SEC. 3. PROHIBITION ON PAYMENTS UNDER MEDICAID
UNTIL COMPLETION OF ORIENTATION, MEDI-
CAL PROFILE, AND IMMUNIZATION.
(a) REQUIREMENT FOR ORIENTATION AND MEDICAL
PROFILE.—
(1) IN GENERAL.—Notwithstanding any other
provision of law, no payment shall be made to a
State under title XIX of the Social Security Act with
respect to expenditures incurred by it for payment
(determined under a prepaid capitation basis or
under any other risk basis) for services provided by
any entity (including a health insuring organization)
for an individual enrolled with the entity until the
entity certifies to the Secretary of Health and
Human Services that—
(A) the entity has provided the enrollee
with such orientation as the Secretary of
Health and Human Services specifies, which
orientation shall include the explanation of
rights described in paragraph (2) and the expla-
nation of access to care described in paragraph
(3);
(B) the entity has a medical profile de-
scribed in section 1876(c)(3)(G)(iii) of the So-
cial Security Act (as added by section 2(a))
with respect to the enrollee; and
(C) if the entity is responsible for the pro-
vision (directly or through arrangements with
providers of services) of immunizations for an
enrollee who is a child—
(i) the entity has obtained the immu-
nization status of such child, and
(ii) the entity has begun to provide
(or is providing) for immunizations of such
child in accordance with the standards es-
tablished for early and periodic screening,
diagnostic, and treatment services under
such title.
(2) EXPLANATION
OF
RIGHTS.—The expla-
nation of rights described in this paragraph shall in-
clude an explanation of an enrollee’s rights under
such title in relation to enrollment with the entity,
including an explanation of—
(A) the enrollee’s rights to benefits from the en-
tity,
(B) the restrictions on payments under such
title for services furnished other than by or through
the entity,
(C) out-of-area coverage provided by the entity,
(D) the entity’s coverage of emergency services
and urgently needed care, and
(E) appeal rights of enrollees.
(3) EXPLANATION OF ACCESS TO CARE.—The
explanation of access to care described in this para-
graph includes an explanation of the following fea-
tures of the benefits offered by the entity under such
title:
(A) Access to care, including choice of phy-
sician, physician location, and hospital coverage.
(B) Utilization review procedures and re-
ferral practices.
(C) Payment structures and benefits.
(D) Any physician incentive plan that such
entity operates in relation to the enrollee.
(E) Any other procedures required by the
entity that affect access of the enrollee to care.
(b) PROMULGATION OF REQUIREMENTS FOR ORI-
ENTATION AND MEDICAL PROFILE.—Not later that 180
days after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall, by rule, first
specify the elements of the orientation and of the medical
profile described in paragraphs (2) and (3) of subsection
(a). Chapter 8 of title 5, United States Code, shall not
apply to such rule. Such rule shall apply on a final basis,
pending notice and opportunity for public comment.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—Subject to paragraph (2),
subsection (a) applies with respect to enrollees as of
the date that is 60 days after the date on which the
Secretary first publishes the rule under subsection
(b) in the Federal Register.
(2) 
IMMUNIZATION
REQUIREMENTS.—Sub-
section (a)(1)(C) applies with respect to enrollees as
of the first day of the first month that begins more
than 60 days after the date on which the Secretary
first publishes the rule under subsection (b) in the
Federal Register.
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