42 USC 1320 - Functions of quality improvement organizations

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

Editorial Notes

Prior Provisions

A prior section 1320c–3, act Aug. 14, 1935, ch. 531, title XI, § 1154, as added Oct. 30, 1972, Puspan. L. 92–603, title II, § 249F(span), 86 Stat. 1432; amended Oct. 25, 1977, Puspan. L. 95–142, § 5(span), (d)(2)(C), 91 Stat. 1184, 1186; Dec. 5, 1980, Puspan. L. 96–499, title IX, § 924(a), 94 Stat. 2628; Aug. 13, 1981, Puspan. L. 97–35, title XXI, §§ 2112(a)(1), (2)(B), (span), 2113(c), 2121(e), 95 Stat. 793, 794, 796, related to trial period for Professional Standards Review Organizations, prior to the general revision of this part by Puspan. L. 97–248.

Amendments

2011—Puspan. L. 112–40, § 261(a)(2)(B), substituted “quality improvement” for “peer review” in section catchline.

Subsec. (a). Puspan. L. 112–40, § 261(a)(2)(C), (c)(2)(A)(i), in introductory provisions, substituted “Subject to subsection (span), any quality improvement” for “Any utilization and quality control peer review” and inserted “one or more of” before “the following functions”.

Subsec. (a)(2)(B), (3)(E)(i), (4)(A). Puspan. L. 112–40, § 261(a)(2)(C), substituted “quality improvement” for “peer review”.

Subsec. (a)(4)(C). Puspan. L. 112–40, § 261(c)(2)(A)(ii), struck out subpar. (C) which related to State-by-State competitive procurement procedures for review of quality of health care services and required certain contractual terms.

Subsec. (a)(10)(B). Puspan. L. 112–40, § 261(a)(2)(C), substituted “quality improvement” for “peer review”.

Subsec. (a)(12). Puspan. L. 112–40, § 261(c)(2)(A)(iii), added par. (12).

Subsec. (a)(15). Puspan. L. 112–40, § 261(c)(2)(A)(iv), substituted “on-site review activities as the Secretary determines appropriate” for “significant on-site review activities, including on-site review in at least 20 percent of the rural hospitals in the organization’s area”.

Subsec. (a)(18). Puspan. L. 112–40, § 261(d), added par. (18).

Subsec. (span). Puspan. L. 112–40, § 261(c)(2)(C), added subsec. (span). Former subsec. (span) redesignated (c).

Subsec. (c). Puspan. L. 112–40, § 261(c)(2)(B), redesignated subsec. (span) as (c). Former subsec. (c) redesignated (d).

Puspan. L. 112–40, § 261(a)(2)(C), substituted “quality improvement” for “utilization and quality control peer review”.

Subsec. (d). Puspan. L. 112–40, § 261(c)(2)(B), redesignated subsec. (c) as (d) and struck out former subsec. (d). Prior to amendment, text read as follows: “Each contract under this part shall require that the utilization and quality control peer review organization’s review responsibility pursuant to subsection (a)(1) of this section will include review of all ambulatory surgical procedures specified pursuant to section 1395l(i)(1)(A) of this title which are performed in the area, or, at the discretion of the Secretary a sample of such procedures.”

Subsec. (f). Puspan. L. 112–40, § 261(a)(2)(C), substituted “quality improvement” for “peer review”.

2003—Subsec. (a)(1). Puspan. L. 108–173, § 109(a), inserted “, to Medicare Advantage organizations pursuant to contracts under part C, and to prescription drug sponsors pursuant to contracts under part D” after “under section 1395mm of this title”.

Subsec. (a)(17). Puspan. L. 108–173, § 109(span), added par. (17).

Subsec. (e)(5). Puspan. L. 108–173, § 948(d), struck out par. (5) which read as follows: “In any review conducted under paragraph (2) or (3), the organization shall solicit the views of the patient involved (or the patient’s representative).”

2000—Subsec. (e)(2) to (4). Puspan. L. 106–554 struck out pars. (2) to (4), which had: in par. (2), authorized peer review organization review of validity of hospital’s determination that a patient no longer required inpatient hospital care but attending physician had not agreed with the hospital’s determination; in par. (3), authorized review of the determination where patient or patient’s representative had received a notice under par. (1) and requested the review; and in par. (4), directed that hospital could not charge patient for inpatient services furnished before noon of the day after the date the patient or representative received notice of the decision where request for review had been made not later than noon of the first working day after notice under par. (1) had been received and section 1395pp(a)(2) conditions had been met.

