Page:United States Statutes at Large Volume 101 Part 2.djvu/870

 101 STAT. 1330-76

PUBLIC LAW 100-203—DEC. 22, 1987

"(i) with respect to claims received in the 3-month period •f. beginning July 1, 1988,10 days, and "(ii) with respect to claims received in the 12-month period K !>ii:>ai, ^; » e beginning October 1, 1988,14 days.".27»> < '^-; (2) Section 1842(c) of such Act (42 U.S.C. 1395u(c)) is amended .;,-v;5 by adding at the end the following new paragraph: contracts. "(3)(A) Each contract under this section which provides for the disbursement of funds, as described in subsection (a)(1)(B), shall provide that no payment shall be issued, mailed, or otherwise transmitted with respect to any claim submitted under this title within the applicable number of calendar days after the date on which the claim is received. "(B) In this paragraph, the term 'applicable number of calendar days' means— "(i) with respect to claims received in the 3-month period beginning July 1, 1988,10 days, and ai;f;')/;.;-f. m "(u) with respect to claims received in the 12-month period beginning October 1, 1988, 14 days.''.^"* 42 USC 1395h (3)(A) The amendments made by paragraphs (1) and (2) shall note. apply to claims received on or after July 1, 1988. Contracts. (B) The Secretary of Health and Human Services shall proRegulations. vide for such timely amendments to agreements under section 1816 of the Social Security Act and contracts under section 1842 of such Act, and regulations, to such extent as may be necessary to implement the provisions of this subsection on a timely basis, 42 USC 1395h note.

«{ir'j

42 USC I395h note.

(b) PROHIBITION OF OTHER POUCIES INTENDED TO SLOW DOWN MEDICARE PAYMENTS.—Notwithstanding any other provision of law,

except as specifically provided in this section, the Secretary of Health and Human Services is not authorized to issue, after the date of the enactment of this Act, and before October 1, 1990, any final regulation, instruction, or other policy change which is primarily intended to have the effect of slowing down claims processing, or delaying payment of claims, under title XVIII of the Social Security Act. (c) BUDGET CONSIDERATIONS.—For purposes of section 202 of the Balanced Budget and Emergency Deficit Control Reaffirmation Act of 1987, this section is a necessary (but secondary) result of a significant policy change. SEC. 4032. DENIALS AND RECONSIDERATIONS OF CLAIMS FOR HOME HEALTH SERVICES, EXTENDED CARE SERVICES, AND POSTHOSPITAL EXTENDED CARE SERVICES. (a) NOTIFICATION AND PHYSICIAN REVIEW.—Section 1816 of

the

Social Security Act (42 U.S.C. 1395h) is amended by adding at the end the following new subsection: "(j) An agreement with an agency or organization under this section shall require that, with respect to a claim for home health services, extended care services, or post-hospital extended care services submitted by a provider to such agency or organization that is denied, such agency or organization— "(1) furnish the provider and the individual with respect to whom the claim is made with a written explanation of the denial and of the statutory or regulatory basis for the denial; and jdt"(2) promptly notify such individual and the provider of disposition of such reconsideration.". - • <. j^ * ' Copy read "days.".

