PEER REVIEW ORGANIZATIONS.

SEC. 4205. PEER REVIEW ORGANIZATIONS. (a) Use of Corrective Action Plans.— (1) In general.— Section 1156(b)(1) (42 U.S.C. 1320c-5(b)(l)) is amended— (A) by inserting “and, if appropriate, after the practitioner or person has been given a reasonable opportunity to enter into and complete a corrective action plan (which may include remedial education) agreed to by the organization, and has failed successfully to complete such plan,” after ‘concerned, ”; and (B) by inserting after the second sentence the following: ‘Tn determining whether2121So in original. Probably should be “whether”. a practitioner or person has demonstrated an unwillingness or lack of ability substan-104 STAT. 1388–113tially to comply with such obligations, the Secretary shall consider the practitioner’s or person’s willingness or lack of ability, during the period before the organization submits its report and recommendations, to enter into and success-fully complete a corrective action plan.”. (2) Effective Date.—The amendments made by paragraph (1) shall apply to initial determinations made by organizations on or after the date of the enactment of this Act. (b) Treatment of Optometrists and Podiatrists.— (1) In general.— Section 1154 (42 U.S.C. 1320c—3) is amended— (A) in subsection (a)(T)(A)(i), by inserting “, optometry, and podiatry” after “dentistry”; and (B) in subsection (c), by striking “or dentistry” each place it appears and inserting “dentistry, optometry, or podiatry”. (2) Effective Date.—The amendments made by paragraph (1) shall apply to contracts entered into or renewed on or after the date of the enactment of this Act. (c) Coordination of PROs and Carriers.— (1) Development and implementation of plan.— The Secretary of Health and Human Services shall develop and implement a plan to coordinate the physician review activities of peer review organizations and carriers. Such plan shall include— (A) the development of common utilization and medical review criteria; (B) criteria for the targeting of reviews by peer review organizations and carriers; and (C) improved methods for exchange of information among peer review organizations and carriers. (2) Report.—Not later than January 1, 1992, the Secretary shall submit to Congress a report on the development of the plan described under paragraph (1) and shall include in the report such recommendations for changes in legislation as may be appropriate. (d) Peer Review Notice.— (1) Notice of proposed sanctions.— (A) Requirement—Section 1154(a)(9) (42 U.S.C. 1320c-3(a)(9)) is amended— (i) by inserting “(A)” after “(9)”; and (ii) by adding at the end the following: “(B) 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.”. (B) Disclosure—Section 1160(b)(D (42 U.S.C. 1320c-9(b)(1)) is amended— (i) by striking “and” at the end of subparagraph (B), (ii) by adding “and” at the end of subparagraph (C), and (iii) by adding at the end the following new subparagraph: “(D) to provide notice to the State medical board in accordance with section 1154(a)(9)(B) when the organization submits a report and recommendations to the Secretary 104 STAT. 1388–114under section 1156(b)(1) with respect to a physician whom the board is responsible for licensing;”. (C) Effective date.—The amendments made by this paragraph shall apply to notices of proposed sanctions issued more than 60 days after the date of the enactment of this Act. (2) Notice to state medical boards when adverse actions taken by secretary—. (A) In general.—Section 1156(b) (42 U.S.C. 1320c–5(b)) is amended by adding at the end the following new paragraph: “(6) When the Secretary effects an exclusion of a physician under paragraph (2), the Secretary shall notify the State board responsible for the licensing of the physician of the exclusion.”. (B) Effective date.—The amendments made by this paragraph shall apply to sanctions effected more than 60 days after the date of the enactment of this Act. (e) Confidentiality of Peer Review Deliberations.— (1) In general.—Section 1160(d) (42 U.S.C. 1320c–9(d)) is amended by adding at the end the following: “No document or other information produced by such an organization in connection with its deliberations in making determinations under section 1154(a)(l)(B) or 1156(a)(2) shall be subject to subpoena or discovery in any administrative or civil proceeding; except that such an organization shall provide) upon request of a practitioner or other person adversely affected by such a determination, a summary of the organization’s findings and conclusions in making the determination.”. (2) Effective date.—The amendments made by paragraph (1) shall apply to all proceedings as of the date of the enactment of this Act. (f) Clarification of Limitation on Liability.—Section 1157(b) (42 U.S.C. 1320c–6(b)) is amended— (1) by inserting “organization having a contract with the Secretary under this part, and no” after “No”, (2) by striking “by him”, and (3) by striking “he has exercised due care” and inserting “due care was exercised in the performance of such duty, function, or activity”. (g) Miscellaneous and Technical Amendments Relating to Peer Review Organizations.— (1) Clarification of patient notification requirements for denial of payment by pro.— (A) In general.— Section 1154(a)(3)(E) (42 U.S.C. 1320c-3(a)(3)(E)) is amended— (i) by striking “(E)” and inserting “(E)(i)”; (ii) by inserting after “items” the following: “provided by a physician that were”; (iii) by striking “physician and hospital.” and inserting “physician.”; and (iv) by adding at the end the following new clause: “(ii) In the case of services or items provided by an entity or practitioner other than a physician, the Secretary may substitute the entity or practitioner which provided the services or items for the term ‘physician’ in the notice described in clause (i).”. 104 STAT. 1388–115 (B) Effective date.—The amendments made by subparagraph (A) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation2222So in original. Probably should be “Reconciliation” Act of 1989. (2) Clarification of application of criteria for denial of payment.— (A) In general.—Section 1154(a)(2) (42 U.S.C. 1320c-3(a)(2)) is amended by striking the third sentence and inserting the following: “The organization shall identify cases for which payment should not be made by reason of paragraph (1KB) only through the use of criteria developed pursuant to guidelines established by the Secretary.T”. (B) Effective date.—The amendment made by subparagraph (A) shall take effect as if included in the enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985.