1994—Subsec. (a)(4)(B). Puspan. L. 103–432, § 171(h)(2), substituted “(or that is subject to review under section 1395ss(t)(3) of this title)” for “(or subject to review under section 1395ss(t) of this title)”.

Subsec. (a)(9)(B). Puspan. L. 103–432, § 156(span)(2)(B), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “If the organization finds, after notice and hearing, that a physician has furnished services in violation of this subsection, the organization shall notify the State board or boards responsible for the licensing or disciplining of the physician of its finding and decision.”

Subsec. (a)(12). Puspan. L. 103–432, § 156(a)(2)(A)(i), struck out par. (12) which read as follows: “The organization shall perform the review, referral, and other functions required under section 1320c–13 of this title.”

Subsec. (d). Puspan. L. 103–432, § 156(a)(2)(A)(ii), struck out “(and except as provided in section 1320c–13 of this title)” after “discretion of the Secretary”.

1990—Subsec. (a)(2). Puspan. L. 101–508, § 4205(g)(2)(A), inserted third sentence and struck out former third sentence which read as follows: “Determinations that payment should not be made by reason of subparagraph (B) of paragraph (1) shall be made only on the basis of criteria which are consistent with guidelines established by the Secretary.”

Subsec. (a)(3)(E). Puspan. L. 101–508, § 4205(g)(1)(A), designated existing provisions as cl. (i), inserted “provided by a physician that were” after “items”, substituted “physician.” for “physician and hospital.”, and added cl. (ii).

Subsec. (a)(4)(B). Puspan. L. 101–508, § 4358(span)(3), inserted “(or subject to review under section 1395ss(t) of this title)” after “section 1395mm of this title” in first sentence.

Subsec. (a)(7)(A)(i). Puspan. L. 101–508, § 4205(span)(1)(A), inserted “, optometry, and podiatry” after “dentistry”.

Subsec. (a)(9). Puspan. L. 101–508, § 4205(d)(1)(A), designated existing provisions as subpar. (A) and added subpar. (B).

Subsec. (a)(16). Puspan. L. 101–508, § 4207(a)(1)(B), formerly § 4027(a)(1)(B), as renumbered by Puspan. L. 103–432, § 160(d)(4), added par. (16).

Subsec. (c). Puspan. L. 101–508, § 4205(span)(1)(B), substituted “dentistry, optometry, or podiatry” for “or dentistry” in three places.

1989—Subsec. (a)(1). Puspan. L. 101–239, § 6224(a)(1), inserted at end “If the organization performs such reviews with respect to a type of health care practitioner other than medical doctors, the organization shall establish procedures for the involvement of health care practitioners of that type in such reviews.”

Subsec. (a)(3)(A). Puspan. L. 101–239, § 6224(span)(1)(A), substituted “subparagraphs (B) and (D)” for “subparagraph (B)”.

Subsec. (a)(3)(B). Puspan. L. 101–239, § 6224(span)(1)(B), inserted “with respect to services or items disapproved by reason of subparagraph (A) or (C) of paragraph (1)” after “under subparagraph (A)”.

Subsec. (a)(3)(D), (E). Puspan. L. 101–239, § 6224(span)(1)(C), added subpars. (D) and (E).

Subsec. (a)(16). Puspan. L. 101–234, repealed Puspan. L. 100–360, § 203(d)(2), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below.

1988—Subsec. (a)(3)(C). Puspan. L. 100–360, § 411(j)(2), designated last sentence of par. (3) as subpar. (C).

Subsec. (a)(4). Puspan. L. 100–360, § 411(e)(3), added Puspan. L. 100–203, § 4039(h)(3), see 1987 Amendment note below.

Subsec. (a)(6). Puspan. L. 100–360, § 411(j)(3)(A), made technical amendment to directory language of Puspan. L. 100–203, § 4094(a), see 1987 Amendment note below.

Subsec. (a)(15). Puspan. L. 100–360, § 411(j)(3)(B), substituted “review in at least” for “review at at least”.

Subsec. (a)(16). Puspan. L. 100–360, § 203(d)(2), added par. (16) which related to review of home intravenous drug therapy services.

