ML20011E285

Suggests Meeting to Discuss Current Issues Re Public Health Svc (Phs).Phs Wishes to Establish Direct Liaison W/Nrc on Operation of Natl Data Bank for Adverse Info on Certain Health Practitioners

ML20011E285
Person / Time
Issue date:	04/05/1988
From:	Lieberman J NRC OFFICE OF ENFORCEMENT (OE)
To:	Cunningham R NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS)
Shared Package
ML20011E283	List: ML20011E282 ML20011E285 ML20011E287
References
FOIA-89-546 NUDOCS 9002130110
Download: ML20011E285 (34)

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umTEo STATES p\\

NUCLEAR REGULATORY COMMIS$10N a'

h WASHING TON, o. C. 20u6

1. g g g g MEMORANDUM FOR:

Richard Cunningham, Director -

Division of Fuel Cycle Medical, Academic, and Commercial Use Safety, NMS$

FROM:

James Lieberman, Director.

Office of Enforcement

SUBJECT:

MEETING TO DISCUSS CURRENT ISSUES CONCERNING THE PUBLIC FEALTH SERVICE This office is developing a response to the Comission's inquiry concerning possible methods of monitoring wrongdoers in the nuclear industry. As part of

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that effort, we are examining the Health Care Quality Improvement Act of j

1986 (PL 99-660).

It requires creation of a national data bank for adverse information cn certain health practitioners who have been disciplined or had l

other negative actions taken as a result of their performance.

The Medicare and Medicaid Patient and Program Protection Act of 1987 (PL 100-93) expands i

the Itst of those health practitioners who will be included in the data bank, i

Attached for your information are copies of the pertinent acts, proposed regulations for the earlier act, the technical amendments added in 1987, and i

an information flow diagram for the data bank.

In seeking information as to the establishnent and operation of the data bank, OE has talked to Margo Wilson, Ph.D., the PHS staff person handling this program. We also provided her with information on two significant enforcement i

matters that appear relevant to the purposes of the data bank.

They are Milford Hospital (Dr. Delgado) and VA Hines (Dr. Freeman).

G. Cant and R.

Rosano of OE met with Dr. Wilson on March 28, 1988. The question arose as to i

the possible role of the NRC as an agency that would provide information to be l

included in the data bank and also our possible access to the data bank for t

evaluating license amendments regarding practitioners.

The language of the

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statutes is not clear whether the NRC qualifies for either function, and if the NRC desires a role, technical amendments to the statute may be i

appropriate. The PHS has just promulgated proposed regulations that would implement the 1986 act, and will be developing regulations for the 1987 act.

An imediate issue is whether the PHS should attempt to write a regulation that would include the NRC or seek a technical amendment to the statute.

Dr. Wilson indicates that the PHS wishes to establish direct liaison with the NRC on these matters.

Specifically, PHS needs to know what role the NRC desires, and whether that role should be established by regulation or amendment to the statute, and whether an agreement or MOV between the agencies is appropriate.

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t 2-Richard Cunningham i

Dr. Wilson has suggested that a meeting be arranged with Dr. Clinton, Assistant Surgeon General and Director, Bureau of Health Professions, and appropriate NRC personnel.

l I will arrange a meeting with you and appropriate members of your division next week to discuss these issues.

h 4

ames Lieberman, Director

Enclosures:

As stated Office of Enforcement i

cc: JTaylor DEDRO LChandler, OGC DNussbaumer, GPA/SLITP.

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cadre every tuo peers.

Report to State itcensing i

board and book.

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DATA AANK screestag appISCent l

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Report physician disci-Medical discipline 16 ZZ7 " - I'IZI ;

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data on phy js! e and 12 Individuals regarding t he I r. m receede STATE per

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NEAT 1DI FARE FJfrITIES W/ PEER REVIEW 3

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practt oners.

Most report adverse actlen en physteten f

I membership to State Icedical Beerd; and may de se en other health pragtt-t tonere membership In their

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• te1 Pas - he mey estabinsh er taptose penserable fees let the eastle-sure of thferesten uneet this ePetteh et erecen 436 The nn.ount of such a fee may het aseeed the earts el preseasihe the M-Guests fet dasOerure trad of prenstne such Werunstiets Such fees than he argustile to J

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Part Vil Department of Health and Human Services

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42 CFR Part 1003 Civil $;loney Penalties for Failure To Report Medical Malpractice Payments an u

for Dreaching the Confide-l'ality of Information; Proposed Rule 45 CTR Part 60 National Data Bank for Adverse information on Physicians and Health Care Practitioners; Proposed Rule S

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3300 Federal Register / Vol. p. No. H / Monday. Mardi 21, 1988 / Proposed Rules I

Dtp AlmagNT OF HEALTH AleD rwelt of medical snelpractice nations rely solely upon litigation under the HUMAM SERVICES and claims, sad (2) certala severse False Cielme Act ce einmal actions taken regarding the licenses and proceedings. Under thle CMP tuthonty, j Offlee of Wie Seeregory clinical pnvileges et s,hysiciana and the Department's Ofnce of lnepector dentista.ne stated purpose of these General has been authertsed under 48 CFR Part 1000 provaions le both to tmprove the quality comme ut&A elthe Social Secunty Act j of med6 cal care by identifytag these and through tmplementing regulations at j Civilll**'Y enalgos for Fouure To pheytefans and dentists who are et Cf1l Part 2003. to admmistrouvely P

A " " '8'II'" " Y * *"'8 engaged in unprofessional behevler.and Ismpose CMPs and aueuments for a one for BreesNng wie CenMentamy to reetnct the abibty of those -

number of false orimproper billms or

'II"""*#88 incompetent pheynciens and dentate le ~ geahty of care v6olations in the Assessvt Office af the Secretary. Offlee move froin State to State without Medicare. Medicaid or Maternal and i

of Inspector Generel(OIC). HH5.

disclosure or discovery of their Csild Health Services Block Grant i

Acteose Proposed rule, damagma or incompetent perforsaanos, programs. These exating CMP The Act requires the Secretary to authorttles have specifically served to Suesasany:This proposed rule would establish, either directly or thtmagh as serongthee the Department's ability to establish cf vil money penettles (CMPol. eppropnate public or pnvete agency protect the health care programe and ite l against any individual or entity that faus deelsneted by the Secntary, a Methonal benenciertes assinet those persons or to report information on medical Data Bank to serve as a national seems organisations that would defraud, abun i malpractica payments in accordance of informattori on physicians deeitiete ce otherwise circuseverit those progroms '

with section art (c) of Pub. L so-een, and. under cetein cecumstances, echar. bp creating an administrative scuon to l Title IV, the Health Cate Quality health care proctitionere concoming'(1) pupplement court litigabon.

improvement Act of 1988, and against Paymente made se a result of medical Congren bu lacnningly used the J

any individual or entity who breeches malpractice actions or claima:(g)

CMP suthorities to insure compliance the conndentiality of information adverse licensure actions taken by with its intended statutory provisions, nported to the National Data Bank Boards of Medical Examinere ese De original CMP suthontin were established to collect and diueminate equivalent State licaneing boards fo' opecincelly designed to address required information in accordance with other health care practitionere: and (3) penalties for falas claims and i

etction 427(b)of that Act, adverse actions on clinical prtydeges unnecessary services, ne authorit for taken by health care enuties, such as levytag CMP was further expande[

DAts:To suure conalderadon.

commente must be mailed and delivered supmaine fw 30 days or longs recent years to addnee leeues involvtry

@epomng oHMonnanon u each of the the quality of care furnished to prograrr.

to the address provided below by May three categorias lor physicians and beneficiaries and othere.With the

20. m enactment of the Health Care Quality Acomese: Addrese commente in wnting p

Improvement Act the Co en has i

to: Office of larpector General.

required for medical malpract44 broadned om a Woung 9

Department of Health and Hurnan

[syments.is voluntary on the part of neontin to specincaUy mface Services. Attention: LRR-15-P, Room ealth can utittee for advetoe actiosa reporting and confidentiality of date 5:46,330 Independents Avenue. SW.

on cimical pnvileges, and is not reporting elements of the National Date i

Washingtort DC 20201.

if you prefer.you may delitse your abalicable to licensure actions.) he 88"I' e reporti requimmente to t Under the curnnt CMP authontles.

comments to Room 6643. 330 Nationel Date nk would apply, as while thne le i maximum peelty Independence Avenue.SWa appropriate, to hospitale. health care armount estatished for each type of Wa shington. DC. In commeating. ple s ee entities, boards of medical examinero, CMP violation the statute requires the tefer to file code LRR-15-P. AgenciH profenional secteues of physicians, and organisations are requested to dentists or other licensed health care Department to take into account a submit commente in duplicate, practitioners, along with individuals and number of factors in determinmg the r

Comments will be available for pubiac enutin (including msurance companies) amount of any penalty or assessments inspection begmning approximately Iwo making payments with nspect to imposed. The OIC regulations et 4: Cri weeks after publication in Room 6643.

mdical malpractice actions or claims.

1003106 presently include specific 330lndependence Avenue.SW.

1.ie Act provides that information guid.hnee that set forth venous factors,>

Weshington. DC on Monday through riported to the Neuonal Deto Bank is and circumstances that may be Friday of each week from e.00 a.m. to confidential and is to be disclosed only considered mitigating-resulting in a 5.00 p.m (202) 472-5270 for purposes specified in the Act.This reduced penalty or enessment amount FOR PVRTMSR INP0stesAT10ss C0erfect',

information may be used solely witn and tho6e that would be considered i.

Jamts Patton. Office of Investigations.

respect to activitin in furtherence of the aggravetmg-resulting in a higher (301) 594-3957, quehty of health care.The specific puolty or assessment up to the procedures and requirements for.

soecified amount stated in the statute.

sueemsastTAAT NeFDnesADees:

reporting and disseminetion of this in addition, the existing OIC

l. Backgrcund informstion by the National Data Bank regulations et 42 CFR Part *.003 Health Core Quality leprovement Act is published elsewhere in this issue of addressing the Department's CMP m Federal Register, authorities provide to those persons an i

l The Health Care Quality improvement organisations against whom penalties c ;

h.snes O/C Cin/ Afoney Penchy assessmente hase been imposed an Act. Title IV of Pub. L 99-660 80^CU0^8 established specific requirements for the opportunity for a hearms on the record reportmg and release of information Until the enactment of the in accordance with the Administratne concernmg (1) the payments made for Department's civil money penalty (CMP) Procedure Act, for appeal to the the benefit of physicians. dentists and authonties undet section 2105 of Pub. L Secretary and for the judicial renew ot {

other health care practitioners as a 9t-35. the Federal government had to the Secretary's final determmation.

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Federal Regleter / Vol.13. No. 84 / Monday, Match 21 tees / Proposed Rules tas1l IL Proeleiens of the Proposed Rule appointment to the medical staff. Such occurrences: and (S) in generet, other 5

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CMP er Wologione uncler Tide Nof information le intended to be used solely '

he no tion, effectuation ud matiere utrod by lust 6ca.

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with rupect to activities for the In en effort te(1)oneourage the betterment of health care provided by appeal procedures under esisting CMP 1

the individuets or entities aquesting this regulations will be und for all efficient and timely collection and information, and is considered violatione renlung from these I

reporting of medical malproctice confidential. Encept for profemelemal previolone, paymente by any person or entity.

review activities and medical including insurance companies, and (2) malpractice actione, thle informaties

&n.eMonMegWoM Opgw promote effective professional peer will not be disclosed to any party other in additloa to thew changes outlined i i

Mview by providing for the protection then to the physician or procutionee above. we are making a number of and confidentiality of the infonostion involved. State licensing boerde and minor conforming and non.eubelantive furnished under these prevlolona.

other parties opeofically autheatsed 99 400 set furth two new authoriues se a under other provisions of law to release revlolone to these regulations by sectione 421(c) and 427(b)(2) of Pub.1.

basis for taking CMP oction.

euch informstion may continue to do so.

inserting "ClG"for 1iecretary"in section 2003.10s. and by deleting the (See accompanying PHS reguletions for eslating peregraph(b)in sect 6en A. CMP for Teilure To Report Medical specific informstion regarding disclosure 2003,114 which is now obsolete.

Malpractice Payments

'I To rot the e nfiden y of III. Regutekry impact Statement he medical malpractice syetem has.

been the primary opproach that Information reported under this A. Esecut/ve Order 12N!

I aggrieved patiente have taken to deel provision. the OIC has been delegated with inadequate medical care, and the the specific responsibility under section Executive Order 122e; rr, quires the effective reporting of such melpractice 4271b)(2) of the Act to levy for each Department to prepare end publish an peyment deto can provide important violation a CMP of up to 310.030 agelnet laitl*I lolofY im

• • N"I' Pact analysis for any friormation for evaluating the any person who inappropriafely P

• **II" 8"I credentiale of health care providere. As discloses such information, regulation that is likely to: ('1) Ha s e en t

indicated above, and addrused further ne CMP sction may lie egelnet State annual eNect on ee economy of 32 in the accompanying Public Health licensing board emplo> ees, employees milhu w mordt) cause a major Service (PHS) regula tiene published in of other health care entities, including inenase in coes w p6cn for

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this issue of the rederal Regleter, any health maintenance organizatlone, and consumm individualindustrin.

person or entity. Including en insurance employees of the Secretary or a private governrunt agencies or 3 phic company, that makes payment on a or public agency, or direcuy against Mgina: w (3) ruult in signi cent medical malproctice action or claim will those entities or organiutione that adverse efrects on competition.

be required to report such information.

violate the confidentiality requiremente employment. lavestment. productivity, and the circumstances of such of section 427(b)(1). In any case in which lanovation or on the ability of United settlement, to the National Date Bank it le determined that rno, than one States. based enterpnses to compete established by the Secretary Also.this party was responsible for improperly with fmign4esed enterption in irtformation must be reported to the disclosing confidentialinformat>on m domestic or export markets.

appropnete Ikaneing board (s)in the accordance with these provisione, a We have determined that thle state in which the medical malpeecuc*

nalty. up to the maximum limit. may proposed rule does not meet the critene action or claim arose. To assure the Imposed against each responsible for a mejor rule es defined by section timely collection and reportmg of individual, entity or organiution.

1(b)of the Eaccutive Order. As Utiliution and Qualit medical malpractice payments. the OIC Ornanlutions (PROS)y Peer Review indicated. these proposed regulatione under Part 5 of would establish new authonty for the has been delegated the specific Title XI of the Social Secunty Act ar, 010 to impose CMPs against those who responsibility under section 421tcl of the Act to levy a CMP of up to $10000 governed by separate confidentiality fall to report required information and -

and penalty provisione contained in 42 ogelnet those who breach the against any individual or entity thei f ile CFR Part 476 confidentiality of the information to report each such payment on a timely and complate boele, es specified in C. Determining de Amount of Penalty gathered by the National Data Bank. As such, we haw concluded that this proposed 42 CFR 80.4. 80.8 and so e of la determining the penalty amount for regulation would have no direct effect the PHS regulations, each occurrence, we are proposing in on the economy or on Federal or State B. CMP for Breeching Confidentielm of these regulatione lhe critena for expenditures, and that an initial Information considerabom 0) The uture ud regulowy impact nelysis is not circumstances resulting in the failure to required.

