Page:United States Statutes at Large Volume 114 Part 5.djvu/579

 PUBLIC LAW 106-554—APPENDIX F 114 STAT. 2763A-539 independent contractor shall provide notice (by telephone and in writing) to the individual and the provider of services and attending physician of the individual of the results of the reconsideration. Such reconsideration shall be conducted regardless of whether the provider of services or supplier will charge the individual for continued services or whether the individual will be liable for payment for such continued services. "(II) CONSULTATION WITH BENEFICIARY.— In such reconsideration, the qualified independent contractor shall solicit the views of the individual involved. "(Ill) SPECIAL RULE FOR HOSPITAL DIS- CHARGES.—^A reconsideration of a discharge from a hospital shall be conducted under this clause in accordance with the provisions of paragraphs (2), (3), and (4) of section 1154(e) as in effect on the date that precedes the date of the enactment of this subparagraph. "(iv) EXTENSION. —An individual requesting a reconsideration under this subparagraph may be granted such additional time as the individual specifies (not to exceed 14 days) for the qualified independent contractor to conclude the reconsideration. The individual may request such additional time orally or in writing. " (D) LIMITATION ON INDIVIDUAL REVIEWING DETERMINA- TIONS.— " (i) PHYSICIANS AND HEALTH CARE PROFESSIONAL.— No physician or health care professional under the employ of a qualified independent contractor may review— "(I) determinations regarding health care services furnished to a patient if the physician or health care professional was directly responsible for furnishing such services; or "(II) determinations regarding health care services provided in or by an institution, organization, or agency, if the physician or any member of the family of the physician or health care professional has, directly or indirectly, a significant financial interest in such institution, organization, or agency. "(ii) FAMILY DESCRIBED. — For purposes of this paragraph, the family of a physician or health care professional includes the spouse (other than a spouse who is legally separated from the physician or health care professional under a decree of divorce or separate maintenance), children (including stepchildren and legally adopted children), grandchildren, parents, and grandparents of the physician or health care professional. "(E) EXPLANATION OF DECISION.—Any decision with respect to a reconsideration of a qualified independent contractor shall be in writing, and shall include a detailed explanation of the decision as well as a discussion of the