Subsec. (d). Puspan. L. 100–360, § 411(e)(3), added Puspan. L. 100–203, § 4039(h)(4), see 1987 Amendment note below.

Subsec. (e)(3)(A)(i). Puspan. L. 100–360, § 411(j)(4)(C), as amended by Puspan. L. 100–485, § 608(d)(25)(B), substituted “paragraph (1)” for “paragraph (1) or (2)”.

Subsec. (e)(3)(B). Puspan. L. 100–360, § 411(j)(4)(C), as amended by Puspan. L. 100–485, § 608(d)(25)(B), substituted “paragraph (1)” for “paragraph (1) or (2)” in introductory provisions.

1987—Subsec. (a)(3). Puspan. L. 100–203, § 4093(a), amended par. (3) generally. Prior to amendment, par. (3) read as follows: “Whenever the organization makes a determination that any health care services or items furnished or to be furnished to a patient by any practitioner or provider are disapproved, the organization shall promptly notify such practitioner or provider, such patient, and the agency or organization responsible for the payment of claims under subchapter XVIII of this chapter. In the case of practitioners and providers of services, the organization shall provide an opportunity for discussion and review of the determination.”

Subsec. (a)(4). Puspan. L. 100–203, § 4039(h)(3), as added by Puspan. L. 100–360, § 411(e)(3), realigned margins for subpars. (B) and (C) and cls. (i) to (iii) of subpar. (C), in subpar. (B), substituted “risk sharing contract under section 1395mm” for “contract under section 1395mm”, and in subpar. (C), inserted “(other than the ability to perform review functions under this section that are not described in subparagraph (B))”.

Subsec. (a)(4)(B). Puspan. L. 100–203, § 4094(c)(2)(A), inserted before period at end of first sentence “and whether individuals enrolled with an eligible organization have adequate access to health care services provided by or through such organization (as determined, in part, by a survey of individuals enrolled with the organization who have not yet used the organization to receive such services). The contract of each organization shall also provide that with respect to health care provided by a health maintenance organization or competitive medical plan under section 1395mm of this title, the organization shall maintain a beneficiary outreach program designed to apprise individuals receiving care under such section of the role of the peer review system, of the rights of the individual under such system, and of the method and purposes for contacting the organization” and substituted “previous two sentences” for “previous sentence” in penultimate sentence.

Subsec. (a)(6). Puspan. L. 100–203, § 4094(c)(1)(A), designated existing provisions as subpar. (A), redesignated former subpars. (A) and (B) as cls. (i) and (ii), respectively, and added subpar. (B).

Puspan. L. 100–203, § 4094(a), as amended by Puspan. L. 100–360, § 411(j)(3)(A), inserted after and below subpar. (A) the following: “As a component of the norms described in clause (i) or (ii), the organization shall take into account the special problems associated with delivering care in remote rural areas, the availability of service alternatives to inpatient hospitalization, and other appropriate factors (such as the distance from a patient’s residence to the site of care, family support, availability of proximate alternative sites of care, and the patient’s ability to carry out necessary or prescribed self-care regimens) that could adversely affect the safety or effectiveness of treatment provided on an outpatient basis.”

Subsec. (a)(7)(A). Puspan. L. 100–203, § 4094(c)(2)(B), designated existing provisions as cl. (i) and added cl. (ii).

Subsec. (a)(15). Puspan. L. 100–203, § 4094(span), added par. (15).

Subsec. (d). Puspan. L. 100–203, § 4039(h)(4), as added by Puspan. L. 100–360, § 411(e)(3), substituted “1320c–13 of this title” for “1320c–13(span)(4) of this title”.

Subsec. (e)(2). Puspan. L. 100–203, § 4096(c)(1), inserted provision at end requiring hospital to notify patient if it has requested a review.

Subsec. (e)(3)(A)(i), (B). Puspan. L. 100–203, § 4096(c)(2), inserted “or (2)” after “paragraph (1)”.

1986—Subsec. (a)(1). Puspan. L. 99–509, § 9343(d)(1), inserted “and subject to the requirements of subsection (d)” after “subject to the terms of the contract” in introductory provisions.

Puspan. L. 99–272, § 9405(a), inserted “(including where payment is made for such services to eligible organizations pursuant to contracts under section 1395mm of this title)” after “subchapter XVIII” in introductory provisions.