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'n accordance with the statute sad the report medical malpractice paymente or proposed PHS regulations, all the discloture ofinformation;(2) the

8. RegulotoryT/taibility Ano/rsis information reported and colletsed t s degree of culpebility of the person or Consistent with the Regulatory the national date bank under thew enuty in falling to provide timely and Flexibility Act of 1980. Pub. L 56-354. $

provisions with respect to e pho i.s complete payment date or in breeching U.S.C. 804ta), we prepare and publish an dentist or other licensed practen,~* :=

the confidentiality of collected initial regulatory flexibility onelysis for to be furnished, upon request. to St.ie informat6on:(31 the matenelity or proposed regulations unless the licensing boards hospitale. and other outnificence of omission of the Secretary cert fies tnat the rule would health care entities (1) that ha s e mkmation to be reported with regard not have e significant economic impact entered. or may 1,4 entering. into a n to merlica.-elprocute payment on a substantiel number of small employment or effiliation relabons%o luogments or sei:'*ments. or the business entiaes. The snelysis is with the physician or practitioner vt ul matenality of the improper disclosure of intended to explain what effect the to which the physician or practinoner mformation:(4) any pnor history of the regulatory action would have on small hee applied for clinical pnvileges or person or entity with respect to these entitles. and to des elop lower cost or

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gang Fedeeml Regletor / Vol 13. No. M / Wonder. Mad 21. 1968 / Proposect Rules burden esterneuves. As indecoted ehese. 8 H eelesLLS,C sa es Flcl.1sete.ya.

thue proposed espelottens would bere 1assistil and tasse(kl.111si{c). and hables'eeckouch person may b se1 ion.

ticpenalty presenbed by this no sipnfisant esensenic hopect. While 11137tb)(3).

part. ted an ateenement mey be -

some CMpaimposed by the 00C se e

16) krleessL This part (1lestablishou unpaaed spe'. net sr:y one such person or result of these segulatises sould bare an pmenderes (or hepoemp-jointly tee severally against tw o or impact on eene small businese esirlies.

(i) Civil senery penalhes and Intre such pusois, bui the aggregate we do not anticipate that a substaaelal asanamente ageiset pome"no who bene amount of Oe assesGeote collected number of small enuties would be submitted certase prohibited claiens effected by this rulemeking Nrefore.

under the Mediente. Med6caid, er the may not ascene k smount that could we bees senciuded thet en initial Meternaland Child Heeith Seresse be ausendif or%*m mu reqmrub enabihty onelysis is met Block Great programe and

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(ii) Civil sooner pensities egninst (2) gy g g gg C hperward Aeduction Act those who fail to report medical determined that more than one pereen malproctica paymenta er who breasdi the

• H M*P'*ble for presenting or Under the paperwork itedwetion Amt confidenhel1 sty of infersmanon reported cavoins le be presented a request for of 19e0. Puk L e6 411. all Departments under Title IV of Pub, L eS.een as payment desenbod in parapoph(b)of are required le submit to the OfBee of specified in 42 Cnt pen es of this titles this secuen. asch such person rna) be Management and Budget for review and (2) Fatablinhos procedurn Ine held liable for the penalty prennbed b>

opproval any reportmg or recordkeept. 3 suspendmg trove the Medicare and this part.

requirementa contained in both Medicaid programa, certain persone S.Section 10t2.103 would be tedeed proposed and final rules. WMle the against whom a dril money pensity se to read as follows:

's proposed regulations prepared by PHS asemearment hee teen imposed; and al t.ontein speciDc Informadon collection ePecifies the appeal nghts of pemon(s g tesiLies Amewit et pens 4 requirements, we ha ve determined that subie'ct se a penalty or assenament.-

(e)% OlG may Lmpose e perialty of these proposed penelly provisions do

3. Section 10011(r1 would be W not more than 32.000 for each item or not contcla p:h information collecUon by adding e deGaition for the tone service that is subject to a determinatior requirements and would not increue "tredical malprecalon actneo or slain" l*

under paragnphe (4) and (b) of the Federalpaperwork burden on the read as follows:

4 1003.108.

Public and pnvete naciore.

l t00s.101 Defwisene, (b)The 040 mayimpose a penelt) of i.

IV. Othee Esquired inforunaties For purposee of this pert:

not more than $14000 against any person or antity, including an insurance.

j A. Response to Comments Because of the sunber of commente

, Medical malpmetsce snodia compsey,for each occurrenos subject to '

means a wntten comnleint or claim a determination under paragraph (cl of we receive os proposed regulations we physician's.peyment inand on e demanding i 1003.102.

caonot scinowledge or respond to these dentiet's or other health

6. Section 100tL106 would he amended l

comments indmdually.How es er. in prepenne the final rule we wdl consid*'

care procritioner's pnrvision of ce.

by recising paragraph (e) to read as all comments recef ad as response to failure to prende, health care services, followe:

these penalty proviesona and nyond to including a lesal actum brought in any l

them m the presels to that document.

State or federal opuet or other i miles tusseneien erwn penscwen adjudscauve body.

IJet of Subjectela et Cf1t Port tons (al A person subject to e penalty or Administrative practice and

4. Section 1000 tot would be amended (ususment daned ende i m by rednignartng and npublishing a) end M mey,in addition, be l

rocedure. Freud. Crant programs-eslth. Health facilities' Healib "18tml ParefrSph (c) to read se suspented from participatire in rofessions Maternal snd child he.lth, parapsph (dt. end try sdding a new Mediu.re for a period of time kledicaid. Medicare Penalties. paragraph (c) to read 6s follows:

dete, mined onder i 1003.107. The OIC i

tray require the appropr. ate State 4 CFR Oapter V. Part 2000 is g goon,,og 3 a.,*' 58*8 ***f Pm'tM4 rp ed to be amended as set forth erW emeaanwnta agency to si. spend the person from it'e Medicare prograrn for a period he shall specify. The State agtncy may rewest h

pART 1003-CfYtt. MONEY PENAL. TIES (c)

OIC may impose a peml?P the OIC to waive suspeassori of a pe un '

AND ASSESSMEffig 888ir8180Y F"'on of *nhtY *Cludif88 frum the Medicaid p*osren under this en insursace connpeny, that fails to section if it uncludea that. because ci

1. The authority citation for Part 1003 repcit imormattom on a peyrnent of a would be revised to read as follon medical malpesetice claim in the shonsge of previders or other health 1

Authonty Seca.1102.1128 tt:aA.164:lil accordance Mtt, section 421 d pab. L care peronnelin the eres. individeels l

eligible te recahe Medicaid benefits and 1642tklof the Soctel Secenty Act and 99-660(41 U SC 1113ll end regulations would be decied access to mdical c4te I

seca 47tici and 42?tbif 21 el Pub. L 9&seo le2 in l 648 of this (4 tit and egelnst any or that sud ir.dividaals would sulfer U S C. t302.13aos.t.13aos ra.139sutil end person or entity that improperly 13N(h L 11lat(c) and 11:371b)(2il.

discloses informetion in violation of harAship' m O!C wel not;fy the Siein

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2. Section 10(n.100 would be remed section 427 of Puh L en eno (4: U S C.

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As to read as follows:

11131) and regrulations in i 60.11 of this l 100 1100 Baele and purpose.

(dl(11In any case in which it ts (al Basis. This part implements determined that more than one person

7. Section lotn.106 wou%e amendeu sectiuns 11'm(c) 11:4A.1642(il and was responsible for presenting or by revieirig persgraphs (al. (b)

IlW:(L)of the SocialSecunty Act and caustng 1o be prnented a clairn es introductory te ut. (bl(t). (2) and (4 ersd sections 421lc) and 427(b)(21 of Pub.L described in peregraph(alof this (c) to read as follows:

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i i

i Federal Regletar / Vol 13. No. sg / Monday. Meteli et. !sse / Proposed Rul i

t!

$ 100000s toeweenemone so m

emenest of she penney ans ma==genene ese amourd claimed for such tome se -

to onepend a respondent from

=ame.

. serv 6ces was substantial la)(1)la detemining the amount af (2)Dogme e/aubo&#fsty. It abould be partespanen in b4edicare er b4edicaid any penalty or usosament. G4 cancedered a midgehas circanetence d in assertienes with thle part. he er sh !

accordases with 6 300s.103 (a) and (bl.the claim for the item er servtes was the must dellwer er send by certified me:D the OlC wdl take into secount twult of an unintentional and retum teceipt requated. to the i

for p)ayswet end the ctronmetances(i ne nature of the claim er request unrecognised erm in the procesa toopondent. wntien nouco of his or hr intent to impose e penalty, assenmer '

e under which it was presented.

t**Pondent followed in pmentme and euapension, as appucable. no c!stma, and cornettve steps wm takea (16)b degree olculpability of the Promptly after the error was discovered.- nouce wulinclude:

person subeusting the claim or requeeg 11 should be consideted an agpavatin8 Olltafmace to the statutory bum 1 for payrnent, circumstance if the respondent knew the the penalty, saaessment and the pe)rson pubantbng the clals op.(iii ne biotory of pnot offenses of

. Item or service was not provided se evepensies; claimed, or if the respondent knew that (2) With twpect to determinaHone '

request for payment.

eo payment could be made because he under 13003.102 (a) and (b) e (iv) ne financial condiHm of the had been excluded from progtsm description of the claims and requnts ;

person pruenting the clatin or request reinbumement se specifWd in for payment with respect to which the ;

for payment. and i 1003.102(a)(2) or because payment penalty, sueument, and suspension e i (v) Such other marten as justka einy would violate the terms of se

[gg (,merpt in com whom the

require, nopecter Cenmlh mlyms upon

{

assignment egreement or en agreement (2)la determlntr>g the arnount of any with a State agency under I 1003.103(b).

statistical sampling purevent to nalty la accordance with (3) Pnor offenses. It should be I 1003.133,in which case $e rouce eh !.

- 1003.1tt2(c), the OlC onll take into cone en aggmvenne circumtance describe those claims and requeste for :

if at any time pnot to the presentation of payment comprising the sample open >

g g,,, g,.

(t)na neture and circumstances -

any claim which included an item or which the Inspector Generalle relymg i resulting in h failure to report medical urvice subject to a determination und" and shall also betoffy desenbe the malpractice yments or the improper l 1N (el and M 6e mopondent staust6 cal sampling technique utilised,

disclosure o information, was hew haw fM cnminal, cM.e by the bispector Generalh (11)% degree of culpabihty of the adminletredn unchone in connwdon (3) With respect to determinatione a pmemm conmd by die part er under j 1003102(c), a description of th >

faith.e is provide timely and completeerson or enbty, indudmg the it.autw in m any oe" pvWe M pnnte pmgma of opleode and the citarnstances under confidentlahty of reported aformation.

"fI *****

which the penalty is being imposed.

payment date or in breaching the

""***"I (4)ne tesson why such claims and I

(iii) ne matenehty, or signtficance of (c) As guidalbes Aw delnmining the toquests for payment or with respect t i

I 9niission, of the inftrmabon to be amount of the penally and aumasmaat Title IV of Pub. L DAeon each failure t reporttd with regard to reedkal to W imposed fM every Hem, earnce or report Mquimd infonnation w bmuh ( '

malpractics payment judgments or incioent subject to a delenninabon confidentiality, subject the mopondent !

settlements, or the snatenehty of the under l 1001102 (a) and (b).

to a penalty, assenment, and tmpropes disclosure of informabon.

(1)H em m sustandalor semel Wapnaion (whm appuc b4h b liv) Any pnot history of an indsvidual mWgaung circurnatances, me assmgate, amoJt of the proposed penalty.

or entity with respect to these wolations, and

('**j'

',("*f[u eQn'tI auspensi n(where applicablek assenment. and the pened of proposec ;

8 n

Y (v) Such othat mattere se luauce rney

'h*fy'y h" g

(5) Any circumstances desenbed in t.

i 1003.10s which wem considered wh require.

determinfr4 the amount of th l

(b) Cuidelh.es for determmwg the th f ct omountof 6epenaltyorcucument. As i ual w e l penalty and assessment and the pened 4 guidelices for takir.3 into account the of suspension (where appbcable);

'88'"*N"8

(('e'y'I"*"* "**

inesoMstedin paragraph (a)(1)of this (8)Ittstructiene for tes onding to the :

o)d notice, including a spect c statement of l nection. ee founweg eticumatances are e

aa ount i

to be conudend; sufficienti close to or at the mammum respondent a right to a heanna. of the L

(1)Noture andcuwmsw.ces of the h""$d {gj, Ifg),*gl and fact that failure to request a heanes

,, i I 3

(

chirn. It abould be consviered a withm 30 da va permits the imposition of l.

nuti$ sting riteumstance tf all the Jtems (3) Unless thare are extra' ordinary the pr posed penalty assenment.ud cr services oubrect to a detenntne0cn mitigating circumstances, the aggregate s

of respondent thoul right to appeal

"'P"'*"*

3 l

under l 10G3.102 (e) and (b) included in amount of the penalty and anessment h

e r 8 t to request an

'he action brought under this part uem should never be less than double the utension of time m which to respond to of the seme type and occurm! withm a opproximate amount of darnages the aotice and a copy of the rules short period of time, there were few sustained by the United States, or any contamed in eis part, l:

svch 6tetne or servicais, and the toisi Stata, as a result of claims subject to a i

amount claimed for sus.hittme or determination undet i 2003102 (a) and

9. Section 1103114 would be amended I

ser% cts was has thu 31.000,it shoed (b).

by revising paragraphs (a). (bl. and (c) tt

8. Subsection 1003.109 would be read se follows:

rc acetf iem 64rnche 8

were of aeretal type occured over a ead ae o lowe I

8'1 N 8**"****8 W "** ' * * ' '

lengthy penod cd tiene. them were many I too3. tot 86etae of pro 9e**d (a)To the extent that a proposed l

such items or serwces (or the nature and ** t *mda***a*

penalty and assessment is based on l

circumstances mdicate a pattern of claims or requeste for pa) ment daims for such items or nrnees), or the (a) Li the inspectoe General proposes presented on or after August 13.1961.

to impen a penalty and naeument. or -

the Inspector General most prove by a

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)

J I

gate Federal Regleter / Vol. 53. No. 64 / Monday. March 21. toes / Proposed Rulee proponderance of the evidonos that the 44 CPR Part GS lmseuni4 front liability for damaree enpondent peseented er caused to be

, with respoot to actione taken in the pruenied such claises or requeste fee National Oste Bank for Adverse course of such review.The purposee of payment es desertbed in i100L108 (a). Information.en Pteyeleiene and Heesten

- the Act are tot e.,e Proo. on au a nnm

• J* u h, rove es.uah

,en,a\\T,*i b_aaa"', Ma7:",e,'Tme-

= * * " " ' * * * " * " * *

=sm Non.e a m r* main oe 7; w.*e,,hyews,,ea u d

,y

.,i,,,,,

ef~i-i 6am cene,ei musi -o by a,,,,oumnce

.u.em

o. n ie wou e a Pro,osed of the evidence that the person or entity Rulemaking (NPRM) proposes rules that ph(ys)icians and denusta felled to report medical melpractice would govem the reporting and release eymente on a timely and complete of Laformation concoming (1) paymente asia. w a party breached the made for the benefit of physiciana.

State to State without disclosure or confidentiality of information reported, dentiste and other health care discovery of their previous damaging e as set forth in i 1003.102(c) and in 42 precutionere se a twelt of medical inemPetent pwfonnance.

CFR Part 80 of this title.

malproctice actions and claims, and (2)

De Department wee not able to i

(c) Where a final determination that c{n,ain e ej e maarding Q,P n

g g

e tu ovember 14.

the rnpondent (1) presented or causa d to be prwented a claim or request for -

(ble W d e m '8 1987, for the utablishment of the fonneuon would be conected la and National Data Bank due to lock of payment falling within the scope of i 1003.102 (a) and (b). or (2) failed rolessed from a National Data Bank. In available funda.no Secretary will within the scope of i 1003.102(c) to acceedance with the requirements of announce the date of operetion for the '

Part 8 of the Health Care Quality NeuonalData Bank in en announceme-report medical malproctice pa-mente o' tmorovement Act of 1908. Title IV of in ee Federal Register, breeched the confidenuality of puk g, m ladividuals and ent6 ties will not be information. has been andered la any

• I" "

DAfe:As discussed below. oceunente "9"I"*'"I' N ** **'Y "P'*"8 proceedirg in which the raepondent was

'""I **

a party r.nd had an opportunity to be are invited. To be censidered commente uonal Data Bank hu W hearv. the twpondent shall be bound by must be voceived b MeY 30.19e8, 8

Y utablished and the Secretary has ev:.n determir.ation in any proceeding Apoestsaa Written comments should announced its operetion. Furthr. date '

g,, g P'g, be addrened to Dr. l. jarmtt Clinton-will only be collected from the dele Director. Bursou of Hulth Profusionale determined and announced by the (BHPr). Health Resources and 5ervices Secutary. not irom November 14.1987.

