Medicare (Title XVIII of the Social Security Act)
Provisions for administration of demonstration program

Provisions for administration of demonstration program323

The Secretary will establish performance standards for the demonstration program including standards for quality of health care items and services, cost-effectiveness and beneficiary satisfaction.324  The Secretary is authorized to disclose to an entity with a program administration contract such information, including medical information, on individuals receiving health care items and services under the program as the entity may require to carry out its responsibilities under the contract.325  The Secretary may require entities with agreements to provide health care items or services under the demonstration program, and entities with program administration contracts to maintain adequate records, afford the Secretary access to such records and to furnish such reports and materials as the Secretary may require for purposes of implementation, oversight, and evaluation of the program and of individuals’ and entities’ effectiveness in performance of such agreements or contracts.326  In order to participate in the demonstration program, an entity must guarantee that it will not deny, limit or condition the coverage or provision of benefits for eligible individuals based on any health status-related factor described in § 2702 of the Public Health Service Act.327  Two years from the date of enactment, and biennially thereafter for six years, the Secretary will report to Congress on the use of authorities under the demonstration program, addressing the impact of the use of those authorities on expenditures, access and quality under the programs.328