46 1 pharmacies after taking into account variations in their cost 2 of operation resulting from regional differences, differences 3 in the volume of drugs dispensed, differences in services 4 provided, and other factors which the Board finds relevant. 5 PAYMENT TO COMPREHENSIVE HEALTH SERVICE 6 ORGANIZATIONS 7 SEC. 87. (a) Payment to a comprehensive health serv8 ice organization, other than for hospital or skilled nursing 9 home services, shall consist of basic capitation payments plus 10 additional payments (if any) determined in accordance with 11 subsection (d). 12 (b) The basic capitation payment shall consist of a 13 basic capitation rate multiplied by the number of eligible 14 15 persons enrolled in the organization. The basic capitation rate shall be the sum of the appropriate capitation rate or 16 rates for professional services (determined under section 17 82 (e)) and a capitation rate fixed by the Board, on the 18 basis of the average reasonable and necessary cost per enrollee, for each other service or class of services (exclusive 20 of hospital and skilled nursing home services) to be furnished 19 21 222 by the organization in accordance with section 47 (c). (c) If the organization furnishes hospital or skilled nurs 23 ing home services through one or more institutions operated by it, payment for these services shall (subject to the pro visions of subsection (e)) be made in accordance with sec 47 1 tion 83 or section 85. If with the approval of the Board the 2 organization furnishes such services through arrangements 3 with other providers to which the organization undertakes 4 to make payment for the services, the Board may reimburse 5 the organization for such payments on the basis of patient6 days of service utilized by persons enrolled in the organiza 7 tion. 8 (d) If it appears to the satisfaction of the Board (1) 9 that the average utilization of hospital and skilled nursing home services by eligible persons enrolled in the or 10 11 ganization (whether or not such services are furnished by 12 the organization, either directly or through other providers) 13 has, during a fiscal year, been less than the average utiliza14 tion of such services under comparable circumstances by 15 comparable population groups not enrolled in comprehen16 sive health service organizations, and (2) that the services 17 of the organization have been of high quality and adequate 18 to the needs of its enrollees, the Board shall (subject to the 19 provisions of subsection (e)) make an additional payment to the organization equal to 75 per centum of the amount 21 which the Board finds has been saved by such lesser utiliza22 tion of hospital and skilled nursing home services. 20 23 (e) In lieu of payments under subsections (c) and (d), 24 the Board may pay the comprehensive health service orga25 nization on a capitation basis for hospital services, or for hos 48 1 pital and skilled nursing home services. The capitation 2 amount for such services shall be determined by the Board 3 on the basis of the average cost of such services under com4 parable circumstances to comparable population groups not 5 enrolled in comprehensive health service organizations, re6 duced by such amount as the Board finds (on the basis 7 of past experience of the organization) is calculated to 8 yield 25 per centum of any saving resulting from average 9 utilization of hospital and skilled nursing home services by persons enrolled in the organization which is less than the 10 11 average utilization of such services by such comparable pop12 ulation groups. 13 (f) The amount of any additional payment under sub14 section (d), or the excess of aggregate payments under 15 subsection (e) over the cost of furnishing hospital and 16 skilled nursing home services to eligible persons enrolled 17 in the organization, may be used by the organization for any of its purposes, including the application of such amounts to the cost of services not covered by this title. 18 19 20 21 228 PAYMENTS TO OTHER PROVIDERS SEC. 88. (a) An agency, organization, or other entity 22 with which the Board has entered into an agreement under 23 section 48 shall be paid by such method (other than the 24 fee-for-service method) as, in accordance with regulations, 49 1 (b) An independent pathology laboratory or an in 2 dependent radiology service shall, at its election, be paid 3 by the fee-for-service method in accordance with a fee 4 schedule approved by the Board, or on the basis of a budget 5 so approved, or on such other basis as may be specified 6 in regulations. 7 (c) Payment for devices, appliances, and equipment, 8 payment for ambulance or other emergency transportation 9 services, and payment for the services of a Christian Science 10 sanatorium shall be made on such basis as may be specified 11 in regulations. 12 13 14 METHODS AND TIME OF PAYMENT SEC. 89. The Board shall periodically determine the amount which should be paid under this part to each par15 ticipating provider of services, and the provider shall be paid 16 at such time or times as the Board finds appropriate (but 17 not less often than monthly) and prior to audit or settlement 18 by the General Accounting Office, the amounts so deter19 mined, with adjustments on account of underpayments or 20 overpayments previously made (including appropriate retro21 spective adjustments following amendment of approved in22 stitutional budgets). Payment may be made in advance 23 in such cases and to such extent as the Board finds necessary 24 to supply providers with working funds, on such terms as it 25 finds sufficient to protect the interests of the United States. 50 1 PART E-PLANNING FUNDS TO IMPROVE SERVICES AND TO ALLEVIATE SHORTAGES OF FACILITIES AND PERSONNEL PURPOSE OF PART E; AVAILABILITY OF FUNDS SEC. 101. (a) The purpose of this part is (1) prior to July 1, 1973, to inaugurate a program of strengthening the Nation's resources of health personnel and facilities and its system of delivery of health services, in order to enable the providers of health services better to meet the demands on them when health security benefits become available, and to that end (A) to expand and intensify the health planning process throughout the United States, with primary emphasis on preparation of the health delivery system to meet the demands of the health security program, and (B) to provide financial and other assistance in alleviating short ages and maldistributions of health personnel and facili ties in order to increase the supply of services, and in improving the organization of health services to increase their accessibility and effective delivery; and (2) after June 30, 1973, to reenforce the operation of the health security program as a mechanism for the continuing improvement of the supply and distribution of health personnel and facilities and the organization of health services, and to that end (A) to coordinate the |