Sec. 5006. REQUIRING PUBLICATION OF FEE-FOR-SERVICE PROVIDER DIRECTORY
952 words·~4 min read·
/statute-compilations/comps-13005/sec-5006A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
## SEC. 5006 REQUIRING PUBLICATION OF FEE-FOR-SERVICE PROVIDER DIRECTORY ###
(a)In general Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended— ####
(1)in paragraph (81), by striking “and” at the end; ####
(2)in paragraph (82), by striking the period at the end and inserting “; and”; and ####
(3)by inserting after paragraph
(82)the following new paragraph: > > #### “(83) > > provide that, not later than January 1, 2017, in the case of a State plan (or waiver of the plan) that provides medical assistance on a fee-for-service basis or through a primary care case-management system described in section 1915(b)(1) (other than a primary care case management entity (as defined by the Secretary)), the State shall publish (and update on at least an annual basis) on the public website of the State agency administering the State plan, a directory of the physicians described in subsection
(mm)and, at State option, other providers described in such subsection that— > > > ##### “(A) > > includes— > > > ###### “(i) > > with respect to each such physician or provider— > > > ###### “(I) > > the name of the physician or provider; > > > ###### “(II) > > the specialty of the physician or provider; > > > ###### “(III) > > the address at which the physician or provider provides services; and > > > ###### “(IV) > > the telephone number of the physician or provider; and > > > ###### “(ii) > > with respect to any such physician or provider participating in such a primary care case-management system, information regarding— > > > ###### “(I) > > whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title; and > > > ###### “(II) > > the physician’s or provider’s cultural and linguistic capabilities, including the languages spoken by the physician or provider or by the skilled medical interpreter providing interpretation services at the physician’s or provider’s office; and > > > ##### “(B) > > may include, at State option, with respect to each such physician or provider— > > > ###### “(i) > > the Internet website of such physician or provider; or > > > ###### “(ii) > > whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title.” > . ###
(b)Directory Physician or Provider Described Section 1902 of the Social Security Act (42 U.S.C. 1396a), as amended by section 5005(a)(3), is further amended by adding at the end the following new subsection: > > ### “(mm) Directory Physician or Provider Described > > A physician or provider described in this subsection is— > > > #### “(1) > > in the case of a physician or provider of a provider type for which the State agency, as a condition on receiving payment for items and services furnished by the physician or provider to individuals eligible to receive medical assistance under the State plan, requires the enrollment of the physician or provider with the State agency, a physician or a provider that— > > > ##### “(A) > > is enrolled with the agency as of the date on which the directory is published or updated (as applicable) under subsection (a)(83); and > > > ##### “(B) > > received payment under the State plan in the 12-month period preceding such date; and > > > #### “(2) > > in the case of a physician or provider of a provider type for which the State agency does not require such enrollment, a physician or provider that received payment under the State plan (or a waiver of the plan) in the 12-month period preceding the date on which the directory is published or updated (as applicable) under subsection (a)(83).” > . ###
(c)Rule of Construction **[**[42 U.S.C. 1396a note](/us/usc/t42/s1396a)**]** ####
(1)In general The amendment made by subsection
(a)shall not be construed to apply in the case of a State (as defined for purposes of title XIX of the Social Security Act) in which all the individuals enrolled in the State plan under such title (or under a waiver of such plan), other than individuals described in paragraph (2), are enrolled with a medicaid managed care organization (as defined in section 1903(m)(1)(A) of such Act (42 U.S.C. 1396b(m)(1)(A))), including prepaid inpatient health plans and prepaid ambulatory health plans (as defined by the Secretary of Health and Human Services). ####
(2)Individuals described An individual described in this paragraph is an individual who is an Indian (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) or an Alaska Native. ###
(d)Exception for State Legislation **[**[42 U.S.C. 1396a note](/us/usc/t42/s1396a)**]** In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet one or more additional requirements imposed by amendments made by this section, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.
Connectionstraces to 4
Citation graph
cites case law
Sec. 5006
REQUIRING PUBLICATION OF FEE-FOR-SERVICE PROVIDER DIRECTORY
Cites 4Cited by 0 across 0 sources