Subsec. (a)(2). Puspan. L. 99–272, § 9403(a), in introductory provisions substituted “subparagraphs (A), (B), and (C)” for “subparagraphs (A) and (C)”, and following subpar. (D) inserted provision that determinations that payment should not be made by reason of subpar. (B) of par. (1) shall be made only on the basis of criteria which are consistent with guidelines established by the Secretary.

Subsec. (a)(4)(A). Puspan. L. 99–509, § 9353(a)(1), inserted at end “Each peer review organization shall provide that a reasonable proportion of its activities are involved with reviewing, under paragraph (1)(B), the quality of services and that a reasonable allocation of such activities is made among the different cases and settings (including post-acute-care settings, ambulatory settings, and health maintenance organizations). In establishing such allocation, the organization shall consider (i) whether there is reason to believe that there is a particular need for reviews of particular cases or settings because of previous problems regarding quality of care, (ii) the cost of such reviews and the likely yield of such reviews in terms of number and seriousness of quality of care problems likely to be discovered as a result of such reviews, and (iii) the availability and adequacy of alternative quality review and assurance mechanisms.”

Puspan. L. 99–509, § 9353(a)(2)(A), inserted “(A)” after “(4)”.

Subsec. (a)(4)(B). Puspan. L. 99–509, § 9353(a)(2)(C), inserted at end “Under the contract the level of effort expended by the organization on reviews under this subparagraph shall be equivalent, on a per enrollee basis, to the level of effort expended by the organization on utilization and quality reviews performed with respect to individuals not enrolled with an eligible organization.”

Puspan. L. 99–509, § 9353(a)(2)(B), added subpar. (B).

Subsec. (a)(4)(C). Puspan. L. 99–509, § 9353(a)(2)(D), added subpar. (C).

Subsec. (a)(8). Puspan. L. 99–272, § 9307(span), inserted “or as may be required to carry out section 1395y(a)(15) of this title” before the period at end.

Subsec. (a)(12). Puspan. L. 99–272, § 9401(a), added par. (12).

Subsec. (a)(13). Puspan. L. 99–509, § 9352(span), added par. (13).

Subsec. (a)(14). Puspan. L. 99–509, § 9353(c)(1), added par. (14).

Subsec. (d). Puspan. L. 99–509, § 9343(d)(2), added subsec. (d).

Subsec. (e). Puspan. L. 99–509, § 9351(a), added subsec. (e).

Subsec. (f). Puspan. L. 99–509, § 9353(a)(3), added subsec. (f).

1983—Subsec. (a)(1)(A). Puspan. L. 97–448, § 309(span)(3), substituted “and whether such services and items are not allowable under subsection (a)(1) or (a)(9) of section 1395y of this title” for “or otherwise allowable under section 1395y(a)(1) of this title”.

Subsec. (a)(2)(B). Puspan. L. 97–448, § 309(span)(4), struck out “posthospital” before “extended care services”.

Statutory Notes and Related Subsidiaries

Effective Date of 2011 Amendment

Amendment by Puspan. L. 112–40 applicable to contracts entered into or renewed on or after Jan. 1, 2012, see section 261(e) of Puspan. L. 112–40, set out as a note under section 1320c of this title.

Effective Date of 2003 Amendment

Puspan. L. 108–173, title I, § 109(c), Dec. 8, 2003, 117 Stat. 2173, provided that: “The amendments made by this section [amending this section] shall apply on and after January 1, 2004.”

Puspan. L. 108–173, title IX, § 948(d), Dec. 8, 2003, 117 Stat. 2426, provided that the amendment made by section 948(d) is effective as if included in the enactment of section 521(c) of BIPA (the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, as enacted by section 1(a)(6) of Puspan. L. 106–554).

Effective Date of 2000 Amendment

Puspan. L. 106–554, § 1(a)(6) [title V, § 521(d)], Dec. 21, 2000, 114 Stat. 2763, 2763A–543, provided that: “The amendments made by this section [amending this section and sections 1395w–22 and 1395ff of this title] shall apply with respect to initial determinations made on or after October 1, 2002.”

Effective Date of 1994 Amendment

Puspan. L. 103–432, title I, § 156(a)(3), Oct. 31, 1994, 108 Stat. 4441, provided that: “The amendments made by this subsection [amending this section and sections 1395l, 1395m, 1395y, and 1395cc of this title and repealing section 1320c–13 of this title] shall apply to services provided on or after the date of the enactment of this Act [Oct. 31, 1994].”

