PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-117 "(6) The agency complies with the requirement of section 1866(f) (relating to maintaining written policies and procedures respecting advance directives).", (e) EFFECTIVE DATES. — (1) The amendments made by subsections (a) and (d) shall apply with respect to services furnished on or after the first day of the first month beginning more than 1 year after the date of the enactment of this Act. (2) The amendments made by subsection (b) shall apply to contracts under section 1876 of the Social Security Act and payments under section 1833(a)(1)(A) of such Act as of first day of the first month beginning more than 1 year after the date of the enactment of this Act. SEC. 4027. MISCELLANEOUS AND TECHNICAL PROVISIONS RELATING TO PARTS A AND B. (a) HOSPITAL AND PHYSICIAN OBLIGATIONS WITH RESPECT TO EMER- GENCY MEDICAL CONDITIONS.— (1) PEER REVIEW. — (A) Section 1867(d) (42 U.S.C 1395dd(d)), as amended by section 4008(b)(3), is amended by adding at the end the following new paragraph: " (3) CONSULTATION WITH PEER REVIEW ORGANIZATIONS. —In considering allegations of violations of the requirements of this section in imposing sanctions under paragraph (1), the Secretary shall request the appropriate utilization and quality control peer review organization (with a contract under part B of title XI) to assess whether the individual involved had an emergency medical condition which had not been stabilized, and provide a report on its findings. Except in the case in which a delay would jeopardize the health or safety of individuals, the Secretary shall request such a review before effecting a sanction under paragraph (1) and shall provide a period of at least 60 days for such review. ^^ (B) Section 1154(a) (42 U.S.C. 1320c-4(a)) is amended by adding at the end the following new paragraph: "(16) The organization shall provide for a review and report to the Secretary when requested by the Secretary under section 1867(d)(3). The organization shall provide reasonable notice of the review to the physician and hospital involved. Within the time period permitted by the Secretary, the organization shall provide a reasonable opportunity for discussion with the physician and hospital involved, and an opportunity for the physician and hospital to submit additional information, before issuing its report to the Secretary under such section.". (C) The amendment made by subparagraph (A) 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. The amendment made by subparagraph (B) shall apply to contracts under part B of title XI of the Social Security Act as of the first day of the first month beginning more than 60 days after the date of the enactment of this Act. (2) CIVIL MONETARY PENALTIES. —Section 1867(d)(2)(B) (42 U.S.C. 1395dd(d)(2)(B)) is amended by striking "knowingly" and inserting "negligently". (3) EXCLUSION.— Section 1867(d)(2)(B) (42 U.S.C. 1395dd(d)(2)(B)) is amended by striking "knowing and willful or negligent" and inserting "is gross and flagrant or is repeated". 42 USC 1395i-3 note. 42 USC 1395/ n ote. 42 USC 1320C-3 note. 42 USC 1320C-3 note.
- ' So in original. Probably should be "review.".".
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