10. Section 1003.125 would be A rninis tauon. Room W PaMawn Dese proposed regulations would mend y mvising paragraph (c) to qu m nte for

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a d

! co re e

Na will be avallabls for public inspec*los the procedures for obtaining informatio ;

and copying at the Office of Program from the National Data Bank. nese i 1come trwai seesnien: eentrdoteve Support. BHPr. Room 7-74. Parifawn vimments would apply to hospitale:

[alth care entitles: boards of m

" " An*8'F-Building. Seco Fishere 1,e ne. Rockville-Maryland, weekdays (Tederal holidays and dental examinere: professional

• • cep ed) betwun the hourt of 8J0 a.m.

societies of physicians, dentiats, or oth, :

(c)The findings of fact shellinclude e nd 540 p.m.

find '

h of th I !!

Licensed health care proctitioners: and PO# PWRT*8a8 #F0*asafs0# C08 TRACT:

individuals and entities (includmg for e e'Y item. service w oc u nc Margaret Wilson, Ph.D Bureau of insurance cornpanies) making payment >

with respect to which a penalty or Health Profeselona, et the abose with respect to medical malproctice assessment was proposed.

eddrna: telephone 30144b34286 actions or claime, The Secretary repare :

(11 Whether the item. aervice or

,9,,urtsast?Any asse0esaAfs0ec Part 8 of the immunity provisions (Part Al of the occurrence le subject to a determination Title IV of the Health Care Quality Act as self.implementlas. Thus. these undet i 1003.102:

Improvement Act of1986 ("the Act"),

proposed regulatione do not eddress (211! the item. service or occurrence is Pub. L 99-400. enacted on November 14.

that portion of the Act.-

subject to e deterwination under 1986. and amended by Pub. L 100-177 De Act permits the '.ecretary to i 1003102 whether there are mitigatmg requirss the Secretary of Health and establish and operate the National Date !

or aggravating circumstances as Human Services to establish. either

. Bank either directly or by contract with '

desenbod in i 1003.100, directly or throulth an appropriate public en appropriate pnvate or public agene) or pns ate agency designate a by the See section 424(b)of the Act.De Secretary, a National Data Bank to Secretary has chosen the latter method Dated tuty 15. test collect and relesse information

• and. as indicated in i 60.4 of the m.P. Kmerow, concerning payments made on behalf of proposed regulations, will announce the :

Inspecie Generol. Decortment o/ Health and physicians. dentists. and other licensed name, eddress telephone number and Humor Semcas.

health care practitioners se a result of other detalle concernmg the Nationel medical malpractice actions and claims.

Data Bank through notice in the Federe Mproved October et toer.

and information concerning certain Register as well as through press

.otis t.se.sa.

ads erse actions regsrding the licenses releases and notices to the venous and clinical pnvileges of physicians and professienal associaHons of hospitals.

Secretory.'

dentists. In addition. Part A of the Act health care providers and insurers. an(

int Doc. e649a4 Filed 3-16-ea. e 45 aml provideo: lot hospitals and members of to boards of medical etaminers. among es macome coe

• e bodies that conduct peee review.

others.

f

Federal Regleter I Vd. 63. No. M./ Monday.. Mmh it.1988 / Proposed Jtules Str it should be seted abat septiort 427!cl.. provteien. dis penelty will be knposed care proctiuonere. Since thle esclusion of the Aes,as emended,supl)cilly through procedures peblished elsewhere ne only releosat to es immunity..

psovidee immunity in any sivil siction for in this issue of that Federal Register provisions of the Act and does no eny person er entity coneers reports proposing to amend 42 CFR Port 100s.

concern the repenas or diectosuto mode to the Net 6enel Data Ita ne organiserion which operetes the provisions, the proposed regatatione d !

immualty ales appl 6ee is he agen.Two National Data Bank will be required to

. net reference this esclusion, i

cy'.

which will o to the National Deta.

venfy theidetttyof allindtviduals and Bank seetrost..

enisadone which report and request Secdon W Men inforwodon amet o)prmation from the Data Senk and forh Poded-he Nat6onalDate Bank would in function se a national ocurce of individuele representing orgenlastions.

DsAcideos Det permit the Secreta ;

_q infonution os physicians, dentista, and, their effiliation to theJequoeting entity. " to reevire repons less often tha i

to e more limited degree, otbar health.

Althovsh the statute does not require monthly (see secuon 424(e)). De l

core proclitionne concerning: lt of the application of these provisions to Department therefore proposes to (1)Peyments made es a resu Federal hulth care entitles, physicians.

require that information be sobreitted '

odical malpreetice actions or c. ?me:

denhets and other health care provides. the NationalData Bank within 30 days (2) Adverse licensure actions taken by the intent of the low appears cieer that Boards of Medical F.meminere, and coverste be se broad u ponible, and following the acuen to be reported. Fori equivalent State Itoereing boerde for hence that Federal providen be medical malpract6ce pa)3 ente, the 30 other health care procutionere; a id included to the entent feasible.

day period would begin when an octua Accordingly, the Secretary le pursuine payment le made,la whole or in port.

(3) Adverse ecuene on clinical privileges taken by health care entities.

the esecetion of Memorende of for adverse ecuase on licenses and clinical privlieges, the evnt tn'esering De Act requirve the toporting of Agreements with the Department of the 30 de pened would be the date of i information in each of these three Defense,the Veterone Administrouon-dedaion y the Board or health care categories for physicians and_S care

denusta, and the Drug Enforcement i

entity, rether than the effecuve dele of i Resording other licensed hea!

Administreuon of the Depa!rtment of practidonere, reporting le required for justice. Also, the Secretary le the cecio6en. it is the Secretary's view i medical malpractjce raymenta,is considen'ng the meaner in which health that the quality of beelth care can best !

voluntary on the part of health care care providers in the Department of be improved byincorporetima entitles for adverse actions on clinical Health end Human Services will informauen in b NanonalIJsla Bank,

privileges, and le not applicable to porttelpete in this Netional Data Sank.

at h eetkut pnectical Hme, consistu ;

ucensure actLms.

De major provietone of these with the mquiremente of es Act. N '

De Act further requires each hospital proposed regulatione are desenbed effective date of the adverse acnes to request information from the Neuonal below.

would be contalmd ta the information :

reported to the National Data Bank h si e.$eEistsaboh7rI ud Section 80.3 Defin/ticas, under ll 90.7 and 90A l

kulth care proctstieners on its medical ne term "Ph W Depensnent u a munne etsff(courtesy or otherwise) or who section 431(3) ofsician"is defined in procedure, Intende to nonfy in the Act to include heet clinical pnvileges. inquiry is also dentiste es avell se osteopathic who em b sub}ect of Mpone, when d ;

required when a physician or health phyeletam mi allopathic phpiciano, reporte are received by the date bank.

care practitioner applies for clinical For claney, the Secretary le proposing to SectionaM AeporwwMedical privileges or e staff position. Other def1ne the term in the traditional sense yo/poetice Arymnts, individuale and entities, se desenbed (i e, osteopathic and allopathic below, are persutted to obtain reports physicians) and to refer to dentiste Punuant to N Act We pedon frors the Neuonal Data Bank. The separately, would require the reporting of pepsen,

Secretary stresses that the informauca ne term

• Board of Medical on medical malpractice actions or from the National Data aank would haminers"is defined to include a claime, ressedlen of the eine of wrve se only an indicator of Board of Osteorethic haminers and a Payment.The Act requires the $*creta professional quality stui not as Board of Dentistry, since the regulations to report toCongrees, by November 14,

conclushe or caraplete evidence of it, would also apply to both dentists and tems, en whehr information on small,

Fue will be imposed on Indivwluela osteopathe physiciano, payments and on allclaime should and enuties who regneet information The term " Health care entity" continue to be required to be reported, from the NationalDets Bank pursuant inclodes a group medical practice which De Act provides a penalty of $10.00r !

to wetion 427tb)of the Act as amended.

sharte facilities. personnel. medical for failure to report information on a ne fees willreflect the costs of records. and respcmsibilities. has payment teruited to be reported. This processing requeste for disclosure and of incomes set by contreet and follows a penalty will be imposed pursuant to providing nch information. De formal peer review process for procedures published elsewhere in this amounts of these feve will be announced forthenns goality health care. *Heshh issue of the Federal Register propoeirg in periodic notices in the Federal care entity," se defined, would aleo' to amend 42 CFR part 2003.

Regteter, include Community and Migrent Health This section liste mformation which The Act and the proposed regulatiene Centers and NationalHealth Service would be required to be reported provide that information reported to the Corps sites, concerntris each payment. Sirmlar liste National Data Bank to confidential and The Secretery notes that the Act are contained in il 60.7 and to 4 for is to be disclosed only for the purposes (section 431(4)(81) excludes from the repornna licensure setions and specified in the Act. nis information dennition of " Health care entity" a profenional review actions on clinical may be used solely with respect to professional society which has been pnvileges.no Secretary invites activities in furtherer ce of the quality of found by the Federal Trade Commiselon comments on the taformation proposed heelth care.N Act provides e penalty or soy court to have ertaged in any to be reported. no information wee of riot more than 310.000 for each anti competitive proctice which hed the dete mined se thet necessary to carry violation of thW confidentiality effect of reerneting the proctice of health oct the pirrpose of the Act while l

l

~

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- =.

i

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tags i Fedesel Resider / Vol ns. No. M / Monday. March it, toeg / Proposed Rolee minimising the borden no,

of reevestins each a heartng. and slee hospital failed to abulaintwestles Secrewy propsees se tify the.

. etetes that the loss of immunity init be frwm the National Deu Snak as reciend physician, dentist er other health care effective for 3 years, by $ g).e(s)and may be med eately wah practitioner whois the eeMeet of a To help assure that thebearing rwpect to litigauon twalting from the, l report es precioch se possible le avoid. Process 6e adminletered u emciendy acuen et c! alm against the hwpitek l

mistakes la esing NeuenalData Bank and cost effectively se sible for the (8) A bodds care eeuty wie twp c'. m I informouse, entlues and the h Government,.

profeselonel review activity: and th w

se Section se# A

,me a ahreing Mverse wg a he (8) A p re88 8' entity who r*queste nie ee a eeuw req *e e u.a.s r',d,ui.ied. new,,o. eda,es w2 inf-a'- = s f-whia *=

ee..

to we,w,,

e e hed..a..

u P **a=*anadar car enuty to meat reg m if= be=6eg be e Isu,y anad

- Ptitt'gl*' healih care eniity, physicia (1) Any professionalreview ection within 30 days after receipt of wrttles

• NFl**C8"" " P****L-that adverwly affects the clinical.

notice froan the Secretary describing the.

Section 80.10(b) tofers to procedures q

privileges of a physiciaa or dentist for a entity's noncompliance, and contain a for obtaining Neuonal Data Bank period longer man 30 days statement of the matenal factualissues information.

(3) When it sesepts the entvender of in dispute to demonstrete that there le ne Department proposes to

• l clinical privileges of a physicien et,

cause for a heartag.no Secretary implement the Act Illetelly conceming dentio6--

i would be authorised to deny a hear 6ng,

wbe may obtain informouon, with the (l) While the physician or dentist le if; excepuon elmedical malpractice J

under invntisetioarby the beelth care (1)ne e, quest for a hearing le beyond actione.

enuty relating to possible incompetence the spectfled time tirait:

d'.

or improper profeselonel conduct, or (2) De entity fails to provide a Section 80.10(e)(4) and (8) are t

(ii)in return for not conducting such statement of meterial factuelleause la

[2 h Act by Pub 1104177*

ed to implement emendments en inneligation or proceeding or dispute: or (3)in the csee of a health care entity (3) The statement of factue'l leeues la Secum MeM. wWeb wouW eneWe whld le a profeestonal ecclety, when it eHwneye 4 obteln inimmeum la tekee a professional review action d![s ute is frivolous or inconsequentialcertale medical malproctice salone. in hte provielon woul:1 also state that which adversely affects the memberehlp the beennes will be held in the intended to " carry out" section 48&(b) of of a phyelcian er denuet in the society.

We ehington. DC. metropolitan ares. no the Act as provided in wction 427(b)(1).

Health esto sauuee would be required Secretary has determb4 that thle le se amended.Secuen 425(b)(see also to report when anladividual has necessary for emclency and economy of ProPwed i to.9(b) below) providu that eurtendered privilegu in order to avoid administreuen.

if a hospital falle to request informatios. '

on advern actica. An example of this to from the National Data Bank as required a physician's eutnnder of clinical Sectionm10 Obtelai information by section 425(4) of the Act. then it is prWileges during, or to avoid. an

/'V8 08N80088 N 8 8AA presumed to have knowledge of this inveeD ntion of poselble incompetence.

Section 60.10(a) opecifice who may information. la ordet for action 425(b)

There is evidence that physicione have obtsin information. and w hat to be "cattled out."it is necepary that surnndered prtvilegee pnor to receipt of information may be avalf able, from the the complainant in a medical en adverse action or to preclude Na tional Date 12enk:

tnetproctice action have access to the Investigetton of their competer.cy in one (1) A hospital that requeste informetion bt is to be unputed to the bealth care entity, but c.sntinued or information concerning i. physician, hospital obtained privileges et another health dentist or health care practiuoner who is propos,d g go.10(e)(9)tellects another care entity which had no knowledge of.

on its medical sieff(courtesy or amendment to secuon 427(b)(1) of the or information on the reason for the otherwise) or bu clinical pnvileges at prior surrender. Congren intended this the hospital:

Act which le intended to enable information to be included in the (2) A physician dentist or health cam Individuele and entitles to obtain Netional Data Bank. These proposed procuuoner who requesta informetion informetion for purpons of reperch.

Accordi ly,informetion from the requirements do not to beyond these of concerning himulf or herself:

Natione sta Bank that does not permit the Act.

(3) A state licensing board or health idenuficohon of awne w hesM can It should be noted that the Act and the care entity which has entered or may be P

proposed regulations require health este entering an employment or affiliation enuties is not conaldered confidential.

entittee tdreport to Boards of htedacal relationship with a physician dentist of Section MiJ fees opp //coble to baminers who. In turn, must report is health care practiuoner, or to which the requests forinformation.

the National Data Bank.ne Act use physician. dentist or health care requires the Boards to monitor the practitioner has applied for clinical This section proposes fees which compliance of beelsh care enicos eth privsleges or appoantment to b medical would apply to alt requeste for these provisions, sta ff.

Informauon from the National Data Under section 411(b)of 6 Act the (4) An attorney, or individual acting Bank. These fees. es provided in section.

Secretary le required to provide e heelth on his own behalf, who has filed a-427(b)(4) of the Act. would be bued on care enuty with an opporturuty for a enedical m.lpractice action or claim in a the costs of processing requeste for hearing before determining that the State or Federal court or other disclosure and of providing such entity has failed to comply with the adjudicatis e body against a hospital.

information.This notice sets forth the reporting requirements of the Act and who requeste information regarding cnteria for establishing the fees and the Section 423(c)(1) provides that such e a specific physician, denust. or health procedures for sueuing and collectmg dalecminauen will teoult in the health care practitioner who is eleo named in fees. The actual amounts of the fees will care entity's lose of the iminunity the action or claim. Provided, that this be announced in periodic notices in the protection of b Act.Section 60 e(ci informe don will be disclosed only upon Federal Register published by the describes the availabthty of and method the subminion of evidence that the Secretary.

