Page:United States Statutes at Large Volume 101 Part 1.djvu/724

 101 STAT. 694

42 USC 405. Ante, p. 680.

PUBLIC LAW 100-93—AUG. 18, 1987

not a provider of services or with a determination described in subsection (b)(2) shall be entitled to a hearing thereon by the Secretary (after reasonable notice) to the same extent as is provided in section 205(b), and to judicial review of the Secretary's final decision after such hearing as is provided in section 205(g). "(2) An institution or agency is not entitled to separate notice and opportunity for a hearing under both section 1128 and this section with respect to a determination or determinations based on the same underlying facts and issues.", (e) CONFORMING AMENDMENT.—Section 1869 (42 U.S.C. 1395ff) is

42 USC 1396a; ante, pp. 689,

amended by striking subsection (c). (f) MEDICAID PLAN REVISIONS.—Section 1902(a) (42 U.S.C. l396b(a)) jg amended— (1) in paragraph (23), by inserting "subsection (g) and in" after "except as provided in", (2) in paragraph (38), by striking "respectively, (A)" and all that follows up to the semicolon at the end and inserting "the information described in section 1128(b)(9)", and (3) in paragraph (39)— ->.L,> (A) by striking "bar" and inserting "exclude", (B) by striking "person" and inserting "individual or entity" each place it appears, and (C) by inserting "or section 1128A" after "section 1128". (g) DENIAL OF FEDERAL FINANCIAL PARTICIPATION UNDER MEDIC-

AID.—Paragraph (2) of section 1903(i) (42 U.S.C. 1396b(i)) is amended to read as follows: "(2) with respect to any amount expended for an item or service (other than an emergency item or service) furnished— "(A) under the plan by any individual or entity during any period when the individual or entity is excluded from participation in the State plan under this title pursuant to Ante, p. 68d. ,, section 1128 or section 1128A, or "(B) at the medical direction or on the prescription of a physician, during the period when such physician is exf. r eluded pursuant to section 1128 or section 1128A from participation in the program under this title and when the person furnishing such item or service knew or had reason . A T to know of the exclusion (after a reasonable time period after reasonable notice has been furnished to the person).". (h) MEDICAID CONFORMING AMENDMENTS.—(1) Subsection (n) of section 1903 (42 U.S.C. 1396b) is repealed. (2) Paragraph (2) of section 1915(a) (42 U.S.C. 1396n(a)) is amended to read as follows: "(2) Restricts for a reasonable period of time the provider or providers from which an individual (eligible for medical assistance for items or services under the State plan) can receive such items or services, if— "(A) the State has found, after notice and opportunity for a hearing (in accordance with procedures established by the State), that the individual has utilized such items or services at a frequency or amount not medically necessary (as {?jl determined in accordance with utilization guidelines established by the State), and "(B) under such restriction, individuals eligible for medico cal assistance for such services have reasonable access ?f (taking into account geographic location and reasonable travel time) to such services of adequate quality.".
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