Page:United States Statutes at Large Volume 117.djvu/2421

 117 STAT. 2402

42 USC 1395i–3 note.

PUBLIC LAW 108–173—DEC. 8, 2003

(and their staffs) and the appellate level staff at the Departmental Appeals Board of the Department of Health and Human Services and educating such judges and staffs on long-term care issues. (d) EFFECTIVE DATE.—The amendments made by this section shall apply to appeals filed on or after October 1, 2004. SEC. 933. REVISIONS TO MEDICARE APPEALS PROCESS.

42 USC 1395ff note.

VerDate 11-MAY-2000

13:59 Aug 30, 2004

(a) REQUIRING FULL AND EARLY PRESENTATION OF EVIDENCE.— (1) IN GENERAL.—Section 1869(b) (42 U.S.C. 1395ff(b)), as amended by section 932(a), is further amended by adding at the end the following new paragraph: ‘‘(3) REQUIRING FULL AND EARLY PRESENTATION OF EVIDENCE BY PROVIDERS.—A provider of services or supplier may not introduce evidence in any appeal under this section that was not presented at the reconsideration conducted by the qualified independent contractor under subsection (c), unless there is good cause which precluded the introduction of such evidence at or before that reconsideration.’’. (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall take effect on October 1, 2004. (b) USE OF PATIENTS’ MEDICAL RECORDS.—Section 1869(c)(3)(B)(i) (42 U.S.C. 1395ff(c)(3)(B)(i)) is amended by inserting ‘‘(including the medical records of the individual involved)’’ after ‘‘clinical experience’’. (c) NOTICE REQUIREMENTS FOR MEDICARE APPEALS.— (1) INITIAL DETERMINATIONS AND REDETERMINATIONS.—Section 1869(a) (42 U.S.C. 1395ff(a)) is amended by adding at the end the following new paragraphs: ‘‘(4) REQUIREMENTS OF NOTICE OF DETERMINATIONS.—With respect to an initial determination insofar as it results in a denial of a claim for benefits— ‘‘(A) the written notice on the determination shall include— ‘‘(i) the reasons for the determination, including whether a local medical review policy or a local coverage determination was used; ‘‘(ii) the procedures for obtaining additional information concerning the determination, including the information described in subparagraph (B); and ‘‘(iii) notification of the right to seek a redetermination or otherwise appeal the determination and instructions on how to initiate such a redetermination under this section; ‘‘(B) such written notice shall be provided in printed form and written in a manner calculated to be understood by the individual entitled to benefits under part A or enrolled under part B, or both; and ‘‘(C) the individual provided such written notice may obtain, upon request, information on the specific provision of the policy, manual, or regulation used in making the redetermination. ‘‘(5) REQUIREMENTS OF NOTICE OF REDETERMINATIONS.— With respect to a redetermination insofar as it results in a denial of a claim for benefits— ‘‘(A) the written notice on the redetermination shall include—

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