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(,

poderal Regleter / Vet St. No. H / Mond6. March art, tSee 1 Proposed R:losi 6

)

Sectionsais HowesdisputetAsf the Department could impose as a result (Room saas). Washington, DC actos.

4 occe,mey of#es/ene/ Dose Son & -

of these segulations might haie an ATTN: Desk OfRcer for HHS, informoden'.

impact on amau enuties, the Deparunent o

a wetion

- a y, dow not. anticipate that a substantial w g g,,g g p,,,,

["8,

,P 3 di' TP W aumber of these amou enuties would be Hulth Profwelena. 64alpmettee.

infwmationm' ee Seculan pmpnes elsmficantly effected by thle rulemaking, insurance compen6n.

minimalinvolmeent is to swoWe of Therefore, the Sewetary certiflee that dio,uta inro,me.o iese mie io ns thle > reposed regulation would not have Accordingly, the Department of 8'c im wesiih and wuman Se, vices,,o we!

88W,,Cof800 thdsvidual p entity su6miinns roculloner ende dio,via,e,0,t. no

• au-e ar*= Pact on en alma.

add a new Port to to Title 48 of of rede,eue.uisoo,,s. as sei fo,.i re ulation would provide for fla ng becutive Onder 12R'?

below.

e"d p od w il e $p to 6 being Execuuve Order 123rl requires the Deted: August IIL toer.

resolved,la the esont that e resolution is Department to prepare end publish en Robert 3. Wiedse, not reached by the parties, the Secretary initial regulatory impact analysis for any AasiesentseemeryforHoo/A would, upon wrttien request. review the proposee major rule. A mejor rule (a dispute and ou relevant evidence. After defined as any regulation that is likely Apped October s. toer.

t review, the Secretary would either:

to:(1) Have en annual effect on the OW R. h (1) Continue to note the information economy of $100 miulon or more:(g)

M88'F-as " disputed" and include a brief cauw a majw ineman in costs or prices statement by the physician or beals' for consumers. Individu'el industries.

PART to-NATIONAL DATA SANK care proctitioner describing the 80"fRm'nt 88"C3" MIMeteP ic FOR ADVERSE INFORMATION ON h

disagreement,if the Secretary concludes "alone: or (3) result in significant PHYSICIANS ANO NEALTH CARE PRACTITIONERS that the information is accutete: or adverse effects on competition, (2) Send corrected information to employment, investment, productMty.

Seport i E.,; praeteteIns

• i Innovation, or on the ability of United I

previous inquirere if the Secretary incormet.

States based enterpriwo to compete g

concludes that the informatiert wee with foreign based enterprises in to.1 The Nationel Dets Senk.

to.3 Appletabillry of thm mguletene-i =

In order to carry out thle prevlolon.

domestic or export markets.

go.3 0,nsitione, the Secretary would maintain o record The Department has detstmined that of allinquiries made to the National these proposed regulatione do not meet gg,,,,, m -'~

g,,,,,

Data Bank and anyinformellon the enteria for a major rule se defined yH in mue be provided as a result of an inquiry.

by section 1(b) of Executive Order inlight of the sensitivit of this 12291.These proposed regulatione

,g,

,,,,nq,,43,,,,,, n, information we specifical y solicit would estabhoh procedures for the p, y,,,g,

l comments on how disputed information mporting and refusing of infoi. nation of Medical F.aemines go y Reporung liconeure actions by Board-should be handled prior to willement of from the National Data Bank on so e Repening odwrw ectione on chnicel t the dispute.

physicians, dentists and health cam pnvileges.

Re.uicioe, neauty Aci se.cudvs Ct,'fai s"47;fe'daa Tli 4*'

r,,,i y,,,,, p - ~ '

d Order 12291 c

concerning certain ad$eroe actione The Secretary certifies that this regarding their licenses and clinical so.s informetion whichhospitale must propowd rule does tot have a pnvileges. As such. this proposed rule obtain from the National Data Bank significant economic impact on a would have no dimct effect on the 8010 Obtaining informahon from the National Dela Sank.

substantial number of smali entitit s. and economy or on Federal or State so.tt Fm opphcable to requests for therefore does not require a regulatory expenditures. Consequently, the information. '

flexibility analysis under the Regulatory Department has concluded that an so.12 Confidentiality of National Data 8ar Denibility Act of 19eo, in t I gulatory impact analysie la not Aegularoty Measbility Act infg*'g g

Nationat Data Bank informateon.

Consistent with the Regulatory R

M Act d M AuW Secam2 of th Huh :

Flesibility Act of 1980 (Pub. L 9er3.M. 8 Sectiene 80.4. a0.6. 80.7,60.e 80.9 and 3[5 ei men Act o Pr,e,,

U.S C. 004(a)). the Department preparee 60,12 contein information collection de by and publishes an initial regulatory requirements which are subject to section oo2 of Pub. L 100-1'r7.101 Stat.100?

flexibility analyste for propoud regulations unless the Secretary certifies review by the Office of Management 100e 142 U.$ C.11to1 11152).

and Budget (OMB) under section 3504th) - Subpart A-4eneralProvialons that the regulation would not hase e of the Paperwork Reduction Act of 1980.

significant economic impact on a The DepartmeC has submitted a copy of le0J The leaM Dets tant eubstantial number of small business these information collection The Health Care Quality improvemer ;

entities.The snelysie le intended to requirements to OMB for appros al.

Act of19e6 (the Act). Title IV of Pub. L explain what effect the regulatory oction Other organtutione and individuale 99-400, se amended, authorites the by the agency would have on small desiring to submit comments on the Secretary to establish (either directly or businesses and other small entities and information collectione should direct by contract) e National Data Bank to to des elop lower cost or burden them to the stency official designeted co!!ect and relesee certain mforma tion alternatives. As indicated abos e, it.we for this purpose whose name oppears in relating to the professional competence proposed regulations would not hase a this preamble, and to the Office of and conduct of physiciano. dewets and '

sign ficant economic impact. While Information and Regulatory Affaire, other health care practitioners. These some of the pensities and assessmente OMB. New Executive Office Buildmg regulatione ut forth the reporting and

t

[.

l sees Fedesel megleter / vet. as, ps M / Mendep. Mad et. sees / Proposed Renee j

_i disclasse._

'--r t deabe Neuenal. (bl An ently that poddeo boele com -

(a) Ptefessisaelredeer actMelee

. Data task. '

... serv 6one.ed to pedeselesel roleled le e ydessional miew ase6.so !

t es. appassmenyofWees W.. redew eseMey a formalpoet

. (b) This lors enoludes actions whis !

,,g,,,,,,,,,, go, p.,p, og are primerey basad om

'fhese segulettees esembheb eeperseg tweertas tisamy bedth ears,w e (1)The phyelden's, doestat's er heele i requiremente appiksble to bosqdeals essesspiese of thatsatatyt er

• ears prestesser's seenciation, or led a '

health eere enuties heards af b4edical.

(c Aprefoestmeelsocietya boar)d, er e committee or egent a-h with a predessional someey haminers polnesissel sonettes d oresameistem physiclass, dentiste er other Ikoneed laeludla adverse licensure er professional review 1.cg g,,g thoes M the setend.Stah, er beelth am precettioners which take (3) The pbpossion'e, dentist's er beeld d.d pbydcena, doness, er cam useer's Jose er the beelth care practsuosere est la pby

's, destore er health eere actione, and ladividuate and entttta (lacluding taeurence --f*) soeunt p,,g to l,,ys,w scyvity thrs a

. permente se a result of medkal formal peer mytew process. for the

'prestsbenor's edvertising er engaging it other sempeettre oces titended to seite I purpose d forthwtag spaMy heem ears, w seule kh g"--- to Jor purposes of pain.ymph (b) of thle.pe-am

payment, hee failed to tubesit a report se requir -

action to the Board within 30 days frone (v) Amount olludgment or settlement by thle wetion, the Secrete y will the dele the advme action wee taken, The Boardicwt submit the informouon and any conditione attached therste, designete another qualilled entity for '

received from a health care entity withia including terms of payment, r, porting ofleformauon under i 80J.

10 doye from the date on whichit (vi) A desenpuon of the acts or 160J deperms admeros setene on received this informa don. If required ominione and injuries or illnenee upoa sentees pesegee, under 140A thle information must be which the action or clats was bases.

(a) Aeporting to the Aoordo/Afedic 4 and submitted by the Board elmultaneously to the appropriate State licensing board (vii) Other informadon se required by Eraminere.-(t) Actions lAof muet be reponadond to svhom the repon must t in the State in which the health care the Secretary and announced teon time be mode. I.ech health care enuty must t entity is located.

to time in the Federst Register.

report to the appropriate Board of (c) Sanctions. Any pmon or eta ty Medical f.meminers the following that fails to report informetloti I'** " 9

• 8 "***'I 6 payment requind to be repor6)1 actions:

P' #*""

nder (a) Ifho must repon. Each perton or this section le subject to a civtb(oney ti) Any profeselon'al review action l

entity. including en insurance company, penalty of up to 310.000 for each such that advernly effects the clinical which makes a payment undet en payment involved. Thle penalty will be privileges of a physicien or dentist for insurance polley, self insuronce, or imposed pursuant to procedures et 42 period longer then 30 days:

otherwin,in Hitlement of or in CFR Part 1W3.

(ii) Acceptente of tne surrender of i

seusfaction in whole or in part of a clinicalpnvileges by a physician or claim or a judgment in a medical l e4.7 TW esenews actlene by d'"U 8I"

1. • eres *t 48***al tsamenore.

(A) While the phyelcian o' dentist is >

melproctice action, must report (e) IPhot octions must be reponed, under investigation by the heel'h care information as set forth in peregraph (b)

Each Board of Medical Eneminere must enuty nieung to poulble incompmnc to the National Data Bank and to the appropriate State licensing boerd(ella report to the National Data Bank any or improper professional conduct, or

~

action (B)In retum for not co*iducting such the State in which the act or omteston (1) Which nvokes or suspende (or which gave rise to the medical otherwise restricts) e physician's or.

en investigation or proceeding or melpreetice claim occurred.

dentist's licenset

[111)la the case of a health care entity i vahich le e professional society, when it (b) Irbotinformotion must be plac)es on probation a physician or(2 Which censures. reprim tokes e profeuionalteview action t

reponed. Persons or entitles desenbed in peregraph (a) must report the dentist, for reasono relating to the which ednreely effects the membmhl i t

following informadon:

physician's or dentist's profesotonal of a phyelclan or dentist in the society, (1) With respect to the physician.

(2) Po/uniory reporting on other dentist or heelth care practitioner for competence or professional conduct: or beo/th compromtionen. A health care (3) Under which a physician's or whose benefit the payment le made-dentie e license to surrendered.

entity may report to the Board of v

(i) Neme.

(11) Work and home addrenes.

(b)Information ihot must be reponed.

MedicalExaminere information se described In peregraph (a)(3) of this (iii) Ucense number (e),

The Board must report the followmg section concerning actione desenbed in information for each action:

peregraph(e)(t)of this section with i

e

g 32 2 Fesleral Register / Vel. 53. No. og / b4onday. March 21. IgeB'/ Proposed Rules rupset to otherhealth ease la the event that the Secretary desdee a wiu be evellebla. epen aquest. to the procutloesee, bearuig. the Secretary will send a persons or entition er detr authoneed p) Whatinfermierten must be wnttaa denial to the health eare entity agenta, es deeanbod below:

reported The health care touty maaet eetung forth the reasons for dealet if a (1) A heepital ht eegesets report the followinginformauen hearing to denied, se 6f se e result of the information concoming a phyolcian, concerning actione deswibed in bearing the entityis found le be in dentist or health care practitioner who is pmgroph (e)(1) of thle sec6en with,

nonotunpuanos, the Secretary wdl on its medical etaff(courtny or respect to Ibe phyetclan er dentist:

publish the name of the health care otherwise) or has dinical pnvuesee at (0 Nemec enuty la the Federal Regleter. la euch the boepitah til)Werk and beme eddress:

case, the immunity protocueno provided (2) A phyelcian, dentist lor hulth em (iii) Ucense nurnbert under section ett elof the Act wdlest procutioner who requeste informauon (1v) Drug Enforcement Administration apply to the hul once entity for concerning himplf or herwit:

regiotreuan number.

professional review ectinties that occur (3) Boards of Medical Examiners or (v) Social Securtty number,if known, during the byear pwiod beginning 38 other State licensina boarda, and health and if obtelned and released le days after the date of publicados of the care entitles whir.h have entered accordamos with opplicable previolone entity's name in b FederalRegleter.

1 be entering employment or affiliation I

of the Prfvecy Act is U.5sC. &&24):

(2) Boortf o/Medicu/haminero. it nledonablps with a phyelciarL dentist or !

(vi) A deoortption of the acts or afler notice of neocompliaase and ortissions or other reasons for privilege providing opportunity to correct heehh care practitioner, or to which the I lose, or. if known for surnnder: and concompliance. & Secsetas phyelcian, dentist or health care i

(vil) Amien taken, dele the action wee deterames met a Board hee failed to practitioner has applied for dinical l

privileges or e,@ ointment to the me$ cal !

t' taken, and effective date of the action:

report information la encordance with

egg, (viu) Other tr/ormouos as required by peregraph(b)of thle section,the-the Secmrtary and announced from time S*crettry wiU dwignate another (4) An attomey, or Individualacting F

to time in the Federal Register, qualified entity for the reportint of thi*

on his own behalf, who has filed a (b) Aaporting by she Aoonf afMedice/ informatloa.

medical malpractice action cr dalm ia e Lominere se she Nesione/Date dona Stale or Federal court or other Each Board must report,in secordense Subperte._, m._ -e ofintenmenon odludicative body a last a hospital onth ll site and etL8. the inferine boe by are NationalDate Senk and who requeste l[ormeties regar reported to it by a heelth care enuty and a specific phyelcian, dentist or beelth any known testances of a hulth care i to.e Wormeuen wedch heepun must care proctitioner who le also named la obtam trem the Mesonar ones sent, the act!on er date, provided, that this entity's fallwe to report talormetion as to Wheninformotlosmusthe ohro)ined. Each bospital must request information willbe diadosed only spon required under parasnph (e)(1l of this the submiselon of evidence that the section. In addition, och Board must

+

simultaneously report thle information information from h NatbaalDets hospital faded to obteln leformat6on to h appropriate State lleenelns board Bank concerning a physkies, dentiet er from the National Data Bank se required in the State in which the beelth c*

health care precuuoner se follows:

by I ea(te), and may be med solely entity la located, if the Board te not euch (1) At the time a physician. dentist er with respect to llt!setion resulting from health care prneduoner opff(courtesy or the scUon or clehn agelnet h hospitek licensing board" lies for a posluon on its medical sta

($) A health care enuty with respect so

(

(c) Sanctions.--(t) Neolth core entities. If the Secretary has reeson to obrwin). or for dialcalprivdeses at profeuional review actMty; and i

believe that a health care entity hee the hospital and (6) A person of enuty who requute

+

(2 Evary 2 years concatalag any phys)ician or health can precuuonar information in a form which does not failed to report informelion in I

permit the identifketion of any accordance enth I 80A the Secretary

(

will conduct an investigeben. If the who la on its medical staff (courtny or particular health care enuty, phyelcien.

I p

investigeuon abows that the halth care otherwise), or has dinical privdego et other health care precationer or petient.

entity has not compiled w th I 60A the h boepini.

