Page:United States Statutes at Large Volume 91.djvu/1219

 PUBLIC LAW 95-142—OCT. 25, 1977

91 STAT. 1185

" (C) such practitioners have a person (who may himself be a practitioner) — " (i) who is in charge of, controls, manages, or super^dses subsitantial aspects of the arrangement or operation for the delivery of health or medical services at such common physical location, other than the direct furnishing of professional health care services by the practitioners to their patients; or " ( i i) who makes available to such practitioners the services of supporting staff who are not employees of such practitioners; and who is compensated in whole or in part, for the use of such common physical location or support services pertaining thereto, on a basis related to amounts charged or collected for the services rendered or ordered at such location or on any basis clearly unrelated to the value of the services provided by the person; and " (D) at least one of such practitioners received payments on a fee-for-service basis under titles V, X VIII, and X IX in an amount exceeding $5,000 for any one month during the preceding 12 months or in an aggregate amount exceeding $40,000 during the preceding 12 months; except that such term does not include a provider of services (as defined in section 1861(u) of this Act), a health maintenance organization (as defined in section 1301(a) of the Public Health Service Act), a hospital cooperative shared services organization meeting the requirements of section 501(e) of the I n t e r n a l Revenue Code of 1954, or any public entity.". (d)(1) Section 1158 of such Act is amended by adding at the end thereof the following new subsection: " (c) Where a Professional Standard s Review Organization (whether designated on a conditional basis or otherwise) has been found competent by the Secretary to assume review responsibility with respect to specified types of health care services or specified providers or practitioners of such services and is performing such reviews, determinations made pursuant to paragraph s (1) and (2) of section 1155 (a) in connection with such reviews shall constitute the conclusive determination on those issues (subject to sections 1159, 1 1 7 1 (a)(1), and 1 1 7 1 (d)(3)) for purposes of payment under this Act, and no reviews with respect to those determinations shall be conducted, for purposes of payment, by agencies and organizations which are parties to agreements entered into by the Secretary pursuant to section 1816, carriers which are parties to contracts entered into by the Secretary pursuant to section 1842, or single State agencies administering or supervising the administration of State plans approved under title XIX.". (2)(A) Section 1152(b)(2) of such Act is amended by strikinj; out "submitted to him by the association, agency, or organization" and inserting in lieu thereof "which shall be developed and submitted by the association, agency, or organization in accordance with subsection (h) ". (B) Section 1152 of such Act is further amended by ndding at the end thereof the following new subsection: " (h)(1) During the development and preparation by an organization of its formal plan under subsection (b)(2) or of any modification of such plan to include review of services in skilled nursing facilities (as defined in section 1861(j)) or intermediate care facilHies (as defined in section 1905(c)) or review of ambulatory care services, the organization shall consult with the single State agency responsible

42 USC 701, 1395, 1396.

42 USC 1395x. 42 USC 300e. 26 USC 501. eiaim payments review. 42 USC 1320C-7.

42 USC 1320C-4. 42 USC 1320C-8. Post, p. 1186.

42 USC 1395h. 42 USC 1395u. 42 USC 1320C-1.

State health care facility plans, preparation.

42 USC 1395x. 42 USC 1396<i.

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