Page:United States Statutes at Large Volume 89.djvu/1114

 89 STAT. 1054 42 USC 1395J.

PUBLIC LAW 94-182—DEC. 31, 1975 title X VIII of the Social Security Act for services performed by doctors of optometry but not presently recognized for purposes of reimbursement with respect to the provision of prosthetic lenses for patients with aphakia. UTILIZATION REVIEW UNDER MEDICAID

42 USC 1396b. 42 USC 1396a.

Effective date. 42 USC 1396b note.

SEC. 110. (a) Section 1903(g)(1)(C) of the Social Security Act is amended to read as follows: "(C) such State has in effect a continuous program of review of utilization pursuant to section 1902(a) (30) whereby each admission is reviewed or screened in accordance with criteria established by medical and other professional personnel who are not themselves directly responsible for the care of the patient involved, and who do not have a significant financial interest in any such institution and are not, except in the case of a hospital, employed by the institution providing the care involved; and the information developed from such review or screening, along with the data obtained from prior reviews of the necessity for admission and continued stay of patients by such professional personnel, shall be used as the basis for establishing the size and composition of the sample of admissions to be subject to review and evaluation by such personnel, and any such sample may be of any size up to 100 per centum of all admissions and must be of sufficient size to serve the purpose of (i) identifying the patterns of care being provided and the changes occurring over time in such patterns so that the need for modification may be ascertained, and (ii) subjecting admissions to early or more extensive review where information indicates that such consideration is warranted; and", (b) The amendment made by subsection (a) shall take effect on the first day of the first calendar month which begins not less than 90 days after the date of enactment of this Act. CONSENT BY STATES TO CERTAIN

42 USC 1396a.

SUITS

SEC. 111. (a) Section 1902 of the Social Security Act is amended by adding at the end thereof the following new subsection: "(g) Notwithstanding any other provision of this title, a State plan tor medical assistance must include a consent by the State to the exercise of the judicial power of the United States in any suit brought against thp State or a State officer by or on behalf of any provider of 42 USC 1395x. services (as defined in section 1861(u)) with respect to the application of subsection (a) (13)(D) to services furnished under such plan after June 30, 1975, and a waiver by the State of any immunity from such a u s e prec. title 1. suit conferred by the 11th amendment to the Constitution or otherwise." 42 USC 1396b. (b) Section 1903 of such Act is amended by adding at the end thereof the following new subsection: " (1) Notwithstanding any other provision of this section, the amount payable to any State under this section with respect to any quarter beginning after December 31, 1975, shall be reduced by 10 per centum of the amount determined with respect to such quarter under the preceding provisions of this section if such State is found by the Secretary Supra. not to be in compliance with section 1902(g)." Effective date. (c) The amendments made by this section shall (except as other42 USC 1396a wise provided therein) become effective January 1, 1976. note.

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