(b) Pynedures for obfo/ning National bosp) ital which dou not obtela thegy yajjuy, go osgoj, jnjo,,,gjog pagagangjgjo,wg;,n,p,7,an,eng Secretary wiu provide the enbry with a enutin may obtain inforestion from the l

wntten souco deecnbing the noncompliance and statmg that the information se required in paragraph (a)

National Data Bank by submitting a entity may request. enthin 30 days afier of thle sectoe to presumed to beve request la euch form and menner es the receipt of such notice a beartr knowledge of any information reported Secutary may prucnbe.new requnie respect to the noncompliance.q with to thr National Data Bank concerning are subject to De es described in The request for a hearing must contain a this pp casa, dentist or health care 1 60.11.

statement of the material factualleaues pn gm, in disputa to demonstrate that there is (c) Ae/ionce on the obtained I88 M #8***PP88*W' " "9""'8'*'

i I

cause for a huring. Thoe luun must information. Each hospital may m!y be both substantive and relevant. no upon the informs tion provided by the (a)Policyon fees De fees ducnbed hearing wiu be held in the Washington.

National Data Bank to the hosp 4tal. A in this section apply lo all requests for DC. artropolitan ares. no Secretary hospital shall not be held liable for this informeune from the National Data will deny a hearing if:

rel:ence unlne the hospitalhee Bank. nue fees are authortred by (i)The request for a beenng is knowledge that the information section 429b)(4 of the Hulth Care I

Quality improve) ment Act of 1986 l.

untimelyt provid,d weg false.

l

(!!)The health care enuty dou not I ao.te OttaHng Wwmenon Irwe me U.S.C.11137). ney reflect the costs of l

provide e statement of metenal factus)

NotenalDeta sent.

processing requeste for disclosure and of providing such inforestloa. The actual issues in dispute: or (a) Who may obtaininformation and fees will be announced by the Secretary (iii) ne statement of factualluuas in what informorion ency be croi/oble, in periodic nouces in the Federel dispute is frivelous or laconsequential.

Informetion in the Na tional Data Bank Register.

G

-e.

i.

Fedoesi Regleter / Vol, 53. No. H / Monday. Merch 21.190s / Proposed Rules 98 N emount et eed fee willhe billing and must be sent to the bdling-(3) Regvesting almultaneously that t!

(b) Criaanie fue Assenninine IAe fee, unit. reyment must be received with6n disputed informetion be entered inte e determined bened en the following 30 deye of the billing date or the

" disputed" status and be reported to criter6e:

epplicent will be charged interest and e inquirers et being in a " disputed" stet.

(t) Une et electronic data processing late lee on the amount overdue.

and equipment to obtain talormation-the a geMI Conneenussey of teoumet tom (3) F.ntering into discussion with the actual eost for the serv 6ce. including Q%

reportmg entity to resolve the dispute.

computer seerd time. runs. printoste-and time of computer programmere and go) Ljm,,,gjene en gj,cfo,y,,

(c)Pacedume for revising disputed Information reported to the National information.(1)If the reportmg entity oPerotore or other employwe'rms of Data Bank to considered confidential (2) Photocopying or otbet fo revises the information onbin.lly reproduction. euch as toegnetic topp--

and shall not be disclosed, except es submitted to the National ate Benk.

actualcost of the roter e time. plus specified in i 60.9. l 00.10 and i 40.13 the Secretary will notify all ent: ties to the cost of the me ine time end the Persons and entities which retelve whom reporte have been sent that the informstion from the National Date orieinalinformation has been revised.

oots cluel coot:

Bank must use it solely with respect to (2)If the repartmg entity fails to teu (4) Sending information by speciel.

the purpose for which it wns provided.

the reported informetion the Sn.rrter) methode recuested by the applicant.)

Nothing in this peregreph shall prevent will, upon request. retten the written such as e apress mail et electronic the disclosun of information by a party Information submitted by both partin trenefer-the actual cost of the special which is authonted under a plicable (the ph)ticien, dentist or heelsh core

,g, State law to make such disc osure.

(c) Assassig andco//ectingfees.

(b1 Perm /tyfor violotions. Any person proctitioner, and the reporting entity).

and related information which is (1) A toquest for information from the who tiolates peregraph (e)of this aveilable. including but not limited to go en agt.em.iio,e, il,e esemeied m"'$:,'"gr;*"ayg'" g''g my **"Y 8

National Data Bank will be regarded se g

that stellable from malpractice insure ieggogsgge,,,

m,,,od (i) Normally, a bill will be sent along

$unt to prmdurn at 42 pen decisione, and the Health Core with or following the delivery of the Financing Administration. After retie-requested information. However. to I to.ta How to saoute ow enowesy se the Secretary will either:

order to avuld sending numerous small esemones Dete pare warmemen-(i) Continue to note the inic,rmation bille to frequent requators. the charsee (el Who may dispute Nationo/ Dole

" disputed"If the Secretary concludes may be aggregeted for certain penods.

BriA information. Any physician, that the information is occurate. and For esemple, such a requester may dentist or henith care practietoner may include a brief statement by the receis e a bill monthly or quarterly, copute the occurney of information in physician. dentist or health care 13)in the event that a requester hn the National Date Bank concerning prwetitioner desenbing the disegreeme feited to pey prevlous bills, the himself or herself.

conceming the information, or requester will be required to pey the fee (b) Procedures forfi/it's o dispute. A (ill Send corrected information to before a request for infonnation is physician. dentist or licensed health previous inquiries il the Secretary processed.

care practitioner may dispute National concludes that the information wu (4) Fees must be paid by check or Data Bank information by:

incorrect.

money order made pe3 eble to "U $

(1) Informing the Secretary and the Department of Health and Hum.n reportatig entity,in writing. of the Int Doc. eMas$ Filed b1HE B 45 emi i

Services" or to the unit stated in the disagreement, and the basis for it:

eiu.ase ones on.w.m WBO l

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PUBL9C IAV/ led-93--AtM M( 19R7 / ' ~

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-4.

3 ce MEDICARE AND MEDICAID PATIENT AND PTtOGRAM PROTECTION ACT OF.1987 -

0 s

.::'.i-."g...

.101 STAT. 689 PUBI,fC LAW 100-93 AUC IM.1987 PUBLICIAW tes-93-AUG 10,191U

't013FA*_

w Ptstilse Law 100-93

'd*"d '# 'he deh*y of an ite'n er semce vnder title Kvtri er i et en!ic

~

jg under any State heelth core pecstrom.

An Act "t21 Cowyseview artAmsc to enterwr newest.-A ind,,,deel er entity I wet hos been cosmeted..nder Federef or3 tee I w.ef To eased ektse Mt. XVftt. and ItX of etw Serial Securky Art se prent hensedsense a criminel onenne relatinet to nest ect er ebene of patiente in l

g(,g,,,,,

.-der ese t=eseh ew* e

-es==

t ehme Are er re s sen e p rewW tennection with the delivery of a heelth core item er eernte

• tbs Preneseneve Ear

.-d etwe.a. e. emm the wir d s

_,,e.ei.is e. en,,.m g,,% g,%,,,,tvesaw.-The Secretary mey esclude the ret:

g, y g

j Ar it eseecdrd &v the Sessede end Moesse af Represensefieve a(tac emder tule XVill and may detect that the I lowing individuals and l

seemesse emd Uniard Spofes e[/asacrerw es Cestgress essesseMed.

mthe be encitsded from participation in any Sete health core -

se.dm.ed prestrem:

' Peeiset and SECTsOst t. Inesos? TTTLE: IEEFEftENCIDI fM ACT: TAgt2 00' tem

~tleI m' setAtesso To ennes -Any *

""..LI er

• M 3,,, 1%deceed Patient and Pregrene Protection Act of ISKr'. _tal Sesoof Trrur.-This Act may be citeil as the "IEghtere eng entity than has twn ceavicted wnder Federal or Sete law, in tesn connectson wdh the delivery of a heelth core item or service er attpSctses ibl Aseawee spers to twe Soe:At. h,

.. Act.-Escept as other.

with respect to any act or emimson in ay operated by or toise specirscelly prevkled.1.~.. in this Act en eenendment is empseemed he terms of en omendaient to er repeal er, e acetion er finemw=d in whole or in port by any rederet. State. er local ether peer isson, the uL...& shall be considered to be snede to that governnient estency. of a etiminal offense relatinet to frowd.

theft, n_y

^. breech of riduciery -

Mety, or other eretion erother..i.of theSociclSecurity Act.

rmencial mm-..

tc) TAmem or h-ne tebic of contents of this Act is as

• i2 Cowysevmw metamec to corrot'crsom er aw mverrscA-p follows.

view.-Any individual er entity that hos been cosmeted, under 3,,, 3. gin,, ens,,. % 3,, a,,. seter de.sieressa Federal er State few, in connection with the !- ^.,.7;.s with 3.c. 2. Eartusen Frsen anserary and Steer heefth core presroma er ob4truction of any samstigation mte any criminel offense sw. a Cs.ie

,es,y,,. shame described m perestemple tilor in sesbarction tea.

l See_ 4. cnsmenes peasseise ser eres In%

sdiese, sad sense tweeth c.,,

't37 CowyscToom me Avneo to cowenos.tJto suestassee.-Any th seemd i praev==a individuel er entity that has been convicted. under Federei er Sec. S. f=8srume+imaeenesembersmartismstehe 2 ty Sisee fireeshe seehorsese useinst

=he e 8 *"h "* e *""** ""4 ermdMe Stste low of a criminel effense relating to the enlawfwi niono-

~

l See. 4. Ote"tsmies et twen'*h es., peer se serve e d yes. larva

[eClure, distribution, preectsytion, er denpensing e o centrolled r

D[7

,,Q,

,,g,,,g,,c,

~t48 tacessee envocarsow est suserwseowAAny indevidual or i

ser. 9. Oersrwo i er sere.d ass e.ri.

,, esimme d Deerst aseertson Art er "Inf-tset "tAl whose license to provide fecelth core less been re-see. si e ma-d

- or dse 6,,.orie,ese.e s

,se se arse voired er -_

12 by any State licesioma eetherity, or se*=ssend by imemd. eta and e.wam..

i See. It. Dennaian at pr-

.een ;_ _ ~, er ee ens wie d wht otherwise lost such e fic arise, for reasons beering ese sec. t2. Candnesuet spemet er eemet A.tre. Ear.t.e

• the individuel's or enEty*e 4- - _.-! competence profee-i i

Sec. Is A dm e sensei., e. f d so e :ig "3w empyssaw est samme nev sio.nal performance.or rneen,cief intestrity.or l

D$

d"'""*"**"*'"""

.tBIwho w 2 " such a lh while a farmet die ciplinary proceedingt wee pendn~ ig hefore such an authority eved the proceedises cerecersied the indevishsel's or entsty e SEC. 2. EXCLifRION F30st IEE90CAftE AND ftTATE 99EALT98 CAe8 i._ _ competence.,,. 4

.

• My,.

PsoceAse!L Econcial intestrity.

._m.

or Section 1125 (42 U.SC.1320s *I is ensended to read as followne

~6 Enctoneow on susessassow oween maa en orate

}

neat.ves came esmonaes.-Any individiset er esetsty which hee "exctm orcentarse ssessesouAss aseo ssefvtsee reces raetscerAvsom been.

~i? or encW frem port @ioa. or ethine t

ese asseecAse Aw9 stAfa steAt.tw Casa Poocesses 8e#CIbO"'d ##dPf~

• 'Sec. Il21L to) Masemascer Enctosecos.-De L..^w shell en-

"I At any Federet progrrem. ' ! l

- - _ er the chede the folloereng individisale and entities fressi guartC_h in Depnetnient of Defense or the Veterone* A7m.inistration.

i eny pregrrem under title XVIII en.1 shall dweet that the followsng involvmsg the provassen er heelth eore. or j

42 ttsc tses.

~t Rt e State heefth coee prenrem.

i individuals and entities be escluded from participation in any State for reasono bearing on the individwere or entity *e

,4 _

health core les defined in embeettson th)l.

competence., i 12 performance, or rmenciel integrity.

• 'ill vocvsess er enoCLAse-estates cetesGB.- Any individ-mal or entity that has been convicied of a crimivial offense "tGI CIAtW9 F9e m2c93Rfee CwancFs on Uwwec7SRant eRevereS,

3 aves eaet.ver or resitaese osicaneravsons to eveser.se esenscate_,

weremner stevoces-Any individual or entity thet the Sec-retary determines-

• tat has toesbmitted or commed to be submitted bille er

.i respisegte for peyneent twhere nesch bille or regpeeste are

171 St'AT. 682 PUBUC IAW 196-93-AUG.18,19ffT PUfBUC IAW 199-93-AUG. IR.191rf '

let MAT.'

a (Jgc tsest beant en chesgos er eseu modse title XVIII er o State heelsh "itse Fcousee so sweet.v eseveeres sneeseemeson'en sue?

core progrene u.^

'- charges for, in applicable coere, For peynnent el costo) for items or. services for-mntencmas aseo sweeuess.-Any L*_ -,; entity ses derened -

n' embetentmelly in encoso of such indsvideol's or entity's in occteen ll248es2n thet feito to supply twsthin such persed se i et 12C12P i

useal charites for, in

. " _ " " conce, substantially ise may be nyeeified ipy the L..^., in regulationet open request estese d such individual,e er entsty*e costel for such itesses specirscelly addressed to the entity by the Secretary er by the i

er serenen, uselsmo the Secretary finds there is good cause State egency admL ' ^.. sser sepervising the edannsstretsen of

- i e State heelth core pregreen-For such bille or rogueses s-

^

',. such charges er custo; "i At fell and u - ; :^ r infersnetion se to tne -.. ", of "IBl hem fornished or ceased to be furnished items or services to patiente (whether er not eligible for benefits e awhcontescter ten dermed by the Secretaev in reweletion=s useder title XVltt er onder a State heelth core prescemi with whom the entity he had. durinet the previce 12 i

. ^ "", ist escess of the needs d seek poteente er of e monthe. beeiness trengsctions in en saarerete onsoant in l

ence=s of $25.ft00. er

[

gestity which feito to suoret pedesseenelly recognised stand-n erdo orhealth eore;

" ins full end u.

.L. _ _^_ ion as to eqenirscent

• ^

l

• IQ io-business trennectione ses dermed by the m ery in

(

t ommeseret "ti) e hoolth seemismeessee set==8==88== tes defined in regulationet, accorting during the five-yeer period endieng i

se tsc essek section 1983ienN providing itenue and services under a en the dote of each request. between the entity and any M tfsc tips.

State plan approved under title XiX.er

s. helly owned supplier er between the entity and any subcontractor.

"lii) ese entsty f_.T_

services ender a waiver

• t t l e Fast.one ve outet.v Pavese.ser snecessavven.-Any at t!NC tseen.

epproved ender section 191T(bRII.

individuel er entity

... ':n,; items or services for wtsch and hem feiled osbetontially to provide

=======ry payment niey be niede ender tule XVlif or o State heelth core er tnac asps Itenes and services that are.,

..-d (esider er the l

centreet with the State under title XIX) to be provided to pregerem thet feils te provide auch infernietion se the Secretary or the oppropriate State enency finds x ---- -toi^.

~

indsvidesele cesered ender that plan er weiver,if the foohere

- whether such peyneente are or were due saI the emeente has edesraely effected for hem a==hme==etsel likehheed of thereof.or hee refused to such etesmastien ef ite recorde adverse *y eGectisg) thsee individuale; or by or en behelf of the.

er thet agency se mey be i

• 1DI is en entety provedsag iteens esed serviene se en t

eligible orgese'ssetiose tender a riskehersag cesstreet useder w _[- to verify ouch informedien.

