PUBLIC LAW 99-509—OCT. 21, 1986
100 STAT. 2025
part for the procedure, the excess of the physician's actual charge over the approved charge, and the coinsurance amount applicable to the procedure. The written estimate may not be used as the basis for, or evidence in, a civil suit. "(2) A physician who fails to make a disclosure required under paragraph (1) with respect to a procedure shall refund on a timely basis to the individual (and shall be liable to the individual for) any amounts collected for the procedure in excess of the charges recognized and approved under this part. "(3) If a physician knowingly and willfully fails to comply with paragraph (2), the Secretary may apply sanctions against such physician in accordance with subsection 0X2). "(4) The Secretary shall provide for such monitoring of requests for payment for physicians' services to which paragraph (1) applies as is necessary to assure compliance with paragraph (2).". (2) EFFECTIVE DATE.—'The amendment made by paragraph (1) shall apply to surgical procedures performed on or after October 1, 1987. (e) MAINTENANCE AND USE OF PARTICIPATING PHYSICIAN DIREC-
Sanctions..-:
42 USC 1395u note, 42 USC I395cc.
TORIES BY H O S P I T A L S. — (1) REQUIREMENT OF PARTICIPATION.—Section
1866(a)(1) of the Social Security Act, as amended by section 9305(b)(1), is further Ante, p. 1989. amended— (A) by striking "and" at the end of subparagraph (L), (B) by striking the period at the end of subparagraph (M) and inserting ", and", and
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(C) by inserting after subparagraph (M) the following new subparagraph: 3 i.|- "(N) in the case of hospitals— "(i) to make available to its patients the directory or directories of participating physicians (published under section 1842(h)(4)) for the area served by the hospital, and "(ii) if hospital personnel (including staff of any emergency or outpatient department) refer a patient to a .J,,., nonparticipating physician for further medical care on an outpatient basis, the personnel must inform the patient r, that the physician is a nonparticipating physician and, whenever practicable, must identify at least one qualified participating physician who is listed in such a directory and J..; • from whom the patient may receive the necessary services.". (2) EFFECTIVE DATE.—The amendment made by paragraph (1) 42 USC 1395cc shall apply to agreements under section 1866(a) of the Social note. Security Act as of October 1, 1987.
SEC. 9333. LIMITS ON REASONABLE CHARGES. (a) PROCEDURES FOR ESTABLISHMENT OF SPECIAL LIMITS ON REASONABLE CHARGES FOR PART B SERVICES.—Section 1842(b)(8) of the Social
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Security Act (42 U.S.C. 1395u(b)(8)) is amended— (1) by redesignating subparagraphs (A) and (B) as clauses (i) T and (ii), respectively; (2) by inserting "(A)" after "(8)"; and (3) by adding at the end the following new subparagraphs: "(B)(i) The Secretary may provide for an increase or decrease in Health care the reasonable charge otherwise recognized under this section with professionals. respect to a specific physicians' service only in accordance with the
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