REQUIRING REASONABLE NOTICE AND OPPORTUNITY FOR DISCUSSION PRIOR TO DENIAL OF CLAIM.

SEC. 4093. REQUIRING REASONABLE NOTICE AND OPPORTUNITY FOR DISCUSSION PRIOR TO DENIAL OF CLAIM. (a) In General.— Section 1154(a)(3) of the Social Security Act (42 U.S.C. 1320c–3(a)(3)) is amended to read as follows: “(3) (A) Subject to subparagraph (B), 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 shall101 STAT. 1330–136 promptly notify such patient and the agency or organization responsible for the payment of claims under title XVIII of this Act of such determination. “(B) The notification under subparagraph (A) shall not occur until 20 days after the date that the organization has— “(i) made a preliminary notification to such practitioner or provider of such proposed determination, and “(ii) provided such practitioner or provider an opportunity for discussion and review of the proposed determination. The discussion and review conducted under subparagraph (B)(ii) shall not affect the rights of a practitioner or provider to a formal reconsideration of a determination under this part (as provided under section 1155).”. (b) Effective Date.— The amendment made by subsection (a) shall apply with respect to determinations made on or after April 1, 1988.