Page:United States Statutes at Large Volume 100 Part 1.djvu/234

 100 STAT. 198

42 USC 1320C-3.

PUBLIC LAW 99-272—APR. 7, 1986 appropriateness of performing the procedure before the performance of the procedure. The Secretary shall develop appropriate measures to ensure that second opinions are only required in situations where a second opinion is needed to resolve outstanding uncertainties as to the medical necessity of the procedure. The organization shall notify, in accordance with section 1154(a)(3), the physician, patient, and hospital or other entity furnishing the service, in the event of a determination under subparagraph (B) or (C) of this paragraph. "(2) PROHIBITION OF PAYMENT IF REQUIRED SECOND OPINION NOT

42 USC 1395c, 1395J.

PROVIDED.—No payment may be made under part A or part B of title XVIII with respect to items or services furnished in connection with a surgical procedure for which there is a determination described in paragraph (1)(C), unless the individual undergoing the procedure obtains the second opinion required under that paragraph. The second opinion need not necessarily agree with the first opinion in order for payment to be made. "(3) EXCEPTIONS FOR ELECTIVE SECOND OPINIONS.—Paragraphs

42 USC 1395mm.

(1)(C) and (2) shall not apply to a surgical procedure if— "(A) a delay in providing the procedure would result in a risk to the patient; "(B) no physician is available (within such reasonable limits as the Secretary shall specify) who is (i) qualified to provide the second opinion, and (ii) a participating physician or a physician who has agreed to accept assignment for the second opinion; or "(C) the procedure is to be performed on a patient who is a member of a health maintenance organization or competitive medical plan having a risk-sharing contract with the Secretary under section 1876. "(d) REFERRAL MECHANISM FOR SECOND OPINIONS.— "(1) ACTING AS REFERRAL CENTER.—Each organization

42 USC I395u.

shall serve as a referral center for second opinions required under this section. "(2) REFERRAL OF PATIENT.—The organization shall maintain a list of physicians qualified to provide a second opinion and shall advise the patient as to which physicians are participating physicians (within the meaning of section 1842(h)) and which physicians have agreed to accept assignment to perform second opinions. The organization shall assist patients in referral to a qualified physician of the appropriate specialty for purposes of providing the opinion. "(3) FORWARDING OF RELEVANT MEDICAL RECORDS.—Each peer review organization shall, if the patient seeking the second opinion so requests, obtain the relevant medical records from the physician who rendered the first opinion that the procedure was necessary, and provide the relevant information to the physician selected by the patient to render the second opinion.

"(e) NOTICE TO PHYSICIANS, HOSPITALS, AND BENEFICIARIES.—The

Secretary shall assure that notice is provided to physicians, hospitals, ambulatory surgical centers, and beneficiaries respecting the activities under this section, including the applicable list of surgical procedures specified under this section.", (b) WAIVER OF DEDUCTIBLE AND COPAYMENTS.—

42 USC 1395Z.

(1) DEDUCTIBLE.—Section 1833(b) of the Social Security Act (42 U.S.C. 13951(b)) is amended by striking out "and" before "(4)",

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