Title I, SEC. 1431. HEALTH PLAN REQUIREMENT. 
      (a) In General. Subject to section 1432, each health plan shall, with 
    respect to each electing essential community provider (as defined in 
    subsection (d), other than a provider of school health services) located 
    within the plan's service area, either 

        (1) enter into a written provider participation agreement (described in 
      subsection (b)) with the provider, or 

        (2) enter into a written agreement under which the plan shall make 
      payment to the provider in accordance with subsection (c). 

      (b) Participation Agreement. A participation agreement between a health 
    plan and an electing essential community provider under this subsection 
    shall provide that the health plan agrees to treat the provider in 
    accordance with terms and conditions at least as favorable as those that 
    are applicable to other providers participating in the health plan with 
    respect to each of the following: 

        (1) The scope of services for which payment is made by the plan to the 
      provider. 

        (2) The rate of payment for covered care and services. 

        (3) The availability of financial incentives to participating 
      providers. 

        (4) Limitations on financial risk provided to other participating 
      providers. 

        (5) Assignment of enrollees to participating providers. 

        (6) Access by the provider's patients to providers in medical 
      specialties or subspecialties participating in the plan. 

      (c) Payments for Providers Without Participation Agreements. 

        (1) In general. Payment in accordance with this subsection is payment 
      based, as elected by the electing essential community provider, either 

          (A) on the fee schedule developed by the applicable health alliance 
        (or the State) under section 1322(c), or 

          (B) on payment methodologies and rates used under the applicable 
        Medicare payment methodology and rates (or the most closely applicable 
        methodology under such program as the Secretary of Health and Human 
        Services specifies in regulations). 

        (2) No application of gate-keeper limitations. Payment in accordance 
      with this subsection may be subject to utilization review, but may not be 
      subject to otherwise applicable gate-keeper requirements under the plan. 

      (d) Election. 

        (1) In general. In this part, the term ``electing essential community 
      provider'' means, with respect to a health plan, an essential community 
      provider that elects this subpart to apply to the health plan. 

        (2) Form of election. An election under this subsection shall be made 
      in a form and manner specified by the Secretary, and shall include notice 
      to the health plan involved. Such an election may be made annually with 
      respect to a health plan, except that the plan and provider may agree to 
      make such an election on a more frequent basis. 

      (e) Special Rule for Providers of School Health Services. A health plan 
    shall pay, to each provider of school health services located in the plan's 
    service area an amount determined by the Secretary for such services 
    furnished to enrollees of the plan.