"il2s nes,ves to ceaser resseessava access.-Any indevedeel et tisc tsee eretion 1876 and has failed embatantially to provide needs-celly e======y itsmo and services that are vegested tender er entity that feite te messet imniediate access, upon reemenable tes dernied by the Secretary in reggeletionn to any of the e

low or such cesstract) to be provided to : f:m " covered fel inst under the riskehering contreet if the fashore hem adversely tA Ti, the Secretary, or to t9 e used by the effected for has a substantnol li,keHhead of adversely effect-

• 17) g three isedivishnels. -

Secretory,r.Ier the purpose specireed ise t erst sentence d isi arction If 4tet trelatiegt to co sepliance with condstions of ar tssc eses.

l FRAtse. Escasacase. Asso OTsueR emessearToo AcTTVTTf5-Any individual er entity that the Secretary determesies has participation er peysseent).

[

Aust se comsnitted en act which as described in section ll2RA er sectsen

" Bt To the Secretary or the State esevicy. to perforsue the t

8 " S-88 8 112108.

reviews and serveys requeired under State plane under pere-j M e eH

• (g) Esrervies coerrectame av a enseersesses snesysevat.-Any graphe (26), (311. and (33) of section 1992tel and ender erinic tsees t

section 1903 sal.

entity with respect to which the Secretary i^_.

..a that a er trst issst person-

"to To the Inspector General of the Departsesent et Health end Homen Services. for the purpose of reviewsnu -

• 1AND witte een _. "", or essetrol iseterest (as defissed I

records, J._..:

and other data seceemmary to the er truc tssa -s.

In section ll24(eX39 in that entity. or perferwience of the statutory functione of the Inspector "tH) who is an effacer. director, egent, or sseeneging em-General.

me., ser.

playee (se derened in section ll26(bH of that entity-i lee

" tdt To a State sucedeceed fraud control unit too defhied in l

r. _

ecction 1993sgte. for the purpose of conducting activities

• IBIII) who hee been eenwicted of any effense damerRied in l

demersed in that opetion.

r mah==ctisse Ie) er in pr egraph (1). (2), or (3) e( this embocctiese:

"fl3s Fast.une tu vane cconectrvr aevion.-Any hempitet thet sesn'honesse l

feile to cosuply substantieHy with a corrective action.,..J smnusa "ti!) assenet whouse a civil 1^_, penalty has been under arction Ifumisfit2nRs.

er traic tsus. !

essresed esiderarct'ese ll2RA;er "tiet Decaut.T en see.at.vos esveavven sonn est sessetAessor "tiii) who less been emeleded frene

^ * '. -- under a i

pregresse under title XVIII or under e State heelth care eeucavenns.-Any individual who the Secretary determsace is e..

in defeelt esi repaymente of scholership obliantsene or Icene in l

connection with heelth

". _... edecotime made er accured, es.onsio semenmue naquenes eseveeseaviess.-Any esstity in whole er in

. by thSecretary and with respect to whens l

t that did not fully and acceretely nieke any dimelessere required -

the Secretary teneve all... M. stepe eveeloble to the by section 1124 or section 1126.

Secretary to accere repeyment of such ebigtetiene er leone, t

'y-

-wr 4

g,Utst,ec IAW 190-93-AUG IB.19R7 191 STAT. f; ennyt that (At the Secretary shall not emeleste.

" to this, peregraph a phywesen who se the sole _....;--Ey phyme,on or 7As of h feet end cwewnestenne of each esclusion Wspewd Wnat en endevidual or My undn We section or eretion sole source of comentiel specialimi services in e consmunity if a A,and

%, ens State regeests that the phymcien not be encloded. end eRe the pn W( M m, M Gn b whach tk Seciatory shall tebe into account in determining whether to ate esency n dwnwd w nelade se indusdeel or entity frone esclude any other physsenen pwniesent to this parastroph eccese of benef*ecieries to physeenen services for which payment sney be

' A' E" Cept se pended m embpemgut i t99, h pened of ee d

er tfsc 1595 mode under title XVIII or XIX 39s

• 1c, y,,,c,, Eccecme Dava. ano Posnoe ce Enct.treson.- 4tt An core f**""mm un n pomgreph (27 enclown a tete

• • • • • • ""I

'""*3"*""""""

ther. e ses esclusion under ihis meetion or under seetioet fl27tA shell be effee-3

,g,

teve et euele time send upon such,___*&

notice to the pusblic and qg, The Snrehry niey weeve ese ividividut*e er eMity*e ewhssisen to the indiddual or entity escluded es may be specified in regul*-

moder e Staw Wh w e under W ct if me Hono cenessknt wie peastmph t27.

Secretary receives end approves e request for the weiver w.th "t2Nht Encept as provsdad m so,

. +.,. (Bl. such en enchseson respect to the individual or entity freeve the State egency administer-shall be effective with respect to services fernsehed to en individuel ing or supervising the administration # the progrom on er offer the effective date of tne esclusion.

3,, Nove to Srave Lecairac Acewenes --The Sweetery shell --

• 191 Unless the Secreta y ^ ;..-. that the heelth end eefety of gi, promptly notify the appropriele State or local agency or indevsdeolo rweestag servsces worrente tiie esclueseen taking efTect euthority having.,._7,J.lety for the Iq'or certeficatices earlier, en esclusion ohell not opply to peyneente made under title of en indivinhsol or entity escluded for detected to be escludedt XVIII or under e State health core peggram for-r,em perficipetion under this section or ecction II2ttA. of the "til mpetient icatitutional servsces fornished.o en indevhhsel fact end cirewmotences of the enciasson, who wee admitted to each ipotitution before the date of the 2s reguest that oppropnote investigatieses he esiede end

• • elseien, or senetione invoked in W. c. + with opphenble State law and

• 1ii) home heelth serviese end heepite emee fernsehed to en policy. and individuel under a plon of core established before the dote of

~t:ss e, quest that the State or local agency or eetherity heep the enchsesen.

the Secretary end the inspector General of tk Department of entil the possage of 3D doye efter the effective date of the encitseson 18eelth and Plumesi Services fully and corrently informed with 73 NAP The Secretary shell specify. in the notice of esclusion respect to any octions teken in response to the request.

under gnaragraph II) and the written notice under sectices ll2ltA. the

• 1f) Norver, lle.ameevo, ane Jtnsecrat Revsew.-419 Sebpret to pero-mmmium pened for, in the case of en esclusion of en individuel graph (21. ony individuel or entity that is escluded for detected to be under embarction (balR the penodt of the encivosori.

encitededt from participetion meider this eretion se entitled to reemen.

~tBt in the come of en enclosien under subsection tel, the o'._..

eble notice end opportunity for a heering thereon by the Secretary pened of enchneien ohell be not les then five years, encept that, to the some entent as is provided in section 295tbl. and le judiesel ertet ees opese the enleest of a State, the Secretary may waive the uL,.c.

renew of the Secretary *e final deenoson efter such hearing as se emder suboretion teNI)in the come of en indivieheel or entity that is proveded in section 205ssti the sole community physicien or sole source of essentiel spreietiePd

~t2I UnIens Obe SNretary determines that the heoIth or eefety Of servsces in a community The Secretoq*e deciosen whether to weive individuele receivmg services warrante the escluesen taking effect the enclusion ehell net be reviewable.

eerlier. eny mdividuel or entity thet is the selgeet of en adverge

• 1C) In the cose of en encitseien of est indiendeel esader ensberetion determination under embocctiosi (bM7) ehell be entitled to e heereng (bRl21 the persed of the esclusion ohell be equel to the som of-by en administrative low jesdite fee provided under opetion 295sbli on

'til the lesagth of the period in which the indieseheel failed to the determination tender enheection (bu7) before any esclusion beoed grant the isoniediate onese L.L,* in thet subsection. and upon the deterwmatien teken effect.

• 1ii) en additional period, not to enceed 90 days, set by the

~13 The promone et section 295thi shell opply with erspret to Seepetery this section end secticaio II25tA and 1156 to the sessee entent se it is at Lusc assee-

• ildt Norses to 9 Pave Acewesse aire Ence.tnesose Useeest Seats applicable with ree A to title II.

er inec see Heat.tse Cans Paeceassa.-tt) Sebject to (31. the See-

~1st Avet.seavsnee en Teasessenvoose ce Enctaseson.-41) An indsvid-retary shall eseresse the motherity under son (bt in a snonne, wel or entity enchsded ter directed to be escludede feese icipotion thet reewite in en individeers or entity's esclusion frenn all the under this section or section ll2ftA mey appl-to the m

. in r'""'--- emder title XVIII and all the Starte heelth core pvogreme the esionner specified tlie Secretary in restubstione end at the eved m which the indiviehsol or entity eney otherwise icipete.

of W minimum per of esclusion provided weider owheection eco te

• 12) The Secretary shell pensnptly notify appropriate State end et noch other times en the Secretary may provide.,for termi-nation of the encianion effected under this meetion or section ll2ftA.

esency admonistering or owpervising the administration c( each State health core program land, in the case of en esclusion effected

• 12) The Secretary eney tenninete the esclusion if the Seew pursuant to embarction tel and to which sectica 304:enSt of the determinea. on h besse of h conduct of W opplicent whic 23 tmcitre Controlled Substences Act niey apply, the Attorney Generalp-occurred efter the dote of the notice of esclusion or which wee enk iewn to the Secretary at the tonne of the esclusion, thet-

^

i

• 1A) there le ne heele under outesetion tel er (b) er section servibe wee Fernesteed that tine pseyeielen suo met lAed avea ll211Afe) for o cesetinentsen of the esclenose, and ise o snedsm1 specialty by a susedsel speenalty heard

'1 when b indevedual wee not se certsfied, or "f!) there are remmenekse _ _ _ _ _ that the types of actseno whsch forsned the beeio for the orgtenel esclassen have not

• 199 is Eer o needecel w other itene or servees Aarusistied i

4 recurred and win not recur-during a persed ise whach 48ee wee encheted usador the

,w under wDesch the was smede pesoment to e "13) The A..^-, ohnft presseptly notify each _,d_

• ^_ _ mate dete,.r.netsess fSE. Il6elb) (so isi ellect en Septesuber 2 the L. __, usedre t9 mis asetsen er under edannistering er super-is t)w edenise of each

,,,g,,,,

g.'t. I Amer. e State care progreat (and, in tiw came of en esclusion efErctoid 19R21.18 Ends N ise ef5ect en the date of time enactoneset er U8C 7 1

^ to ouleectsen (e) esed to whsch esetiese 3 Deter 56 of the Strelled Substestees Act sney apply, the Attorney Gesseret) of the h h enow Petsent and W Protection

"'8C'P st tse est.

Fact and esecessestances of each termmeteen of eachssion neede useder Ad d M. er 19964 er".

MerR-l (2)Sedsinn 112RAfeN2)is essended-i h

ee State Hantsie Came Paeoames.-For perpense

1. ,, ggg,3 Muut, p. W.

ef this certiess, esed sectione i12RA and 11259, time terne " Mate heelth g,g, f.

g, et h M **w (Dp en W W = -

a tsc tset.

State plan appresed under title XIX.

uet RG g

I1 RA a*

entended-

" "C *

""I % moder eisch

.g of such autosetsen t)w, W_., w(2) and before the end emett (A) by insertisig ener te air

• (3) any receiving funde under title KK er freen en M

i a tsc tspf.

eBotseent tee andersuch title 73I Ni myoct to casosage under ude section 1r. mformatsen tInst he kswee or has ru

,i> ces. evee oe rs.a -Fe,,.ri se.f e.has.Hes.ies.ed a ).e

===c la physiesen er other individual is concedered to have been

• convicted-met y es ;

g, er,,,,5,,.

gy,,,,_

is fiotee or -8da-A== and that eseld. __ --, be cepeeted to

• EI) trhese e Ju4nsent of convic* lose hee been esotered anoinst safluence ele dessen when to discherWe such pesen w emether l

the or isehvidual by a Federet. State. er local court.

Ind*d**l I'** #8" heeP'tel;". ed es whether there le en appeal pendisq er whether the 18)in the smetter felleerung verugveph(Sp- -

i

~

consheet hee been espunged.

$sr each indevident with respect to eb,falso er selefood-er conviction er other record eletsag to criminal ti) by insertseg 7er. in - under

.. 634 818A88 1

• (2) witen there has been a fheding d against the physi.

Ing infernmotion wee J' before alw pered at the end of i

clan er inehvidual by a Federal. State, or I court; the first h j

• t3)whene of guilty or suele contendere by the playonelen (ii) addiay at the end thereof tim followhq sww eco-er inshvidual been accepted by a Federal. State er local tesoco-addition the Secretary ammy snake a _ _

court;er tiese in the seeme peecoedesqr to eachsde slee geresse frome

• t4) wisen the phyoielen er indwishmal hee entered into portici.

participation ise the progresmo under title Kvm esed to L

poteen in a f5 ret offender er other progrene where Jinignient of direct the

^

to enchede the pereen fresse, C,. -r _ _ State r

conviction hee been withheld.".

^' ~ ist any State care progresa..

Ib) Spartres ce Lasserassess est AcTeosse.-Subesettese (cNI) of see-setsme.asonernev runt.mn..

tien ll28A (se redesignated by sectiese SSISteMIND) of the Oensibus j

1 (e) Geotmas see lesseerrion.-41) Sect;ese ll2RAleWI)(42 UAC.

thedget neeerwa=H-= Act of 19959 is essended by adding at time end 13:We-7eleNIH is oneended by striking "the Secreterg determisese" the following new senteseens' " flee A. ^.- i smay not instieto en

[

end all that follows through "; er" and inserting the Secretary actsen under this see'iese with respect te any classe later these sie t

deterneinee-yeere ener tim date the eleim wee

^ - _"_ 'llie L. ^ _i seer 7A) is for a snedical er other itene or service that the mitiate en actmen under tisis secteen h serving netsee of the setion person knows er has reemen to kneer was not provided as cleinned.

g,, any nienner motherised by Rule 4 et the Federal Stelse of Ovil Pree dur,.".

se tscey

• tB is for a nueshcol er other Inesse er eer,km and the ic3 c,,,,,,,,,, assessenswee.-Saheectissue feA EdL (st and th) of persese kssows or has resser. to kneer the eleien is fietse er s'audulent.

sectnese II2RA oro each esmonded by striking "

y er enano-sesent" and insertang "penesity. ensomment, or each plees

• • to is preerseted for a peepadelsse*e service ter ese itesse ser service incident to e physician's services by a pereen who ggERevue Paveemer se Recomesse to Spees Aa""*""-

knowe er hee reemen te know that the indevahsel who Soberetion (fMINA)of sectmen ll2BA is enmended strikisig"egnal to furnieleed for -,...cf the f. _ l' en the servece-

"til was seet heensed se e phye;sc,ien.

the State's ehere of the menount paid by taw agmey and "tii) was licenord as a physicien, but outte leeense had husertuig W the sesne proportion to the total enuseet secov-been obtemed through e -.6_^_^ ion of nieternal ered as the State's shore of the enesesnt paid by the State egency for fact tincluding cheeting on an enemination eveguired for such claien beers to the total asnoont pid".

licemmst, or g,, pg,,,c,,,3,,,, m_c_ _ ;; (h)of esetion ll2BA is

• tiii). y. __. _. to the patient et the tinue the Further semended by inserteng *the. m.:_ State er

^

er eeper,uing tlie adensaistration of 4B'g*

"""-8*P9.* y *

==

es

• i

?

131 STAT. 698 -

PUBI,st,* I,AW 100-93-AUG.18.1987 PUBtJC LAW top-93-AUG. IR,19fff tel STAT. W19 f.=ar, y em.

heelth care pregesmo tem defined in ocction II21erhn." ener "presso. -

^

of tBue value of tBee smede by emete oncle r

sienet ormonisation.~.

sadevedeel or entity under the centract, noe tf) Aretsratune ce Streperna Poeren aws leastssectsva Pt,wses.-

"siis in the case of en entity that is e r.i'u of servecen Aasr.p 84.

