Page:United States Statutes at Large Volume 101 Part 2.djvu/929

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-135

(2) Section 1153(e) of such Act (42 U.S.C. 1320c-2(e)) is amended— (A) by inserting "(1)" after "(e)"; " ? (B) by striking "Contracting" and inserting "Except as provided in paragraph (2), contracting"; and (C) by adding at the end the following new paragraph: "(2) If a peer review organization with a contract under this section is required to carry out a review function in addition to any function required to be carried out at the time the Secretary entered into or renewed the contract with the organization, the Secretary shall, before requiring such organization to carry out such additional function, negotiate the necessary contractual modifications, including modifications that provide for an appropriate adjustment (in light of the cost of such additional function) to the amount of reimbursement made to the organization.". (3) The amendments made by paragraphs (1) and (2) shall 42 USC 1320C-2 note. become effective on the date of enactment of this Act. SEC. 4092. PREFERENCE IN CONTRACTING WITH IN-STATE ORGANIZATIONS.

(a) IN GENERAL.—Section 1153 of the Social Security Act (42 U.S.C. 1320C-2), as amended by section 4091(bKl) of this part, is further amended by adding at the end the following new subsection: "(i)(1) Notwithstanding any other provision of this section, the Secretary shall not renew a contract with any organization that is not an in-State organization (as defined in paragraph (3)) unless the Secretary has first complied with the requirements of paragraph (2). "(2)(A) Not later than six months before the date on which a contract period ends with respect to an organization that is not an in-State organization, the Secretary shall publish in the Federal Register— "(i) the date on which such period ends; and "(ii) the period of time in which an in-State organization may submit a proposal for the contract ending on such date. "(B) If one or more qualified in-State organizations submits a proposal within the period of time specified under subparagraph (A)(ii), the Secretary shall not automatically renew the current contract on a noncompetitive basis, but shall provide for competition for the contract in the same manner as a new contract under subsection (b). "(3) For purposes of this subsection, an in-State organization is an organization that has its primary place of business in the State in which review will be conducted (or, which is owned by a parent corporation the headquarters of which is located in such State).". (b) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply with respect to contracts scheduled to be renewed on or after the first day of the eighth month to begin after the date of enactment of this Act. SEC. 4093. REQUIRING REASONABLE NOTICE AND OPPORTUNITY FOR DISCUSSION PRIOR TO DENIAL OF CLAIM.

(a) IN GENERAL.—Section 1154(a)(3) of the Social Security Act (42 U.S.C. 1320c-3(a)(3)) is amended to read as follows: "(3)(A) Subject to subparagraph (B), whenever the organization makes a determination that any health care services or items furnished or to be furnished to a patient by any practitioner or provider are disapproved, the organization shall

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Federal Register, publication.

42 USC 1320C-2 note.

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