organization in accordance with formal
investigation and compliance procedures established by the Secretary
under which--
``(A) the Secretary first provides the organization with the
reasonable opportunity to develop and implement a corrective
action plan to correct the deficiencies that were the basis of
the Secretary's determination under paragraph (1) and the
organization fails to develop or implement such a plan;
``(B) in deciding whether to impose sanctions, the Secretary
considers aggravating factors such as whether an organization
has a history of deficiencies or has not taken action to correct
deficiencies the Secretary has brought to the organization's
attention;
``(C) there are no unreasonable or unnecessary delays
between the finding of a deficiency and the imposition of
sanctions; and
``(D) the Secretary provides the organization with
reasonable notice and opportunity for hearing (including the
right to appeal an initial decision) before imposing any
sanction or terminating the contract.''.
(4) Conforming amendments.--Section 1876(i)(6)(B) (42 U.S.C.
1395mm(i)(6)(B)) is amended by striking the second sentence.
(b) Agreements With Peer Review Organizations.--Section
1876(i)(7)(A) (42 U.S.C. 1395mm(i)(7)(A)) is amended by striking ``an
agreement'' and inserting ``a written agreement''.
(c) Effective <<NOTE: 42 USC 1395mm note.>> Date.--The amendments
made by this section shall apply with respect to contract years
beginning on or after January 1, 1997.
Contents
Contents
Prev
Next
Last
