Page:United States Statutes at Large Volume 96 Part 1.djvu/427

 PUBLIC LAW 97-248—SEPT. 3, 1982

96 STAT. 385

serving on such panel individuals shall be paid at a per diem rate not to exceed the current per diem equivalent at the time that service on the panel is rendered for grade GS-18 under section 5332 of title 5, United States Code. Appointments shall be made without regard to title 5, United States Code. "(e) Contracting authority of the Secretary under this section may be carried out without regard to any provision of law relating to the making, performance, amendment, or modification of contracts of the United States as the Secretary may determine to be inconsistent with the purposes of this part. The Secretary may use different contracting methods with respect to different geographical areas. "(f) Any determination by the Secretary to terminate or not to renew a contract under this section shall not be subject to judicial review. "FUNCTIONS OF PEER REVIEW ORGANIZATIONS

"SEC. 1154. (a) Any utilization and quality control peer review 42 USC i320c-3. organization entering into a contract with the Secretary under this part must perform the following functions: "(1) The organization shall review some or all of the professional activities in the area, subject to the terms of the contract, of physicians and other health care practitioners and institutional and noninstitutional providers of health care services in the provision of health care services and items for which payment may be made (in whole or in part) under title XVIII for 42 USC 1395. the purpose of determining whether— "(A) such services and items are or were reasonable and medically necessary or otherwise allowable under section 1862(a)(1); "(B) the quality of such services meets professionally recognized standards of health care; and "(C) in case such services and items are proposed to be provided in a hospital or other health care facility on an inpatient basis, such services and items could, consistent with the provision of appropriate medical care, be effectively provided more economically on an outpatient basis or in an inpatient health care facility of a different type. "(2) The organization shall determine, on the basis of the review carried out under subparagraphs (A) and (C) of paragraph (1), whether payment shall be made for services under title XVIII. Such determination shall constitute the conclusive determination on those issues for purposes of payment under title XVIII, except that payment may be made if— "(A) such payment is allowed by reason of section 1879; "(B) in the case of inpatient hospital services or posthospital extended care services, the peer review organization determines that additional time is required in order to arrange for postdischarge care, but payment may be continued under this subparagraph for not more than two days, bui only in the case where the provider of such services did not know and could not reasonably have been expected to know (as determined under section 1879) that payment 42 USC I395pp. would not otherwise be made for such services under title XVIII prior to notification by the organization under paragraph (3);

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