Amendment by section 171(h)(2) of Puspan. L. 103–432 effective as if included in the enactment of Puspan. L. 101–508, see section 171(l) of Puspan. L. 103–432, set out as a note under section 1395ss of this title.

Effective Date of 1990 Amendment

Puspan. L. 101–508, title IV, § 4205(span)(2), Nov. 5, 1990, 104 Stat. 1388–113, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to contracts entered into or renewed on or after the date of the enactment of this Act [Nov. 5, 1990].”

Puspan. L. 101–508, title IV, § 4205(d)(1)(C), Nov. 5, 1990, 104 Stat. 1388–114, provided that: “The amendments made by this paragraph [amending this section and section 1320c–9 of this title] shall apply to notices of proposed sanctions issued more than 60 days after the date of the enactment of this Act [Nov. 5, 1990].”

Puspan. L. 101–508, title IV, § 4205(g)(1)(B), Nov. 5, 1990, 104 Stat. 1388–115, provided that: “The amendments made by subparagraph (A) [amending this section] shall take effect as if included in the enactment of the Omnibus Budget Reconiliation [sic] Act of 1989 [Puspan. L. 101–239].”

Puspan. L. 101–508, title IV, § 4205(g)(2)(B), Nov. 5, 1990, 104 Stat. 1388–115, provided that: “The amendment made by subparagraph (A) [amending this section] shall take effect as if included in the enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985 [Puspan. L. 99–272].”

Puspan. L. 101–508, title IV, § 4207(a)(1)(C), formerly § 4027(a)(1)(C), Nov. 5, 1990, 104 Stat. 1388–117, as renumbered by Puspan. L. 103–432, title I, § 160(d)(4), Oct. 31, 1994, 108 Stat. 4444, provided that: “The amendment made by subparagraph (A) [amending section 1395dd of this title] shall take effect on the first day of the first month beginning more than 60 days after the date of the enactment of this Act [Nov. 5, 1990]. The amendment made by subparagraph (B) [amending this section] shall apply to contracts under part B of title XI of the Social Security Act [42 U.S.C. 1320c et seq.] as of the first day of the first month beginning more than 60 days after the date of the enactment of this Act.”

Puspan. L. 101–508, title IV, § 4358(c), Nov. 5, 1990, 104 Stat. 1388–137, as amended by Puspan. L. 103–432, title I, § 172(a), Oct. 31, 1994, 108 Stat. 4452; Puspan. L. 104–18, § 1, July 7, 1995, 109 Stat. 192, provided that:

“(1) The amendments made by this section [amending this section and section 1395ss of this title] shall only apply—

“(A) in 15 States (as determined by the Secretary of Health and Human Services) and such other States as elect such amendments to apply to them, and

“(B) subject to paragraph (2), during the 6½-year period beginning with 1992.

For purposes of this paragraph, the term ‘State’ has the meaning given such term by section 210(h) of the Social Security Act (42 U.S.C. 410(h)).

“(2)

(A) The Secretary of Health and Human Services shall conduct a study that compares the health care costs, quality of care, and access to services under medicare select policies with that under other medicare supplemental policies. The study shall be based on surveys of appropriate age-adjusted sample populations. The study shall be completed by June 30, 1997.

“(B) Not later than December 31, 1997, the Secretary shall determine, based on the results of the study under subparagraph (A), if any of the following findings are true:

“(i) The amendments made by this section have not resulted in savings of premium costs to those enrolled in medicare select policies (in comparison to their enrollment in medicare supplemental policies that are not medicare select policies and that provide comparable coverage).

“(ii) There have been significant additional expenditures under the medicare program as a result of such amendments.

“(iii) Access to and quality of care has been significantly diminished as a result of such amendments.

“(C) The amendments made by this section shall remain in effect beyond the 6½-year period described in paragraph (1)(B) unless the Secretary determines that any of the findings described in clause (i), (ii), or (iii) of subparagraph (B) are true.

“(3) The Comptroller General shall conduct a study to determine the extent to which individuals who are continuously covered under a medicare supplemental policy are subject to medical underwriting if they change the policy under which they are covered, and to identify options, if necessary, for modifying the medicare supplemental insurance market to make sure that continuously insured beneficiaries are able to switch plans without medical underwriting. By not later than June 30, 1996, the Comptroller General shall submit to the Congress a report on the study. The report shall include a description of the potential impact on the cost and availability of medicare supplemental policies of each option identified in the study.”

