Page:United States Statutes at Large Volume 114 Part 5.djvu/574

 114 STAT. 2763A-534 PUBLIC LAW 106-554—APPENDIX F (b) EFFECTIVE DATE. —The amendment made by subsection (a) shall apply to portions of cost reporting periods occurring on or after January 1, 2001. Subtitle C—Changes in Medicare Coverage and Appeals Process SEC. 521. REVISIONS TO MEDICARE APPEALS PROCESS. (a) CONDUCT OF RECONSIDERATIONS OF DETERMINATIONS BY INDEPENDENT CONTRACTORS.—Section 1869 (42 U.S.C. 1395ff) is amended to read as follows: "DETERMINATIONS; APPEALS "SEC. 1869. (a) INITIAL DETERMINATIONS.— "(1) PROMULGATIONS OF REGULATIONS.— The Secretary shall promulgate regulations and make initial determinations with respect to benefits under part A or part B in accordance with those regulations for the following: "(A) The initial determination of whether an individual is entitled to benefits under such parts. "(B) The initial determination of the amount of benefits available to the individual under such parts. "(C) Any other initial determination with respect to a claim for benefits under such parts, including an initial determination by the Secretary that payment may not be made, or may no longer be made, for an item or service under such parts, an initial determination made by a utilization and quality control peer review organization under section 1154(a)(2), and an initial determination made by an entity pursuant to a contract (other than a contract under section 1852) with the Secretary to administer provisions of this title or title XI. " (2) DEADLINES FOR MAKING INITIAL DETERMINATIONS. — "(A) IN GENERAL. — Subject to subparagraph (B), in promulgating regulations under paragraph (1), initial determinations shall be concluded by not later than the 45-day period beginning on the date the fiscal intermediary or the carrier, as the case may be, receives a claim for benefits from an individual as described in paragraph (1). Notice of such determination shall be mailed to the individual filing the claim before the conclusion of such 45-day period. " (B) CLEAN CLAIMS.—Subparagraph (A) shall not apply with respect to any claim that is subject to the requirements of section 1816(c)(2) or 1842(c)(2). "(3) REDETERMINATIONS.— "(A) IN GENERAL.—In promulgating regulations under paragraph (1) with respect to initial determinations, such regulations shall provide for a fiscal intermediary or a carrier to make a redetermination with respect to a claim for benefits that is denied in whole or in part. "(B) LIMITATIONS. — " (i) APPEAL RIGHTS.— No initial determination may be reconsidered or appealed under subsection (b) unless

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