Settien Il2ftA is forther amended by adding at the end the following tes defined in secteen IIIIsttent, the permes. discleese (in each at13sc tspte.

new embocctions-form and nienner es the Secretary..,__; to the entity at tJsc ses.

't The prownesens of soberctions ads and fel of sectiese 295 shell ond, upese reqqiseet, to Llee Secretary the enseunt vecerwed y with respect to this section to the some estent es they are from each such vesador w'th respect to purcheese made by eppliemble with respect to title H. The Secretary mey delegote the or en behelfef the entity.";

=

authority granted by section 205 d9 tes snede opplicable to this (7) in embarction (et by striking "er hasne tweltle og acy les sectioni to the Inspector General of the Deportweent of Heekh and these ternie eve

,4 ? in this titlet esid sneerting "hosme Homen Sereices for purpoore of any investigation under this heekh estency. er other entity for which cwtifiestsen is egened.

e,cti.

under title XVH1 or e State heelth core progrem'; and at tisc sses<

1 th e Whessever the Secretary has reemen to behese that any person est in subsectmen edt by striking "this tstle" and insertig l

has e9eesed, is enregnig. or is about to engeste in any activity wbch

" title XIX~ each psere it appears.

et UsC IM l

snakes the pereen subpect to a civil monetary penalty under this ibt Ceneweas. Pewan.rses con Pwvescsaw h-section. the L.h sney bring on action in en appropriate district Subsection tel ef such entsen w further amended-court of the United dietes ter,if appliceble, a United States court of (II by etnkmg "er" et h end of (34 i

f2

1. et the end W NW any territoryl to empoon such activity, or to esejoin the pereen fron, wq**E * #'

cessceoling. ressecesag. em- - "_ _ d s. or C ',. of enarts wheh I3I e civil neonetary penelty if any sec may be requested in order to penelty were to he or to seek other appropriate relief.,h pseeesets se causes to be presented e cloine for a phyee-cess==

e servsee for obch W sney be usede useder a prp sett". s. (1tteetMat. PeMAS.TH58 FvsEt ACFM IMTot.Y9 fee; serfsM* Alt 0C Asen tender title XVfft er a State heekh core program esed knowe STATE sestas.Tse ramst ratew:mAmn that the indsvieheel who furnished the serence was not heensed tot hecsewsCat. Asseweservers.-Section 1999 f42 U.SC 139dhi is ge, "R er Set'viese 187Md) me Bet'esow H2NRiel.-

• • '*8'd -

Subsection (d) of section 1877 (42 USC.1395 ant is.. "

22 es tit by ___.

_ the heedsng to reed as follows-embarction te) and is transferred and inserted in section Ife9 et the et Usc asseet end thereof.

• • cstessesent eewat.tvee cost acts esevos.vsseo meseecame en orate g p.,,,,a,,,,,,,, gag.vesse 1999 at Usc.

,,op.

ess,ess.ed i., seb.ecuene

.me S.eerso,n 11298.-SecGon so - can - m

i. of. esetsen. i. -

i red-no-d - -

n=== - is t-f- * = xi ed - '=

u (2, in sub ese t..i b, stri.

. St.te s.

et Usc tses.

ender this title" and inserting **e progreen under title Niilg immed entsen 28A.

enbmerHose IdlUneroef which

(

e State heelth care presteeni les defined m section ll234thM" E3 in the snetter m subsection tot follownig peregraph (4f. by wee transferfed under subsectsen (c) of this eretion) is repeeled-

+

i striking "this title" the first place it appears and inserting "the ssEc, s. sesenerseavson <mescassenso taasecvsons taasp er serats pregram ;

t smenessc Atryssostryses Acaewer senat.tw came pnacrs.

tot in the last sentence of soberetion tot by striking "this Traversts Asse rnovenemm.

title" the first piece it appears end inserting " title XIK~. and by at Usc tses tel Reesecasep Puse Roguesessepe-Secoon 198Sa) (42 UAC f

striking "this title" the second piece it appears and inserting thet title 139tietett is essiended --

M=t.ee pt.eDe e

ill by striking "esed" st tine sund ef,-

. *(484 (5) in peregraphe flNAL tinRt. dNAI. (2WBt. and (34AD of (2) strikisig the persed at the end of'the,._.,. " (47)

==a==, tion tbt, by striking "this tatte~ and inserting title XVllt addeel ion 94thet of time Osnmbus Budget ReconcIltation

}

er a State heekh core program ** coch place it appears; Act of 9146 and ---.;.4 e scenecolon esed ^ u' and at tisc tseen.

46)in emberetion tbs 36-inserting such peregraph eher -._," 1464 (Al by striking "and" at the eved of. } :. ". I AL (3) by striking the et the end of the perugveph (47)

IBt by striking the persed at the end of _ _, _..__, *_189 edded by section 11 of the Anti-Drag Abese Act of 1996 et Usc135em and inserting "; end", and and inserting "; and'. by redesgtneting such peregraph as i

1. C) by adding at ahe end the following-(48L and by t._

'....g and ' _ _ _ ^.4 such pere-

"tC) any amoesnt paid by a vender of goods or servirve to e peregraph 147).end 9sereen authorsned to act as a purcheems estent for a group of

( ) by wiserting eher peregrepIn (49) the foNewing seew i

mdividuels or entitien who are furnie hing services reimbursed peregraph under title XVIll or e State health core program if-

• t499 precide that the State win precide leefernanteese esed

?

Om=*earta "til the person has a written contreet, with each such eteens to certem saforssistsen respect eenctions teinen egesseet individuel or entity, which specifice the amount to be paid heelth core practitionere and pree by State licensing

}

the person which amount may be e fixed amount or a fined authorities in accordance with section 1921.".

not p. ese.

r

[

- - ---- n n -

~

heaux IAW' 199-93-AUG. Ifl.1967 (b) *.

' l'.t STAT 991 ing section 1921 as sections 1922 and inserting efter section 1929 theh Regossen.-Title XIX le essended

. e tfBcIsues "est to hospitete sad other heelsh core entities een deGird in followsag new ocction-section 4 t1 er the Health Cme Quelty.?-~_ -..; Act et sesusen,.

l'oWo. with respect ta physicians or other licenerd heelth core vari'a==

,,sseecessavson cosecsonsseo sessevnesse vasen av stata utessenespr:ctstionere that have entered ser may be enterinste into en 42 taec tetst.

atrTecometsen acaspeer senat.vu cans pea..m._ ano enoessess em;L,..-..; er ofElistion relationship =4th. er have opplied For

+

Sec. 1921. (e) Issesseemtsose Itsecovesso 7 -- - n -h cimecel privileges or appemtssients to the needical o aff of, such er tpse tsuerd s

A ar. e see, ele or other heelth care entities tend each ? '.... ^ ion provede for the '"_ i..sogenossent ederved to in sectson 1902telt49) is that the State must ohn I be deemed to be deoclowd perseent to section 427 of. end 7=.,ve m. set.

l be subpret to the provisiesee of. thet Act t.

er tsee sim.

i in efFeet e oystesse of re"lH Inseessatson esconvesso overuse.-h State nouet have

~873 to the Attorney Gesneral and such other low d.m.._..;

respect to forneal p porting the folleensig infernestson with emeiel,== the Seevetery deems appropriete, and

(

". too defuseet by the Secretary in 714s upon regocet to the Coewytroller Generet.

tugulatis.nel conehsdeel egoinot a heelth care in order for much notharitien te determine the thrices of inesideolo entity by any authority of the State ter of e itioner er to provide heefth core services, to protect the heelth and safet thereoD responeeble for the licenomg d embdiession h cere practs.

individenle remving heelth care threegh each pregreams, of tieners er entities-protect the fiscat ~mtegrky eroesch programs to

• TA) Any adessee action taben by seek Ileoneing mother.

~tcl Onneenememany oc leernessation Pucevees.-h Secretary Ity se a reendt of the proceeding, isichading any revocation ehell provsde for evitable safeweerde for the conrelenties,ty or the..

(

informotion fornishmi under estueretion s t Nothing in this subspe.

er omspenomen et a Heesene (and the length of any such e

tie shell suspenesent, reprimiend. censure. er probationJ t the disclemore of each inferenstsen by e party i

l "tB) Any diornissel or closure of the N "

which is of ice authorised, under opplicable State leur, to metic by reason 8ch disc!coure.

ef the practitioner er entity a....1.;-e the license or leeeing the State orjoiRedictson.

"ed Acesoreta i

"to Any other less e2 the license of the practitioneer er the mensmem :;ts Coceernavson.-The Secretary shell provide for i

coordonetton in the..-

-,..;stson of j

c,.-

entity whether by openstiese of law. veteestery surrevider.

embention tel of this section end, acetion 422 of tive Health Core I

9'*Id or C.

7 'niwenent Act of 19R6..

(

at17sc tust.

str. s. usesAsatwes ese 90EAf.M CAWE PetAmT9MO:stM A%n PWt TOstF8

""'I

~

'8" ***

I*

Section 1156 442 U.S C.1328e-51is eenended-

".]M

)

such

~

the

.E - t e H by striking " title XVill" and ** ouch title" in emboettien tel

, eny be secreemary for the d

m.

7 o U ".

._the and as and insert' "this Act"" in each instance, and 3rcenestances concerning the actione esed deteroninetieses de.

(

"this Act~ eech place it *PP""*~82 by stri isig " title XVill" in embeec rrebed in e1ch ;_.

..c. For the purpose of carrymg east this

(

4ct.

t

4) Fosse or Isseenesassose.~h int %rnietion demerilwd in==h==e.

see c.t. Etttswome tweseta vest ses:sserAfD fit M;RA10.

I tien (altt) shall be provided to the Secretary ter to en appropriate 3,,,;e, 3,02142 U.SC.13'esbt is emended b er pubise esency under suitable arrenamente snede by the m;,, nits added by section 3ibe f the E- +",y wdeeinneting the I

^

i wMb respect to soeript. stermese, protection of confidential.

for thenbled AM_.

Act es emteection tot end by inserting efter o

.-.. Opportunities ity. end diesenninetion d * "1.

^h)in eisch a form esed snensier as each sobeection the fol; awing siew subsection:

etitse samen i

the i "_.

-_ to be n..r.'

in order to provide fe" spo1: In addit:ces to any ether methority, o State sney eachsde any

.=ar,e eos i

actiestano d almetly er flarsegh under titis Act and in order to preende, individual or entit for purposes of porticipating tender the State

^'

errengensente omede by the Secretary.

plon e., der this tit esclude the individuel er entity fresrifor any reeerin fe-which the L.

^-.y could j

"II) to egemetes icipetiese ese e prostrom

• '_ ^ 4 Federal lineith care progrenas.

under title XVill ender sections 18254. II A, or lesfiEsbet21.

Including private entities administerosig susch progrenes under "t2s in order for e State to recesse payments for snedical monistence attMectsek

contract, under section 190: hen. with respect to payments the State seeolice to e=*ggem.

• T2) to lleonolog authorities deserted in mahamrtion leltD heelth - --

^_.._r., ergeneration too deGned in section 19031mW or Q,,*

• 13) to State

- - '-- d

_.mo er susperviseng the to en entity fornishing services under a weever approved under et tisc d

~ ' ' -

tw

~* ~*

^

e=er.p eie.

section ll2RihM, health core programs too defitted in ecction 191Jbop, the state snaret provsde thet it will cochsde from porticipation. se each on crunnitetsen er entity, any organitetier. or er treec tason.

i tiesis L.il he part B of title XI and to approprsete entities"l4) to utili==e8== esed spoolity centrol peer entity thet-it tset tssee.

"tAs constd be wLil under settiwn ll2RebsMi trelatinst to

<217sc 122er-3 with contracts under arction ll64telt4 NO with respect to eligible e=nere end -

' _ _ _ reviewed sender the contracte.

certain crimes or rece,imi ether sanctione'. orn Ar. who hav-bwn convice, of s.

551 to State assedecend freed control unite fee defined in

" Ills hee. directly or indirectly, e embetantiel contractuel wie-2179C IStek section 1983h )l.

tiembip des denned by the Secretaryl with on indsviduel er Osmereret l

entit, tW4 is i il in ocction i12ftbuMeRt i

e 1

NN'

~~s e **

UC Ill.1987 PUllWC LAW 199-93-AUG.18.1937

' ggg gray, "t3s As used in this embarction, the term 'eschsde" includes t'he talin peregraph :27-refusal ta enter into or reneur o participation agreement or the ait by amendmg _. _,.

^

". EAl to reed se reflows-termination of such on agreement.".

• 1Aleveludme e phyenesen from porticipation in the progrome Mer.o. me=itts.t.Aweses Avv empism19tw AeN.SpsO9tpsT%

under this title for e period not to esceed S years, in sensedence with the procedures of submedsene tet.tD end eglef eection 31234, g, gp tel Mavenwat. awe Cmts Heat.vn Poocease.-Section 564tbt (42 er.end US C 704 bn ie smended-tiis,67 mrikiny "borred from porticipation in h pen.

(II by atriking "or" et the end of peregraph (41 gram m the estesed seretence end insertme "eschsded frism (21 by striking the persed at the end of peregraph (51 and po'ticipation in the

" end inserting ": or", end iB' by =triking "her,.. _ _ _peregraph 43uAI and inserting in s3s by oddmg et the esed thervef the fonowing new peregraph.

"esclude" "ttil payonent for any item or servste tether then en eneer-831Section Ifus2the41142 US C 13psyihadw is amended by striking gency item er services furnished-

,peregraphs (21 end 835 of euheection adr* end insertmg "sohnectione "I Al en individuel or entity during the period when let sf). and ist of section I12N".

such ~ sviduel or entity is escluded perement to section (49 Pererraph (39 of section ' IflRliift (42 USC 1395,wtrie is Amer.pp.ene, 1128 or section ll2MA frmn participetson in the program amer. led to reed se follows:

8"E under this title.or

• 13: The proviesene of ouhecctione tel through egt of eretion !!28 "IBI et the needecol dieection or en the prescription or c

. hell opply to ia /

ione made ender peregraph m in the esine physicson during the period when the physsenen is eachsded menner es they apply to coclue,one effected under sectig,n purseent to eretion 11278 or section ll2AA from perticipe-II2nrbal3p.,

i tion in the progrene under this title end when the person it Tesenwaesow or Phoemen Acesessesers Usesse Mesecame.-

i fornishing such itern or service knew or had remmon to know Section IMGG (42 US C 1395cet is amended-

+

of the encloeien (ofter a reasonalde time period efter t ilin sebecctiers tes -.

reemonable notice has been furnished to the persont".

t A9 by striking y.,.

" g31, and tbl Dmetmouse Regeneeseesers_--411 Subsection tel of arction 1126 Bs by redesignating peregraph (49 se -,. J (3s-(42 US C 1320s-5s is ;..

..AJ-m by amending subsectson (be to reed so follows-talin the first sentence, by striking "or other institution" and "the19 A provider of e=rvwco snef terminste en agreensent with I

all that followei through the persed et the end and inserting "or the Secretary under this section et such time end upon such notice other entity tother ths.n en individual practitioner ar group of to the ~% and the public so sney be prweided in reguletiene.

~

i practitioneret shall be required to disclose to the Secretary or to

]78TheS'ewterythat netste of snore then sie snenths shell not be reggewe the appropriate State egency the name of any person t1 et is e refuse to enter into en agreessment under person demerihed in subperegrophe (Al and (BI of ecction then sectson or, open veesonable notice to the provider and the II2flibuR)". and public es sney be spreified in regtteletiene. siey refuse to renew or tB: in the second sentence. by striking " institution, orgenssa.

may terminete each en agreensent etter the S,c,etery-tien,or egeney" and inserting entity".