[Puspan. L. 103–432, title I, § 172(span), Oct. 31, 1994, 108 Stat. 4452, provided that: “The amendment made by subsection (a) [amending section 4358(c) of Puspan. L. 101–508, set out above] shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1990 [Puspan. L. 101–508].”]

Effective Date of 1989 Amendment

Puspan. L. 101–239, title VI, § 6224(a)(2), Dec. 19, 1989, 103 Stat. 2257, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to contracts entered into after the date of the enactment of this Act [Dec. 19, 1989].”

Puspan. L. 101–239, title VI, § 6224(span)(3), Dec. 19, 1989, 103 Stat. 2257, provided that: “The amendments made by this subsection [amending this section and section 1320c–4 of this title] shall apply to determinations by utilization and quality control peer review organizations with respect to which preliminary notifications were made under section 1154(a)(3)(B) of the Social Security Act [42 U.S.C. 1320c–3(a)(3)(B)] more than 30 days after the date of the enactment of this Act [Dec. 19, 1989].”

Amendment by Puspan. L. 101–234 effective Jan. 1, 1990, see section 201(c) of Puspan. L. 101–234, set out as a note under section 1320a–7a of this title.

Effective Date of 1988 Amendment

Amendment by Puspan. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Puspan. L. 100–360, see section 608(g)(1) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Puspan. L. 100–360, title II, § 203(g), July 1, 1988, 102 Stat. 725, which had provided that the amendments made by section 203 of Puspan. L. 100–360 (amending this section and sections 1395h, 1395k to 1395n, 1395w–2, 1395x, 1395z, and 1395aa of this title) were to apply to items and services furnished on or after January 1, 1990, was repealed by Puspan. L. 101–234, title II, § 201(a), Dec. 13, 1989, 103 Stat. 1981.

Except as specifically provided in section 411 of Puspan. L. 100–360, amendment by section 411(e)(3), (j)(2), (3), (4)(C) of Puspan. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, effective as if included in the enactment of that provision in Puspan. L. 100–203, see section 411(a) of Puspan. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.

Effective Date of 1987 Amendment

Puspan. L. 100–203, title IV, § 4093(span), Dec. 22, 1987, 101 Stat. 1330–136, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to determinations made on or after April 1, 1988.”

Puspan. L. 100–203, title IV, § 4094(c)(1)(B), Dec. 22, 1987, 101 Stat. 1330–137, provided that: “The amendments made by subparagraph (A) [amending this section] shall apply to contracts under part B of title XI of the Social Security Act [42 U.S.C. 1320c et seq.] entered into or renewed more than 6 months after the date of the enactment of this Act [Dec. 22, 1987].”

Puspan. L. 100–203, title IV, § 4094(c)(2)(C), Dec. 22, 1987, 101 Stat. 1330–137, provided that: “The amendments made by this paragraph [amending this section] shall apply with respect to contracts entered into or renewed on or after the date of enactment of this Act [Dec. 22, 1987].”

Puspan. L. 100–203, title IV, § 4096(d), Dec. 22, 1987, 101 Stat. 1330–140, provided that: “The amendments made by this section [amending this section and sections 1395u, 1395gg, and 1395pp of this title] shall apply to services furnished on or after January 1, 1988.”

Effective Date of 1986 Amendment

Amendment by section 9343(d) of Puspan. L. 99–509 applicable to contracts entered into or renewed after Jan. 1, 1987, see section 9343(h)(4) of Puspan. L. 99–509, as amended, set out as a note under section 1395l of this title.

Puspan. L. 99–509, title IX, § 9351(span), Oct. 21, 1986, 100 Stat. 2044, provided that:

“(1) Except as provided in paragraph (2), the amendment made by subsection (a) [amending this section] shall apply to denial notices furnished by hospitals to individuals on or after the first day of the first month that begins more than 30 days after the date of the enactment of this Act [Oct. 21, 1986].

“(2) Section 1154(e)(4) of the Social Security Act [subsec. (e)(4) of this section] (as added by the amendment made by subsection (a)) shall take effect on the date of the enactment of this Act [Oct. 21, 1986].”

