PEER REVIEW NORMS AND EDUCATION.

SEC. 4094. PEER REVIEW NORMS AND EDUCATION. (a) Standards Applied by Pros.— Section 1154(a)(6) of the Social Security Act (42 U.S.C. 1320c–3(a)(6)) is amended by adding after and below subparagraph (B) thereof 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.” (b) On-Site Review.— Section 1154(a) of such Act (42 U.S.C. 1320c–3(a)) is amended by adding at the end the following new paragraph: “(15) During each year of the contract entered into under section 1153(b), the organization shall perform significant onsite review activities, including on-site review at at least 20 percent of the rural hospitals in the organization’s area.”. (c) Reports to Providers and Educational Activities.— (1) (A) Section 1154(a)(6) of such Act4747Copy read “1154(a)(6) such Act”. (42 U.S.C. 1320c–3(a)(6)) is amended— (i) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, (ii) by inserting “(A)” after “(6)”, and (iii) by adding at the end the following: “(B) The organization shall— “(i) offer to provide, several times each year, for a physician representing the organization to meet (at a hospital or at a regional meeting) with medical and administrative staff of each hospital (the services of which are reviewed by g the organization) respecting the organization’s review of the hospital’s services for which payment may be made under title XVIII, and 101 STAT. 1330–137 “(ii) publish (not less often than annually) and distribute to providers and practitioners whose services are subject to review a report that describes the organization’s findings with respect to the types of cases in which the organization has frequently determined that (I) inappropriate or unnecessary care has been provided, (II) services were rendered in an inappropriate setting, or (III) services did not meet professionally recognized standards of health care.”. (B) The amendments made by subparagraph (A) shall apply to contracts under part B of title XI of the Social Security Act entered into or renewed more than 6 months after the date of the enactment of this Act. (2) (A) Section 1154(a)(4)(B) of the Social Security Act (42 U.S.C. 1320c–3(a)(4)(B)) is amended— (i) by inserting before the period at the end of the first sentence the following: “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 1876, 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 (ii) by striking “previous sentence” and inserting “previous two sentences”. (B) Section 1154(a)(7)(A) of such Act (42 U.S.C. 1320c–3(a)(7)(A)) is amended— (i) by inserting “(i)” after “(A)”, (ii) by striking the semicolon and inserting “; and”, and (iii) by adding at the end thereof the following new clause: “(ii) in the case of psychiatric and physical rehabilitation services, make arrangements to ensure that (to the extent possible) initial review of such services be made by a physician who is trained in psychiatry or physical rehabilitation (as appropriate).”. (C) The amendments made by this paragraph shall apply with respect to contracts entered into or renewed on or after the date of enactment of this Act. (d) Peer Review Emphasis on Educational Activities.— (1) Section 1153(c) of such Act (42 U.S.C. 1320c–2(c)) is amended by adding after and below paragraph (8) the following: “In evaluating the performance of utilization and quality control peer review organizations under contracts under this part, the Secretary shall place emphasis on the performance of such organizations in educating providers and practitioners (particularly those in rural areas) concerning the review process and criteria being applied by the organization.”. (2) The amendment made by paragraph (1) shall apply to contracts under part B of title XI of the Social Security Act as of January 1, 1988. 101 STAT. 1330–138 (e) Telecommunications Demonstration Projects.— The Secretary of Health and Human Services shall enter into agreements with entities submitting applications under this subsection (in such form as the Secretary may provide) to establish demonstration projects to examine the feasability of requiring instruction and oversight of rural physicians, in lieu of imposing sanctions, through use of video communication between rural hospitals and teaching hospitals under this title. Under such demonstration projects, the Secretary may provide for payments to physicians consulted via video communication systems. No funds may be expended under the demonstration projects for the acquisition of capital items including computer hardware.