A bill to amend section 1876 of the Social Security Act to protect medicare beneficiaries enrolled in an eligible organization with a risk-sharing contract under such section against certain practices.

Summary

Amends title XVIII (Medicare) of the Social Security Act to require a health maintenance organization (HMO) to notify individuals who are enrolled or eligible to enroll with such organization that the organization can terminate or refuse to renew its contract with the Secretary of Health and Human Services and that this may result in the termination of an individual's enrollment with the organization. Imposes civil monetary penalties and intermediate sanctions on HMOs which: (1) fail substantially to provide medically necessary items and services if the failure adversely affects the enrollee; (2) charge an individual a greater premium than is permitted; (3) act to expel or refuse to re-enroll an individual for medical reasons; (4) engage in any practice that denies or discourages enrollment by individuals whose medical condition or history indicates a need for substantial future medical services; or (5) misrepresent or falsify enrollment information, or enroll an individual without the individual's knowledge or consent or after making a material inducement to the individual. Prohibits the Secretary from entering into or renewing a contract with an HMO in a State which does not require the licensure of HMO agents or employees who solicit enrollments.

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Documents

1 official file

• Introduced in Senate

  summary · EN · 3 August 1987

  Open at official source

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