Puspan. L. 99–509, title IX, § 9352(c)(2), Oct. 21, 1986, 100 Stat. 2044, provided that: “The amendment made by subsection (span) [amending this section] shall apply to contracts entered into or renewed on or after January 1, 1987, except that in applying such amendment before January 1, 1989, the term ‘post-hospital services’ does not include physicians’ services, other than physicians’ services furnished in a hospital, other inpatient facility, ambulatory surgical center, or rural health clinic.”

Puspan. L. 99–509, title IX, § 9353(a)(6), Oct. 21, 1986, 100 Stat. 2046, as amended by Puspan. L. 100–203, title IV, § 4039(h)(9)(A), (B), as added Puspan. L. 100–360, title IV, § 411(e)(3), July 1, 1988, 102 Stat. 776, provided that:

“(A)

(i) Except as provided in clause (ii), the amendments made by paragraph (1) [amending this section] shall apply to contracts entered into or renewed on or after January 1, 1987.

“(ii) The amendment made by paragraph (1) shall not be construed as requiring, before January 1, 1989, the review of physicians’ services, other than physicians’ services furnished in a hospital, other inpatient facility, ambulatory surgical center, or rural health clinic.

“(B) The amendments made by paragraphs (2)(B) and (2)(D) [amending this section] shall apply to contracts as of April 1, 1987.

“(C) The amendment made by paragraph (2)(C) [amending this section] shall apply to review activities conducted by organizations on or after January 1, 1988.

“(D) The amendment made by paragraph (3) [amending this section] becomes effective on the date of the enactment of this Act [Oct. 21, 1986].”

Puspan. L. 99–509, title IX, § 9353(c)(2), Oct. 21, 1986, 100 Stat. 2047, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to complaints received on or after the first day of the first month that begins more than 9 months after the date of the enactment of this Act [Oct. 21, 1986].”

Puspan. L. 99–272, title IX, § 9307(e), Apr. 7, 1986, 100 Stat. 194, provided that: “The amendments made by this section [amending this section and sections 1395u and 1395y of this title] shall apply to services performed on or after April 1, 1986.”

Puspan. L. 99–272, title IX, § 9401(d), Apr. 7, 1986, 100 Stat. 200, provided that: “The amendments made by subsection (a) [amending this section] shall apply to items and services furnished on or after January 1, 1987. The Secretary of Health and Human Services shall provide for such modification of contracts under part B of title XI of the Social Security Act [42 U.S.C. 1320c et seq.] that are in effect on that date as may be necessary to effect these amendments on a timely basis.”

Puspan. L. 99–272, title IX, § 9403(c), Apr. 7, 1986, 100 Stat. 200, provided that: “The amendments made by this section [amending this section and section 1395cc of this title] shall become effective on the date of the enactment of this Act [Apr. 7, 1986].”

Puspan. L. 99–272, title IX, § 9405(span), Apr. 7, 1986, 100 Stat. 201, as amended by Puspan. L. 99–509, title IX, § 9353(a)(5), Oct. 21, 1986, 100 Stat. 2046, provided that: “The amendment made by this section [amending this section] shall apply to items and services furnished on or after April 1, 1987.”

Effective Date of 1983 Amendment

Amendment by Puspan. L. 97–448 effective as if originally included as a part of this section as this section was added by the Tax Equity and Fiscal Responsibility Act of 1982, Puspan. L. 97–248, see section 309(c)(2) of Puspan. L. 97–448, set out as a note under section 426–1 of this title.

State Regulatory Programs

For provisions relating to changes required to conform State regulatory programs to amendments by section 171 of Puspan. L. 103–432, see section 171(m) of Puspan. L. 103–432, set out as a note under section 1395ss of this title.

Review and Analysis of Variations in Utilization of Hospital and Other Health Care Services

Puspan. L. 99–509, title IX, § 9353(a)(4), Oct. 21, 1986, 100 Stat. 2046, provided that: “The Secretary of Health and Human Services shall provide, to at least 12 utilization and quality control peer review organizations with contracts under part B of title XI of the Social Security Act [42 U.S.C. 1320c et seq.], data and data processing assistance to allow each of these organizations to review and analyze small-area variations, in the service area of the organization, in the utilization of hospital and other health care services for which payment is made under title XVIII of such Act [42 U.S.C. 1395 et seq.].”