Page:United States Statutes at Large Volume 101 Part 2.djvu/931

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-137

"(ii) publish (not less often than annually) and distribute to providers and practitioners whose services are subject to review a report that describes the organization's findings with respect to the types of cases in which the organization has frequently determined that (I) inappropriate or unnecessary care has been provided, (II) services were rendered in an inappropriate setting, or (III) services did not meet professionally recognized standards of health care.". (B) The amendments made by subparagraph (A) shall apply to contracts under part B of title XI of the Social Security Act entered into or renewed more than 6 months after the date of the enactment of this Act. (2)(A) Section 1154(a)(4)(B) of the Social Security Act (42 U.S.C. 1320c-3(a)(4)(B)) is amended— (i) by inserting before the period at the end of the first sentence the following: "and whether individuals enrolled with an eligible organization have adequate access to health care services provided by or through such organization (as determined, in part, by a survey of individuals enrolled with the organization who have not yet used the organization to receive such services). The contract of each organization shall also provide that with respect to health care provided by a health maintenance organization or competitive medical plan under section 1876, the organization shall maintain a beneficiary outreach program designed to apprise individuals receiving care under such section of the role of the peer review system, of the rights of the individual under such system, and of the method and purposes for contacting the organization"; and (ii) by striking "previous sentence" and inserting "previous two sentences". (B) Section 1154(a)(7)(A) of such Act (42 U.S.C. 1320c3(a)(7)(A)) is amended— (i) by inserting "(i)" after "(A)", (ii) by striking the semicolon and inserting "; and", and (iii) by adding at the end thereof the following new clause: "(ii) in the case of psychiatric and physical rehabilitation 'VRx'<}ti services, make arrangements to ensure that (to the extent > possible) initial review of such services be made by a physician who is trained in psychiatry or physical rehabilitation (as appropriate).''. (C) The amendments made by this paragraph shall apply with respect to contracts entered into or renewed on or after the date of enactment of this Act.

Contracts. 42 USC 1320C-3 note.

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Contracts. 42 USC 1320C-3 note.

(d) PEER REVIEW EMPHASIS ON EDUCATIONAL ACTIVITIES.—

(1) Section 1153(c) of such Act (42 U.S.C. 1320c-2(c)) is amended by adding after and below paragraph (8) the following: "In evaluating the performance of utilization and quality control peer review organizations under contracts under this part, the Secretary shall place emphasis on the performance of such organizations in educating providers and practitioners (particularly those in rural areas) concerning the review process and criteria being applied by the organization.". (2) The amendment made by paragraph (1) shall apply to Contracts. contracts under part B of title XI of the Social Security Act as of 42 USC 1320C-2 note. January 1, 1988.

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