42 USC 1396 - Information concerning sanctions taken by State licensing authorities against health care practitioners and providers

1 So in original. The semicolon probably should be a comma.

2 So in original. Probably should be “to quality improvement organizations”.

described in part B of subchapter XI and to appropriate entities with contracts under section 1320c–3(a)(4)(C) 

3 See References in Text note below.

of this title with respect to eligible organizations reviewed under the contracts, but only with respect to information provided pursuant to subsection (a)(1)(A),

Editorial Notes

References in Text

Section 1320c–3(a)(4)(C) of this title, referred to in subsec. (span)(4), was repealed by Puspan. L. 112–40, title II, § 261(c)(2)(A)(ii), Oct. 21, 2011, 125 Stat. 425.

The Health Care Quality Improvement Act of 1986 and that Act, referred to in subsecs. (span)(6) and (h), are title IV of Puspan. L. 99–660, Nov. 14, 1986, 100 Stat. 3784, which is classified generally to chapter 117 (§ 11101 et seq.) of this title. Part B of the Act is classified generally to subchapter II (§ 11131 et seq.) of chapter 117 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 11101 of this title and Tables.

Prior Provisions

A prior section 1921 of act Aug. 14, 1935, was renumbered section 1939 and is classified to section 1396v of this title.

Amendments

2010—Subsec. (a)(1). Puspan. L. 111–148, § 6403(span)(1)(A)(ii), redesignated subpars. (A) to (D) as cls. (i) to (iv), respectively, of subpar. (A).

Puspan. L. 111–148, § 6403(span)(1)(A)(i), which directed adding subpar. (A) and striking out “The State” and all that follows through the “semicolon”, was executed by adding subpar. (A) and striking out “The State must have in effect a system of reporting the following information with respect to formal proceedings (as defined by the Secretary in regulations) concluded against a health care practitioner or entity by any authority of the State (or of a political subdivision thereof) responsible for the licensing of health care practitioners (or any peer review organization or private accreditation entity reviewing the services provided by health care practitioners) or entities:”, to reflect the probable intent of Congress.

Subsec. (a)(1)(A)(iii). Puspan. L. 111–148, § 6403(span)(1)(A)(iii), substituted “license or the right to apply for, or renew, a license by” for “the license of” and inserted “nonrenewability,” after “voluntary surrender,”.

Subsec. (a)(1)(B). Puspan. L. 111–148, § 6403(span)(1)(A)(iv), added subpar. (B).

Subsec. (a)(2). Puspan. L. 111–148, § 6403(span)(1)(B), substituted “a State licensing or certification agency or State law or fraud enforcement agency” for “the authority described in paragraph (1)”.

Subsec. (span)(2). Puspan. L. 111–148, § 6403(span)(2)(A), added par. (2) and struck out former par. (2) which read as follows: “to licensing authorities described in subsection (a)(1) of this section,”.

Subsec. (span)(4). Puspan. L. 111–148, § 6403(span)(2)(B), inserted “, but only with respect to information provided pursuant to subsection (a)(1)(A)” before comma at end.

Subsec. (span)(5). Puspan. L. 111–148, § 6403(span)(2)(C), added par. (5) and struck out former par. (5) which read as follows: “to State medicaid fraud control units (as defined in section 1396span(q) of this title),”.

Subsec. (span)(6). Puspan. L. 111–148, § 6403(span)(2)(B), inserted “, but only with respect to information provided pursuant to subsection (a)(1)(A)” before comma at end.

Subsec. (span)(7) to (9). Puspan. L. 111–148, § 6403(span)(2)(D), (E), added par. (7) and redesignated former pars. (7) and (8) as (8) and (9), respectively.

Subsecs. (d) to (g). Puspan. L. 111–148, § 6403(span)(3), added subsecs. (d) to (g). Former subsec. (d) redesignated (h).

Subsec. (h). Puspan. L. 111–148, § 6403(span)(3), (4), redesignated subsec. (d) as (h) and substituted “In implementing this section, the Secretary shall provide for the maximum appropriate coordination with part B of the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11131 et seq.) and section 1320a–7e of this title.” for “The Secretary shall provide for the maximum appropriate coordination in the implementation of subsection (a) of this section and section 422 of the Health Care Quality Improvement Act of 1986.”

1990—Subsec. (a)(1). Puspan. L. 101–508, § 4752(f)(1)(A), inserted “(or any peer review organization or private accreditation entity reviewing the services provided by health care practitioners)” after “health care practitioners” in introductory provisions.

Subsec. (a)(1)(D). Puspan. L. 101–508, § 4752(f)(1)(B), added subpar. (D).

Statutory Notes and Related Subsidiaries

Effective Date of 2010 Amendment

Amendment by Puspan. L. 111–148 effective on the first day after the final day of the transition period defined in section 6403(d)(5) of Puspan. L. 111–148, see section 6403(d)(6) of Puspan. L. 111–148, set out as a Transition Process; Regulations; Effective Date of 2010 Amendment note under section 1320a–7e of this title.

Effective Date of 1990 Amendment

Puspan. L. 101–508, title IV, § 4752(f)(2), Nov. 5, 1990, 104 Stat. 1388– 208, provided that:

“The amendments made by paragraph (1) [amending this section] shall apply to State information reporting systems as of January 1, 1992, without regard to whether or not the Secretary of Health and Human Services has promulgated any regulations to carry out such amendments by such date.”

Effective Date

Section applicable, with certain exceptions, to payments under subchapter XIX of this chapter for calendar quarters beginning more than thirty days after Aug. 18, 1987, without regard to whether or not final regulations to carry out this section have been published by that date, see section 15(c)(1), (2) of Puspan. L. 100–93 set out as an Effective Date of 1987 Amendment note under section 1320a–7 of this title.