Page:United States Statutes at Large Volume 100 Part 3.djvu/186

 100 STAT. 1994 42 USC 1395WW note. 42 USC 1395x note. Health care facilities.

42 USC 1395c, 1395J. Health care facilities. Health care professionals.

42 USC 1395.

-> Grants. Contracts. 42 USC 13951.

42 USC 1395.

PUBLIC LAW 99-509—OCT. 21, 1986 (2) EFFECTIVE DATE.—The amendment made by paragraph (1)(B) shall apply to reports for years beginning with 1986.

(k) PRIOR PROJECT.—

AND CONCURRENT

AUTHORIZATION

DEMONSTRATION

(1) IN GENERAL.—The Secretary of Health and Human Serv:TV ices shall conduct a demonstration program concerning prior and concurrent authorization for post-hospital extended care services and home health services furnished under part A or part B of title XVIII of the Social Security Act. (2) SCOPE.—The program shall include at least four projects and shall be initiated by not later than January 1, 1987. (3) CONSULTATION AND MONITORING.—The program shall be ' developed in consultation with an advisory panel that includes experts in the delivery of post-hospital extended care services, ^ '• home health services, and long-term care services and includes representatives of hospitals, of physicians, of skilled nursing facilities, of home health agencies, of long-term care providers, '' of fiscal intermediaries, and of medicare beneficiaries. The Sec•' retary shall monitor the acceptance of individuals entitled to benefits under title XVIII of the Social Security Act by providers to ensure that the placement of such individuals is not , delayed until the results of prior and concurrent review are known. (4) EVALUATION AND REPORT.—The Secretary shall evaluate the demonstration program conducted under this subsection and shall report to Congress on such evaluation no later than February 1, 1989. Such evaluation and report shall address— (A) the administrative and program costs for prior and concurrent authorization across demonstration projects and in comparison to administrative and program costs under the current system of retroactive review, including costs for uncovered services paid under the waiver of liability which would not be incurred under prior or concurrent authorization; (B) impact of prior or concurrent authorization on access to and availability of extended care services and home . health services in comparison to the current system (including costs to providers) and on timely discharge of hospital inpatients; and (C) accuracy and associated cost savings of payment determinations and rates of claim reversals under prior or concurrent authorization versus the current system. (5) FUNDING.—Expenditures made for the demonstration program shall be made from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act. Grants and payments under contracts may be made either in advance or by I • way of reimbursement, as may be determined by the Secretary, and shall be made in such installments and on such conditions as the Secretary finds necessary to carry out the purpose of this subsection. i 4 (6) WAIVER OF MEDICARE REQUIREMENTS.—The Secretary shall waive compliance with such requirements of title XVIII of the Social Security Act to the extent and for the period the Secretary finds necessary for the conduct of the demonstration program.

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