Page:United States Statutes at Large Volume 101 Part 2.djvu/930

 101 STAT. 1330-136

PUBLIC LAW 100-203—DEC. 22, 1987

gi promptly notify such patient and the agency or organization responsible for the payment of claims under title XVIII of this Act of such determination. .^^ "(B) The notification under subparagraph (A) shall not occur until 20 days after the date that the organization has— ,^. "(i) made a preliminary notification to such practitioner , or provider of such proposed determination, and V. "(ii) provided such practitioner or provider an opporKc tunity for discussion and review of the proposed determination. The discussion and review conducted under subparagraph (B)(ii) shall not affect the rights of a practitioner or provider to a formal reconsideration of a determination under this part (as provided under section 1155).". 42 USC 1320C-3 (b) EFFECTIVE DATE.—The amendment made by subsection (a) note. shall apply with respect to determinations made on or after April 1, >-r, 1988. SEC. 4094. PEER REVIEW NORMS AND EDUCATION.

Contracts.

(a) STANDARDS APPLIED BY PROS.—Section 1154(a)(6) of the Social Security Act (42 U.S.C. 1320c-3(a)(6)) is amended by adding after and below subparagraph (B) thereof the following: "As a component of the norms described in clause (i) or (ii), the organization shall take into account the special problems associated with delivering care in remote rural areas, the availability of service alternatives to inpatient hospitalization, and other appropriate factors (such as the distance from a patient's residence to the site of care, family support, availability of proximate alternative sites of care, and the patient's ability to carry jj, out necessary or prescribed self-care regimens) that could adversely affect the safety or effectiveness of treatment provided on an outpatient basis.. (b) ON-SITE REVIEW.—Section 1154(a) of such Act (42 U.S.C. 1320c-3(a)) is amended by adding at the end the following new paragraph: "(15) During each year of the contract entered into under section 1153(b), the organization shall perform significant onsite review activities, including on-site review at at least 20 percent of the rural hospitals in the organization's area.". (c) REPORTS TO PROVIDERS AND EDUCATIONAL ACTIVITIES.—

(I)(A) Section 1154(a)(6) of such Act " (42 U.S.C. 132Gc-3(a)(6)) n is amended— tf (i) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, ^)au SI {,: (ii) by inserting "(A)" after "(6)", and ^, (iii) by adding at the end the following: ic "(B) The organization shall— "(i) offer to provide, several times each year, for a physician representing the organization to meet (at a hospital or ^1^* at a regional meeting) with medical and administrative staff of each hospital (the services of which are reviewed by g the organization) respecting the organization's review of the hospital'services for which payment may be made under title XVIII, and ' s i i V v iv|
 * "* Copy read "1154(aK6) such Act".

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