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(2) consistent with the State health security 
budget. 
SEC. 618. PAYMENT INCENTIVES FOR MEDICALLY UNDER-
SERVED AREAS. 
(a) MODEL PAYMENT METHODOLOGIES.—In addi-
tion to the payment amounts otherwise provided in this 
title, the Board shall establish model payment methodolo-
gies and other incentives that promote the provision of 
covered health care services in medically underserved 
areas, particularly in rural and inner-city underserved 
areas. 
(b) CONSTRUCTION.—Nothing in this title shall be 
construed as limiting the authority of State health security 
programs to increase payment amounts or otherwise pro-
vide additional incentives, consistent with the State health 
security budget, to encourage the provision of medically 
necessary and appropriate services in underserved areas. 
SEC. 619. AUTHORITY FOR ALTERNATIVE PAYMENT METH-
ODOLOGIES. 
A State health security program, as part of its plan 
under section 404(a), may use a payment methodology 
other than a methodology required under this subtitle so 
long as— 
(1) such payment methodology does not affect 
the entitlement of individuals to coverage, the 
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weighting of fee schedules to encourage an increase 
in the number of primary care providers, the ability 
of individuals to choose among qualified providers, 
the benefits covered under the program, or the com-
pliance of the program with the State health security 
budget under subtitle A; and 
(2) the program submits periodic reports to the 
Board showing the operation and effectiveness of the 
alternative methodology, in order for the Board to 
evaluate the appropriateness of applying the alter-
native methodology to other States. 
Subtitle C—Mandatory Assignment 
and Administrative Provisions 
SEC. 631. MANDATORY ASSIGNMENT. 
(a) NO BALANCE BILLING.—Payments for benefits 
under this Act shall constitute payment in full for such 
benefits and the entity furnishing an item or service for 
which payment is made under this Act shall accept such 
payment as payment in full for the item or service and 
may not accept any payment or impose any charge for 
any such item or service other than accepting payment 
from the State health security program in accordance with 
this Act. 
(b) ENFORCEMENT.—If an entity knowingly and will-
fully bills for an item or service or accepts payment in 
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violation of subsection (a), the Board may apply sanctions 
against the entity in the same manner as sanctions could 
have been imposed under section 1842(j)(2) of the Social 
Security Act for a violation of section 1842(j)(1) of such 
Act. Such sanctions are in addition to any sanctions that 
a State may impose under its State health security pro-
gram. 
SEC. 632. PROCEDURES FOR REIMBURSEMENT; APPEALS. 
(a) PROCEDURES FOR REIMBURSEMENT.—In accord-
ance with standards issued by the Board, a State health 
security program shall establish a timely and administra-
tively simple procedure to assure payment within 60 days 
of the date of submission of clean claims by providers 
under this Act. 
(b) APPEALS PROCESS.—Each State health security 
program shall establish an appeals process to handle all 
grievances pertaining to payment to providers under this 
title. 
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