Pub. L. 117–328, div. FF, title V, § 5123(a), (d),
(1) in subparagraph (B)(i), by inserting “, including as required by subparagraph (E)” before the period at the end; and(2) by adding at the end the following new subparagraph:
(E) Provider directories
(i) In general
Each managed care organization, prepaid inpatient health plan (as defined by the Secretary), prepaid ambulatory health plan (as defined by the Secretary), and, when appropriate, primary care case management entity (as defined by the Secretary) with a contract with a State to enroll individuals who are eligible for medical assistance under the State plan under this subchapter or under a waiver of such plan, shall publish (and update on at least a quarterly basis or more frequently as required by the Secretary) on a public website, a searchable directory of network providers, which shall include physicians, hospitals, pharmacies, providers of mental health services, providers of substance use disorder services, providers of long term services and supports as appropriate, and such other providers as required by the Secretary, and that includes with respect to each such provider—
(I) the name of the provider;
(II) the specialty of the provider;
(III) the address at which the provider provides services;
(IV) the telephone number of the provider; and
(V) information regarding—
(aa) the provider’s cultural and linguistic capabilities, including languages (including American Sign Language) offered by the provider or by a skilled medical interpreter who provides interpretation services at the provider’s office;
(bb) whether the provider is accepting as new patients, individuals who receive medical assistance under this subchapter;
(cc) whether the provider’s office or facility has accommodations for individuals with physical disabilities, including offices, exam rooms, and equipment;
(dd) the Internet website of such provider, if applicable; and
(ee) whether the provider offers covered services via telehealth; and
(VI) other relevant information, as required by the Secretary.
(ii) Network provider defined
In this subparagraph, the term “network provider” includes any provider, group of providers, or entity that has a network provider agreement with a managed care organization, a prepaid inpatient health plan (as defined by the Secretary), a prepaid ambulatory health plan (as defined by the Secretary), or a primary care case management entity (as defined by the Secretary) or a subcontractor of any such entity or plan, and receives payment under this subchapter directly or indirectly to order, refer, or render covered services as a result of the State’s contract with the entity or plan. For purposes of this subparagraph, a network provider shall not be considered to be a subcontractor by virtue of the network provider agreement.
See 2022 Amendment notes below.
Section 4(c) of the Indian Health Care Improvement Act of 1976, referred to in subsec. (a)(2)(C), probably means section 4(c) of the Indian Health Care Improvement Act, which was redesignated section 4(13) of the Act by Pub. L. 111–148, title X, § 10221(a),
The Indian Self-Determination Act, referred to in subsec. (a)(2)(C)(ii), is title I of Pub. L. 93–638,
The Indian Health Care Improvement Act, referred to in subsec. (a)(2)(C)(iii), is Pub. L. 94–437,
Section 9517(c)(3) of the Omnibus Budget Reconciliation Act of 1985, referred to in subsec. (a)(3)(C)(i)(II), is section 9517(c)(3) of Pub. L. 99–272, which is set out as a note under section 1396b of this title.
The Employee Retirement Income Security Act of 1974, referred to in subsec. (b)(3)(B), is Pub. L. 93–406,
The Public Health Service Act, referred to in subsec. (b)(8), is act July 1, 1944, ch. 373, 58 Stat. 682. Subpart 2 of part A of title XXVII of the Act may refer to subpart II of part A of subchapter XXV of chapter 6A of this title. Pub. L. 111–148, title I, §§ 1001(5), 1563(c)(2), (11), formerly § 1562(c)(2), (11), title X, § 10107(b)(1),
Executive Order No. 12549, referred to in subsec. (d)(1)(C)(i), is set out as a note under section 6101 of Title 31, Money and Finance.
In subsec. (d)(3), “chapter 21 of title 41” substituted for “section 27 of the Office of Federal Procurement Policy Act (41 U.S.C. 423)” on authority of Pub. L. 111–350, § 6(c),
A prior section 1932 of act
2022—Subsec. (a)(5)(B)(i). Pub. L. 117–328, § 5123(a)(1), inserted “, including as required by subparagraph (E)” before period at end.
Subsec. (a)(5)(E). Pub. L. 117–328, § 5123(a)(2), added subpar. (E).
2020—Subsec. (b)(8). Pub. L. 116–260 inserted at end “In applying the previous sentence with respect to requirements under paragraph (8) of section 300gg–26(a) of this title, a Medicaid managed care organization (or a prepaid inpatient health plan (as defined by the Secretary) or prepaid ambulatory health plan (as defined by the Secretary) that offers services to enrollees of a Medicaid managed care organization) shall be treated as in compliance with such requirements if the Medicaid managed care organization (or prepaid inpatient health plan or prepaid ambulatory health plan) is in compliance with subpart K of part 438 of title 42, Code of Federal Regulations, and section 438.3(n) of such title, or any successor regulation.”
2018—Subsec. (i). Pub. L. 115–271 added subsec. (i).
2016—Subsec. (d)(5). Pub. L. 114–255, § 5005(a)(2), added par. (5).
Subsec. (d)(6). Pub. L. 114–255, § 5005(b)(2), added par. (6).
2010—Subsec. (f). Pub. L. 111–152 inserted “; adequacy of payment for primary care services” after “payment” in heading and “and, in the case of primary care services described in section 1396a(a)(13)(C) of this title, consistent with the minimum payment rates specified in such section (regardless of the manner in which such payments are made, including in the form of capitation or partial capitation)” before period at end of text.
2009—Subsec. (h). Pub. L. 111–5 added subsec. (h).
2006—Subsec. (b)(2)(D). Pub. L. 109–171 added subpar. (D).
2000—Subsec. (g). Pub. L. 106–554 added subsec. (g).
1999—Subsec. (c)(2)(C). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(w)(1)], inserted “part” before “C of subchapter XVIII”.
Subsec. (d)(1)(C)(ii). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(w)(2)(A)], substituted “Regulation” for “Act”.
Subsec. (d)(2)(B). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(w)(2)(B)], substituted “1396d(t)(3) of this title” for “1396b(t)(3) of this title”.
1997—Subsec. (b). Pub. L. 105–33, § 4704(a), added subsec. (b).
Subsec. (c). Pub. L. 105–33, § 4705(a), added subsec. (c).
Subsecs. (d), (e). Pub. L. 105–33, § 4707(a), added subsecs. (d) and (e).
Subsec. (f). Pub. L. 105–33, § 4708(c), added subsec. (f).
References to Medicare+Choice deemed to refer to Medicare Advantage or MA, subject to an appropriate transition provided by the Secretary of Health and Human Services in the use of those terms, see section 201 of Pub. L. 108–173, set out as a note under section 1395w–21 of this title.
Amendment by Pub. L. 117–328 effective
Amendment by Pub. L. 111–5 effective
Pub. L. 109–171, title VI, § 6085(b),
Pub. L. 106–554, § 1(a)(6) [title VII, § 701(b)(3)(A)],
Section effective
Nothing in amendment by Pub. L. 114–255 to be construed as changing or limiting the appeal rights of providers or the process for appeals of States under the Social Security Act, see section 5005(d) of Pub. L. 114–255, set out as a note under section 1396a of this title.
Pub. L. 105–33, title IV, § 4705(c),