Page:United States Statutes at Large Volume 96 Part 1.djvu/435

 PUBLIC LAW 97-248—SEPT. 3, 1982 "(5) the total costs incurred under titles XVIII and XIX of this Act in the implementation and operation of all procedures required by such titles for the review of services to determine their medical necessity, appropriateness of use, and quality; and "(6) descriptions of the criteria upon which decisions are made, and the selection and relative weights of such criteria.

96 STAT. 393 42 USC 1395, 1396.

EXEMPTIONS OF CHRISTIAN SCIENCE SANATORIUMS

"SEC. 1162. The provisions of this part shall not apply with respect 42 USC I320c-ll. to a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts. " M E D I C A L OFFICERS I N AMERICAN SAMOA, THE NORTHERN MARIANA ISLANDS, A N D THE TRUST TERRITORY OF THE PACIFIC ISLANDS TO BE INCLUDED IN THE UTILIZATION A N D QUALITY CONTROL PEER REVIEW PROGRAM

"SEC. 1163. For purposes of applying this part to American Samoa, 42 USC I320c-12. the Northern Mariana Islands, and the Trust Territory of the Pacific Islands, individuals licensed to practice medicine in those places shall be considered to be physicians and doctors of medicine.". FACILITATION OF PRIVATE REVIEW

SEC. 144. Section 1866(a)(1) of the Social Security Act is amended— 42 USC 1395CC. (1) by striking out "and" at the end of subparagraphs (A), (B), and (C); (2) by striking out the period at the end of subparagraph (D) and inserting in lieu thereof ", and"; and (3) by inserting after subparagraph (D) the following new subparagraph: "(E) to release data with respect to patients of such provider upon request to an organization having a contract with the Secretary under part B of title XI as may be necessary (i) to 42 USC 1320c. allow such organization to carry out its functions under such contract, or (ii) to allow such organization to carry out similar review functions under any contract the organization may have with a private or public agency paying for health care in the same area with respect to patients who authorize release of such data for such purposes.". WAIVER OF LIABILITY PROVISION

SEC. 145. Section 1879(a) of the Social Security Act is amended by 42 USC 1395pp. adding at the end thereof the following new sentence: "Any provider or other person furnishing items or services for which payment may not be made by reason of section 1862(a)(1) or (9) shall be deemed to 42 USC I395y. have knowledge that payment cannot be made for such items or services if the claim relating to such items or services involves a case, provider or other person furnishing services, procedure, or test, with respect to which such provider or other person has been notified by the Secretary (including notification by a utilization and quality control peer review organization) that a pattern of inappropriate utilization has occurred in the past, and such provider or other person has been allowed a reasonable time to correct such inappropriate utilization.".

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