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or class of services which services are outside
the scope of the provider’s normal practice.
(B) No charge will be made for any cov-
ered services other than for payment authorized
by this Act.
(C) The provider agrees to furnish such in-
formation as may be reasonably required by the
Board or a State health security program, in
accordance with uniform reporting standards
established under section 401(g)(1), for—
(i) quality review by designated enti-
ties;
(ii) the making of payments under
this Act (including the examination of
records as may be necessary for the ver-
ification of information on which payments
are based);
(iii) statistical or other studies re-
quired for the implementation of this Act;
and
(iv) such other purposes as the Board
or State may specify.
(D) The provider agrees not to bill the pro-
gram for any services for which benefits are not
available because of section 204(g).
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(E) In the case of a provider that is not
an individual, the provider agrees not to employ
or use for the provision of health services any
individual or other provider who or which has
had a participation agreement under this sub-
section terminated for cause.
(F) In the case of a provider paid under a
fee-for-service basis under section 612, the pro-
vider agrees to submit bills and any required
supporting documentation relating to the provi-
sion of covered services within 30 days (or such
shorter period as a State health security pro-
gram may require) after the date of providing
such services.
(2) TERMINATION
OF
PARTICIPATION
AGREE-
MENTS.—
(A) IN
GENERAL.—Participation agree-
ments may be terminated, with appropriate no-
tice—
(i) by the Board or a State health se-
curity program for failure to meet the
requirements of this title, or
(ii) by a provider.
(B) TERMINATION
PROCESS.—Providers
shall be provided notice and a reasonable oppor-
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tunity to correct deficiencies before the Board
or a State health security program terminates
an agreement unless a more immediate termi-
nation is required for public safety or similar
reasons.
SEC. 302. QUALIFICATIONS FOR PROVIDERS.
(a) IN GENERAL.—A health care provider is consid-
ered to be qualified to provide covered services if the pro-
vider is licensed or certified and meets—
(1) all the requirements of State law to provide
such services,
(2) applicable requirements of Federal law to
provide such services, and
(3) any applicable standards established under
subsection (b).
(b) MINIMUM PROVIDER STANDARDS.—
(1) IN GENERAL.—The Board shall establish,
evaluate, and update national minimum standards to
assure the quality of services provided under this
Act and to monitor efforts by State health security
programs to assure the quality of such services. A
State health security program may also establish ad-
ditional minimum standards which providers must
meet.
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(2) NATIONAL MINIMUM STANDARDS.—The na-
tional minimum standards under paragraph (1) shall
be established for institutional providers of services,
individual health care practitioners, and comprehen-
sive health service organizations. Except as the
Board may specify in order to carry out this title,
a hospital, nursing facility, or other institutional
provider of services shall meet standards for such a
facility under the medicare program under title
XVIII of the Social Security Act. Such standards
also may include, where appropriate, elements relat-
ing to—
(A) adequacy and quality of facilities;
(B) training and competence of personnel
(including continuing education requirements);
(C) comprehensiveness of service;
(D) continuity of service;
(E) patient satisfaction (including waiting
time and access to services); and
(F) performance standards (including or-
ganization, facilities, structure of services, effi-
ciency of operation, and outcome in palliation,
improvement of health, stabilization, cure, or
rehabilitation).
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(3) TRANSITION
IN
APPLICATION.—If the
Board provides for additional requirements for pro-
viders under this subsection, any such additional re-
quirement shall be implemented in a manner that
provides for a reasonable period during which a pre-
viously qualified provider is permitted to meet such
an additional requirement.
(4) EXCHANGE OF INFORMATION.—The Board
shall provide for an exchange, at least annually,
among State health security programs of informa-
tion with respect to quality assurance and cost
containment.
SEC. 303. QUALIFICATIONS FOR COMPREHENSIVE HEALTH
SERVICE ORGANIZATIONS.
(a) IN GENERAL.—For purposes of this Act, a com-
prehensive health service organization (in this section re-
ferred to as a ‘‘CHSO’’) is a public or private organization
which, in return for a capitated payment amount, under-
takes to furnish, arrange for the provision of, or provide
payment with respect to—
(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,
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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 overtax-
ing 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
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
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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
financial 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.
(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-