IMPROVEMENT IN QUALITY OF PHYSICIAN SERVICES.

SEC. 4752. IMPROVEMENT IN QUALITY OF PHYSICIAN SERVICES. (a) Use of Unique Physician Identifiers.— (1) Establishment of system.— (A) In general.— Section 1902 (42 U.S.C. 1396a) as amended by sections 4601(d), 4701(a), 4711(a), 4722(a), and 4751(a) is further amended by adding at the end the following new subsection: “(x) The Secretary shall establish a system, for implementation by not later than July 1, 1991, which provides for a unique identifier for each physician who furnishes services for which payment may be made under a State plan approved under this title.”. (B) Deadline and considerations.—The system established under the amendment made by subparagraph (A) may be the same as, or different from, the system established under section 9202(g) of the Consolidated Omnibus Budget Reconciliation Act of 1985. (2) Requiring inclusion with claims.— Section 1903(i) (42 U.S.C. 1396b(i)), as amended by this title, is amended— (A) by striking the period at the end of paragraph (11) and inserting or”, and (B) by inserting after paragraph (11) the following new paragraph: “(12) with respect to any amount expended for physicians’ services furnished on or after the first day of the first quarter beginning more than 60 days after the date of establishment of the physician identifier system under section 1902(x), unless the claim for the services includes the unique physician identifier provided under such system.”, (b) Maintenance of Encounter Data by Health Maintenance Organizations.— (1) In general.— Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)), as amended by this title, is amended— (A) by striking “and” at the end of clause (ix), (B) by striking the period at the end of clause (x) and inserting “; and”, and (C) by adding at the end the following new clause: “(xi) such contract provides for maintenance of sufficient patient encounter data to identify the physician who delivers services to patients.”. (2) Effective date.—The amendments made by paragraph (1) shall apply to contract years beginning after the date of the establishment of the system described in section 1902(x) of the Social Security Act. (c) Maintenance of List of Physicians by States.— (1) In general.— Section 1902(a) (42 U.S.C. 1396a(a)), as amended by this title, is further amended— (A) by striking “and” at the end of paragraph (56), (B) by striking the period at the end of paragraph (57) and inserting “; and”, and 104 STAT. 1388–207 (C) by inserting after paragraph (57) the following new paragraph: “(58) maintain a list (updated not less often than monthly, and containing each physician’s unique identifier provided under the system established under subsection (v)) of all physicians who are certified to participate under the State plan.”. (2) Effective date.—The amendments made by paragraph (1) shall apply to medical assistance for calendar quarters beginning more than 60 days after the date of establishment of the physician identifier system under section 1902(x) of the Social Security Act. (d) Foreign Medical Graduate Certification.— (1) Passage of fmgems examination in order to obtain identifier.— The Secretary of Health and Human Service 5353So in original. Probably should be “Services”.shall provide, in the identifier system established under section 1902(x) of the Social Security Act, that no foreign medical graduate (as defined in section 1886(h)(5)(D) of such Act) shall be issued an identifier under such system unless the individual— (A) has passed the FMGEMS examination (as defined in section 1886(h)(5)(E) of such Act); (B) has previously received certification from, or has previously passed the examination of, the Educational Commission for Foreign Medical Graduates; or (C) has held a license from 1 or more States continuously since 1958. (2) Effective date.—Paragraph (1) shall apply with respect to issuance of an identifier applicable to services furnished on or after January 1, 1992. (e) Minimum Qualifications for Billing for Physicians’ Services to Children and Pregnant Women.—Section 1903(i) (42 U.S.C. 1396b(i)), as amended by this title and subsection (a)(2) of this section, is further amended— (1) by striking the period at the end of paragraph (13) and inserting “; or”; and (2) by inserting after paragraph (13) the following new paragraph: (14) with respect to any amount expended for physicians’ services furnished by a physician on or after January 1, 1992, “(A) a child under 21 years of age, unless the physician— “(i) is certified in family practice or pediatrics by the medical specialty board recognized by the American Board of Medical Specialties for family practice or pediatrics, “(ii) is employed by, or affiliated with, a Federally-qualified health center (as defined in section 19O5(1)(2)(B)), “(iii) holds admitting privileges at a hospital participating in a State plan approved under this title, “(iv) is a member of the National Health Service Corps, “(v) documents a current, formal, consultation and referral arrangement with a pediatrician or family practitioner who has the certification described in clause (i) for purposes of specialized treatment and admission to a hospital, or 104 STAT. 1388–208 “(vi) has been certified by the Secretary as qualified to provide physicians’ services to a child under 21 years of age; or “(B) to a pregnant woman (or during the 60 day period beginning on the date of termination of the pregnancy) unless the physician— “(i) is certified in family practice or obstetrics by the medical specialty board recognized by the American Board of Medical Specialties for family practice or obstetrics, “(ii) is employed by, or affiliated with, a Federally-qualified health center (as defined in section 19O5(1)(2)(B)), “(iii) holds admitting privileges at a hospital participating in a State plan approved under this title, “(iv) is a member of the National Health Service Corps, “(v) documents a current, formal, consultation and referral arrangement with an obstetrician or family practitioner who has the certification described in clause (i) for purposes of specialized treatment and admission to a hospital, or “(vi) has been certified by the Secretary as qualified to provide physicians’ services to pregnant women.”. (f) Reporting of Misconduct or Substandard Care— (1) In general.— Section 1921(a) (42 U.S.C. 1396r-2(a)) is amended— (A) in paragraph (1), in the matter before subparagraph (A), by inserting “(or any peer review organization or private accreditation entity reviewing the services provided by health care practitioners)” after “health care practitioners”; and (B) in paragraph (1), by adding at the end the following new subparagraph: “(D) Any negative action or finding by such authority, organization, or entity regarding the practitioner or entity.”, (2) Effective date.—The amendments made by paragraph (1) 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.