; (B) by striking For purposes of and inserting the following: (1) In general For purposes of ; and (C) by adding at the end the following: (2) Exclusions Such term does not include any services described in subparagraph (A) or (B) of paragraph (1) if such services are provided in an emergency department of a hospital. . (2) Effective date The amendments made by paragraph (1) shall apply with respect to primary care services provided on or after the first day of the period described in subparagraph (C)(ii) of section 1902(a)(13) of the Social Security Act ( 42 U.S.C. 1396a(a)(13) ), as amended by section 2. (c) Ensuring payment by managed care entities (1) In general Section 1903(m)(2)(A) of the Social Security Act ( 42 U.S.C. 1396b(m)(2)(A) ) is amended— (A) in clause (xii), by striking and after the semicolon; (B) in clause (xiii)— (i) by moving the margin of such clause 2 ems to the left; and (ii) by striking the period at the end and inserting ; and