Page:United States Statutes at Large Volume 94 Part 2.djvu/1369

 PUBLIC LAW 96-499—DEC. 5, 1980

94 STAT. 2647

records of such organization that are necessary to verify the nature and extent of such costs. The Secretary shall prescribe in regulation criteria and procedures which the Secretary shall use in obtaining access to books, documents, and records under clauses required in contracts and subcontracts under this subparagraph.". MEDICARE LIABILITY SECONDARY WHERE PAYMENT CAN BE MADE UNDER LIABILITY OR NO FAULT INSURANCE

S E C 953. Section 1862(b) of the Social Security Act is amended— 42 USC I395y. (1) by inserting "or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance" before the period at the end of the first sentence; (2) by inserting ", policy, plan, or insurance" before the period at the end of the second sentence; and (3) by adding at the end the following new sentence: "The Secretary may waive the provisions of this subsection in the case of an individual claim if he determines that the probability of recovery or amount involved in such claim does not warrant the pursuing of the claim.". PAYMENT FOR PHYSICIANS' SERVICES WHERE BENEFICIARY HAS DIED

SEC. 954. (a) Section 1870(0 of the Social Security Act is amended to 42 USC I395gg. read as follows: "(f) If an individual who received medical and other health services for which payment may be made under section 1832(a)(1) dies, and no 42 USC I395k. assignment of the right to payment for such services was made by such individual before his death, and payment for such services has not been made— "(1) if the person or persons who furnished the services agree that the reasonable charge is the full charge for the services, payment for such services shall be made to such person or persons, and "(2) if the person or persons who furnished the services do not agree that the reasonable charge is the full charge for the services, payment for such services shall be made on the basis of an itemized bill to the person who has agreed to assume the legal obligation to make payment for such services and files a request for payment (with such accompanying evidence of such legal obligation as may be required in regulations), but only in such amount and subject to such conditions as would be applicable if the individual who received the services had not died.". (b) The amendment made by this section shall apply only to claims ^2 USC I395gg note. filed on or after January 1, 1981. PROVIDER REIMBURSEMENT REVIEW BOARD

SEC. 955. Section 1878(f)(1) of the Social Security Act is amended by 42 USC l395oo. inserting the following after the second sentence thereof: "Providers shall also have the right to obtain judicial review of any action of the fiscal intermediary which involves a question of law or regulations relevant to the matters in controversy whenever the Board determines (on its own motion or at the request of a provider of services as described in the following sentence) that it is without authority to decide the question, by a civil action commenced within sixty days of the date on which such determination is rendered. If a provider of

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