PUBLIC LAW 99-509—OCT. 21, 1986
100 STAT. 2043
demonstration program shall not exceed $5,900,000 over the duration of the program.".
PART 4—IMPROVED REVIEW OF QUALITY BY PEER REVIEW ORGANIZATIONS SEC. 9351. PRO REVIEW OF HOSPITAL DENIAL NOTICES.
(a) IN GENERAL.—Section 1154 of the Social Security Act (42 U.S.C. 1320c-3), as amended by section 9343(d)(2) of this subtitle, is amended by adding at the end the following new subsection: "(e)(1) I f "(A) a hospital has determined that a patient no longer requires inpatient hospital care, and "(B) the attending physician has agreed with the hospital's determination, the hospital may provide the patient (or the patient's representative) with a notice (meeting conditions prescribed by the Secretary under section 1879) of the determination. "(2)If— "(A) a hospital has determined that a patient no longer requires inpatient hospital care, but "(B) the attending physician has not agreed with the hospital's determination, the hospital may request the appropriate peer review organization to review under subsection (a) the validity of the hospital's determination. "(3)(A) If a patient (or a patient's representative)— "(i) has received a notice under paragraph (1), and "(ii) requests the appropriate peer review organization to review the determination, then, the organization shall conduct a review under subsection (a) of the validity of the hospital's determination and shall provide notice (by telephone and in writing) to the patient or representative and the hospital and attending physician involved of the results of the review. Such review shall be conducted regardless of whether or not the hospital will charge for continued hospital care or whether or not the patient will be liable for payment for such continued care. "(B) If a patient (or a patient's representative) requests a review under subparagraph (A) while the patient is still an inpatient in the hospital and not later than noon of the first working day after the date the patient receives the notice under paragraph (1), then— "(i) the hospital shall provide to the appropriate peer review organization the records required to review the determination by the close of business of such first working day, and "(ii) the peer review organization must provide the notice under subparagraph (A) by not later than one full working day after the date the organization has received the request and such records. "(4) If— "(A) a request is made under paragraph (3)(A) not later than < noon of the first working day after the date the patient (or patient's representative) receives the notice under paragraph (1), and "(B) the conditions described in section 1879(a)(2) with respect to the patient or representative are met.
Health care facilities.
Ante, p. 1991.
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