(1) a full range of health services (as identified 
by the Board), including at least hospital services 
and physicians services; and 
(2) out-of-area coverage in the case of urgently 
needed services; 
to an identified population which is living in or near a 
specified service area and which enrolls voluntarily in the 
organization. 
(b) ENROLLMENT.— 
(1) IN GENERAL.—All eligible persons living in 
or near the specified service area of a CHSO are eli-
gible to enroll in the organization; except that the 
number of enrollees may be limited to avoid over-
taxing the resources of the organization. 
(2) MINIMUM ENROLLMENT PERIOD.—Subject 
to paragraph (3), the minimum period of enrollment 
with a CHSO shall be twelve months, unless the en-
rolled individual becomes ineligible to enroll with the 
organization. 
(3) WITHDRAWAL
FOR
CAUSE.—Each CHSO 
shall permit an enrolled individual to disenroll from 
the organization for cause at any time. 
(c) REQUIREMENTS FOR CHSOS.— 
(1) ACCESSIBLE
SERVICES.—Each CHSO, to 
the maximum extent feasible, shall make all services 
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readily and promptly accessible to enrollees who live 
in the specified service area. 
(2) CONTINUITY OF CARE.—Each CHSO shall 
furnish services in such manner as to provide con-
tinuity of care and (when services are furnished by 
different providers) shall provide ready referral of 
patients to such services and at such times as may 
be medically appropriate. 
(3) BOARD OF DIRECTORS.—In the case of a 
CHSO that is a private organization— 
(A) 
CONSUMER
REPRESENTATION.—At 
least one-third of the members of the CHSO’s 
board of directors must be consumer members 
with no direct or indirect, personal or family fi-
nancial relationship to the organization. 
(B) PROVIDER
REPRESENTATION.—The 
CHSO’s board of directors must include at 
least one member who represents health care 
providers. 
(4) PATIENT
GRIEVANCE
PROGRAM.—Each 
CHSO must have in effect a patient grievance pro-
gram and must conduct regularly surveys of the sat-
isfaction of members with services provided by or 
through the organization. 
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(5) MEDICAL STANDARDS.—Each CHSO must 
provide that a committee or committees of health 
care practitioners associated with the organization 
will promulgate medical standards, oversee the pro-
fessional aspects of the delivery of care, perform the 
functions of a pharmacy and drug therapeutics com-
mittee, and monitor and review the quality of all 
health services (including drugs, education, and pre-
ventive services). 
(6) PREMIUMS.—Premiums or other charges by 
a CHSO for any services not paid for under this Act 
must be reasonable. 
(7) UTILIZATION AND BONUS INFORMATION.— 
Each CHSO must— 
(A) comply with the requirements of sec-
tion 1876(i)(8) of the Social Security Act (re-
lating to prohibiting physician incentive plans 
that provide specific inducements to reduce or 
limit medically necessary services); and 
(B) make available to its membership utili-
zation information and data regarding financial 
performance, including bonus or incentive pay-
ment arrangements to practitioners. 
(8) PROVISION OF SERVICES TO ENROLLEES AT 
INSTITUTIONS
OPERATING
UNDER
GLOBAL
BUDG-
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ETS.—The organization shall arrange to reimburse 
for hospital services and other facility-based services 
(as identified by the Board) for services provided to 
members of the organization in accordance with the 
global operating budget of the hospital or facility ap-
proved under section 611. 
(9) BROAD
MARKETING.—Each CHSO must 
provide for the marketing of its services (including 
dissemination of marketing materials) to potential 
enrollees in a manner that is designed to enroll indi-
viduals representative of the different population 
groups and geographic areas included within its 
service area and meets such requirements as the 
Board or a State health security program may speci-
fy. 
(10) 
ADDITIONAL
REQUIREMENTS.—Each 
CHSO must meet— 
(A) such requirements relating to min-
imum enrollment; 
(B) such requirements relating to financial 
solvency; 
(C) such requirements relating to quality 
and availability of care; and 
(D) such other requirements, 
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