S 1582 · 100th Congress · Social Welfare
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.
Bill Progress
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Introduced2
Committee3
Senate Vote4
House5
EnactedLatest: Read twice and referred to the Committee on Finance.(1987-08-03)
Plain Language Summary
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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 requ…
Summarized by Claude AI · Non-partisan · For informational purposes only