"I A t has 4.

l that the

.O. feito to cessuply susheten-(2) Soberetson (b) of such section is emended by striking "instite.

tieHy with the preemosons of the.....-.c. with the pro,sesone tien, orgenization, or egency'* ar d inserting " entity" each place it of thee title and nvtwletiens ;"-.. l.. or with a corrective edien repsired under section IMfWif1:28 Bt.

I eppeers.

le

• 1Rt has M.

.2 that the prweider fails substantiefly to tcp Messcame Pavesesers.-fli Section Ifl62 (42 US.C 1395y emended-sneet the opplicable prowsesene et section IftEl. or e tfsc tses.

(Alby repeeling subsectien tdl. ond "tC) hem escluded the pro,sder from portiempme'ag in a pro-

?

(BI by amending subacetion ter to reen; se follows.

• 1f* A termination of an enveement or e refusal to review onunde I

• 1el No pe3 ment mey be made under this title with seepect to 13Een-7a i

eny item or service tother then en...-.y..g item or servic,,

furnished-dote end m, vnder this saberetion ohell bensme effective en the emme egnement the emme menner es en ceclusion frism porticipation "II) by en indivsehsel or entity during the period when such t r ier t,he propreme under thh title becomes effective onder acetion indivishsel or eretity is escluded.-.

O to section II28 or In2Mict ;

l section ll2flA from participetion in the pengram under this 139,* peregraphs til and (29 et oubacetion kt, by stribhqg "aggy title:or agreement filed under this title by e

...?. er arrvices hoe "t2) et the snedical direction or en the prearription of a been terminated by the Secretary" smd inserting "the Secretory l

phyeecian during the period when he is escluded pueseent to has terminated or has refuerd to review on agreement under i

arction I12M or acetion I12RA from participatian in the progrem this title with a provider of services":

wnder this title and when the pefoon fornishisq ouch item or 149 by sneertnq **er._.. ;..e;. " in subsection tel efter service knew or had reessa te know of the esclusion lefter e

" termination ceen gdocc it eppeare; end reasonable time persed efter reasonable notice hem been for-f.M by adding et the end the following new eesbarctien-t mehed te ttie persont".

• 1htli Encept en provided in peregraph (2t son institestion or t

(2f Section 1842 tit (42 US C 1395eQtlis ensended-esency dienstisfied with a determinetson by the Secretary that it is I

i l

i

__,m..

.v a.w -. h w --

PUBUC LAW 198L93-AUG.18,1987

.m

- tel 31'A1 !

test a pe elder d serTIces er with O dew desefIb80 I#

embosction abMS shall:he entitled to o heersag fliercen by 'the til T>rts XX.-Section 2009e) (42 USC 13pMieN le asnended- ~

1 secretyy tener reasonside noticep te tf o sense estent as se provided (1)bystrikisig"er"at theenderperseveph(7L ~

u t,nic a in section 295tbt, and tajediciel re,ww of the Secretary e finol (2) by strikin deciesen eher such heering en is provided in section 2ONat inserting" or".g (fie persed at the end of peregreple get and ~

and "t21 An institution er estency is n A entitled to notice and (3) by addeng et the esed therver the following new w. " -

)

w ' en opportunity for e heersna esader both section 11' end this section

• t9) for yeysnent for an

,ith to e 2... _ _ ?

• ion er determnietions based on the

_.,r., seem er serviews "y item er servoce tether then 'en --

.f * -

some ying facts and issues.".

tA) en ifU "

" or entity durmg the persed whose.

te) coneveenno Ameeneseewr.-Section 1989 (42 USC 1395m is such el or entity is esesoded perament to section emended b striking subsection (cf.

112R or section ll2RA freen porticipetsen in the program f

4euse: =

m meescaeo Ptan Revanone.-Section 1982tel(42 USE 1398 blew under,this title,or Ae.se 5 ow. ye 88 is enended-sep-

,g et the needical direction er en the prescription of e s't -

phyescion dorsag the period when the playoscion is eachsded (1)in peregraph (23), by insertintf ~=h==rtion (g)and in ener "cocept as provided in",

purement to arction 1128 er eretion ll2RA from porticipe.

I (2) en peregraph (38A by striking "respectively. (Af* and all tien in time program under this title end when the peam that follows op to the senneelen et the end and inserting "the formehing such item er servsce knew or had season to knew infersnation described in section 112Rlbl(9f" and of the eschsesen tener a reasonable time persed eRer (3)in (397-r,esonable seatice hee been formehed to the pevoont".

Q) Damas, Revocation, ce C

_- or Recsernassen To

( ) by streking "bor'~ and ' _ _.^J.w "esclude".

Mawtreacsves, Dieressens, en Diseenes a Coeremos.ame Sveerasoce entity"y striking " person" and inserteng "individusi er (B) b l

each place it appears, and

,oe Everrreos Escwees Fineer vsee Mesecast Pesoceans.-Section (Cp by inserting "or ocction II2RA" eHer "section 1125".

304te) of the Controlled C ^ ^

Act (21 USC 824 ten is emended-(g) Densas. or Fasemat. Fnensecsat Paersesearsow Uween Menec-aeo ru'Io._. ". (2) of ocetion 1983 rip (42 IFSn 1396btin is amended ID by strikles "er" et the end of peregraph (St to reed ee llows-(2) by striking the period at the end of peregraph (4) and i

"t2) with to any amosent empended for en let=m er inserting or",and service tether t en :-... 4 item er service formehed-(3) by ing mRor peregraph (4) tlee t"_

.., siew.

"tA) under the plan by any indevedeel or entit during peregraph, "t5) has been escluded for directed to be escluded) frusne esey period when the n./ _" : er entity lo esel from J

'ious in e porticipation in the State under this title pursuant to QI$scurity Act.y paroisent to sectaen ll2 Riel of the

~~

-1;;';'2,", gi he: o, e,e ti,e,ees.ri,oose of.

et, re i

,s physicien, during the period when such physsenen is es.

- e. t- -

sanmessemns attor mu.

claded purement to section 1128 er section ll28A from Sect porticipation in the p under this title esid when the gn.3g, ion 23731c) of time DeGeit Nedertion Act of 1994 (Fieblic I.sw person f. _ "..., such stem er service knew or had reason

.9R Stat. M 12)ie amended to r==,1 as follows-same asisese to know et the esclusion feRer a reasonable time persed

"*tc)t t) The of Health enet f wien Serviene shall seet tube D8C 885 efter ressenable notice has been ftsenished to the percent.

any m /

x.

Iowance. pre., or other.

" _ _ _, actson I

th) Me.necase Cu. a Assewoneswes.--41) Sasheection in) of egoinst a State with respect to the m,oraternsen per,iod described ise paragraph (2) by reason of seeh State's plan described in paragenple section 1903 (42 USn 1396b) is repealed'US C 1396mley is er.eended (5) under title XIX of the Seesel Security Act tincluding any part of (2) r

"_ (2)of section 1915qe)(42 ge,seg oglo.gfoise-the plan opersing porouent to settlen 1982tf) of such Acta or the seuse asos.

operation t".. _ _ f.. being.".

"12) Restricts for a reasonalple persed of ti8ne the greender er et trse essen.

freen whleh en individemi qeligilde for nwahces assistence givt, tyg -

_l to be in vietetion of clause

,r (Vit of sectson 19021eMiellANiil or sectsesi itenis or services under the State plen) con receeve each itene er 1992ieM19NCliinfft) of such Act en account of such plese*e ter ice operation) hevoeg e etsaderd er ul -

,,,, ices, gf_

%) time State has fossed. eher notice and unity for snterpreto es being less restreetsve than the standard or nc"" ",, which the) t e hearing (in accordence with proceghwoo inhed by the r,qe,,,d usuler eveh sec* ion, powvided that such plan ter its oper.

F"etel, that the individual has utilised such items er serv-etion) does not make ineligilige any indevidual who weeld lie elisilite icco et a freiseency or emeemt not enedicelly n*cesasey tes but for the provisione of this " J --.

i a, _ _ _ _ _ _3 in accordance with utilisation guidelinee esteb.

"12)*llie moratorium persed is the perkd bewiseness een October 1 19RI. and endmg 18 sesenthe after the dote on wisch the A.L,

}

liehed by the Statet and embmits the report..

..J moeder peregraph (31.

"tBl under such restriction, indivaksele elistible for nwdi-col assistence for such services have reasonable eawee "t3711.e %..:., shett report to the t' t

witlein 12 seesothe nes-em (taking into acceamt geographic Iccation end,,NM eher the date of time enactonent of thio Act with respect to the travel tiene) to eisch services of adeepsete quality..

R.,

^_.

and impact en States and secspeq'nte of suwdical l

ensistence, of applying standerde end snethodelerwe utilised in coole t

e

~ ~ ~ ^

• 101 STAT. 696 PUBLIC LAW 100-93-AUG.18,19R7 MLIC IAW 199-93-AUG.18,1987 ggg gpgy,g ' )

sosistevice progressie to these recipeents of snedical --sce who [le ser....==mem or er W,m.

rm e v n,in j

^

enTv~n e y net reccew cash assistence, and any eh-

.. ". ions for chansiae i

- in such myneements.

Sectiese II24tes3sAnii)(42 USC 1329e-3rer3sAsiin is amended

• (4) No prowneson of leur shell repeal or suspend the nuoretorsum by st riking ~325,000 or"~

lenpened by this saberetion unice each prevseson specificolly smende or repeels this emberetion.

spr. er. noneservers As, Acesov As.nr amMAt, noAt.vsus rArst.stsEn.

i 751 In this sebsection, e State plan is considered to, _,,

Section !!Ull (42 USC 1395rri is ensended by addmg et the end

• tA) any amendment or ether change in the plan which is the following new embecction:

~Ihullla eny case where theSecretary lity ins not in subs submitted by a State.er "tA) rmde thet a renel dhlysis reci "tB) any policy or guideline delineated in the Medeceid oper, stion or program nioneele of the State which are submittee by c.mps;ence with,,,,.i,,enente for such feeilitice pe, scribed e

under subsectio i tbulNA),

~

the State to the Secretary.

whether belece or efter the date of enactaient of this Act and "tBI f~mda that the facility *e deficieneses de not *

._2 ; 'y jeep (C) has given the facility a reasonable opportunity erdine the heelth and esfety of patiente, end wheth=r er not the amendneent er change, or the operstmg or progrene nioneel was,,

2. J,. -- acted upon, or not its dersciencies, rect acted upon by the Secretary the Secretary may, in lieu of termuneting approvel of the feeility.

"t6) During the neerstorines perled, thel..^_ y shall I f -. ^

detennme that peyneent under this title shell be neede to the facitety tend shall net change by ademestrative actient the policy in only.ty before the effective dote of the noticefor services 3*enished to effect et the beginning of enoratorhsm period with rompect to.-

Incele "IA) the point in tirm et which en isistitetsesialised ividevedung

• t2) The Secretary a decessen to evetrict paysseente under this noust sell his home (in order that it not be counted as e ressourcet evid submaction ohell be made effective only eRer such notie to time i

public and to the facility as sney Ise presenbed in reguletione, and "tB) the tinie periest eBowed for sole of a home of any such shall remem in effect, entil (A) the Secretary rends tiist the facility is isodiht.

m enhetantiel compliance with the recluiremente ender subsection who is en applicent for er e4.. ^. *if sucedical assistence under the (bMINA). or (R) the Secretary ^e :.

^a the agreement under thie State plan es e needicell needy individual (deoersbed a section

[

A.=,, ens.

1902 ten 10NC) of the Socie Security Act) or se en optione catetton-UQ'g h,,,

I i'

l j

eS4 cally needy individtsel (dreenbed m eretson 1902te410NAMii) of such under g-e.,

Acil,-

g g. (1) ehell be esetseled to a heereng thereon by the g

in orcion 205fbt, and to jusdeciel revsew of the Secretary's fmet SEC. to. IJeftfAftoft OF IJA99t,fTT OF SIE99 CASE SENEF9CtAR9ES 1etT98 et tpscses.

dectosen efter each hemormg as is 2 in section 205tg).".

RESPECT TO SERVICES FtfReet9WED ST EXCI,tfDED fMDfVfD.

r.

tfAt,ft AND 5.MTfffES.

9,,y., ts. AnfENDHENT REE.ATWec TO FRAtfD fMv9t.YHeC MRDOCARE Title XVitt la emended by adding et the end the following new st!Prt,EsetMTAt, tNstmAlett

{

• • hnowingly or willfully" and inserting " knowingly and willfu section:

"t.fte"rAftoer ce tJAsetJTT Oc ses8eesCSAetes WrTit mWeecT TO seovsCSs 9eJC. e4.MT4aggeggsg pgg Airyg ggm3mm pgggggggsput.

ruentenee er enct.trosto esecevsouAtm Ano eteTTTves i

(e) Rootst.Avsosse 'The Secretary of Health and Homen Servicea, o ma.ut "Sec.1990. Where en indiendeel eHetible for benents wwler tisis

,"g"*he Aj,terney lots then yeer mem ht ertpse assa a I

42 tisc tssenen title sabenste a claim for payssient for iterne er servicce furnished by

• tl,

p_g g Amer. p, eso.

en isodivkhsel or entity escluded from partscopotson en the programs reguletione, and not leter then 2 years efter the the enact-es9.e2 Use onder this title

_ to ocction 112R. Il2flA.1856,1160 fee in ment of them Act shell promeleste finet regruletiene,

- ying

'N gw,~

effect en M, n.2.19R2), Ifl62 tdt (as in effect een the date of the payment practices that shelt not Ise treeted as a ' '

enense enactseent of the Meeheere and Medicend Patient and under eretion ll2R9fl9 ef the Seelal Seewrity Act esed sher not serve A.et y esp.

on the benie for en estelusioen wonder eretion IttittbR7) of occh Act.

Amer. pp. evt.

Proesetlen Act of 19R7), or 1f166, cad such benersesery did not now A et,t eso.

or heee reason to t< sow that Sach mdividual or entity was so Any practices specif' sed in regreistione purement to the preceding ess escluded, then, to the extent permitted by this title, and footwith-sentence shell be in addition to the practiceo described in subpoes-etanoing such ed - - --. pm t shell be made for each items or grapho t At through tCl ef oection II2HImbu3p.

services. In each emeh case t Secretary shell notify the benefstiety tb) Coenemat. Vsot.ntsove.-Section II2BRibu31. as amended end er tage of the esclusion of the individual or entity furnishing the items or g 4 -d by eretion 4 of this Act,is forther amended-assen-m servicco. Payneent shsil not be made for itenne or services furnished til by striking "end st thc esed of (Bl.

by en escleded individoel or entity to e beviereenery after a re onon-(2) by strik' the iod et the end of ou (C) and gene, ting ";

". e oble tinue les determened by the L.v"wy in regulational efter the i

Secretary has esotefied the benericiary of the excitssion of that

0) by addmg et the end thereof the following view r_^

i individual or entity.".

graph t

t e,

~

./tft STAT. EB51 '

PtMitJC IAC 199-93-AUG.18.1987.

Pubax emo ses-s

D-A(Mif18. INEW

' awl STAT. ggy g

*ttM eny payneemt p*ectice specilled by the Seteveery in rege-'.

eft Tsaavesant se Osmenne Denemas se Paveseser.-Fbr perpasse d L lations m.--

L ^ _ f purement to ouctisse lates of the Med6cere section InstbettsBuisis of stee Seeses Sea,rity Act ten e,e.e,,s gy:

and Medicoed Patieset and Progrene Protection Act of 19H7".

ecction 2 of this Actt, o person shell be caseside ed to have beess I'""' F*3*i'i'"

""O * 'E'"" ""8'r title XVIII if " ~e use sess.

, ggy.,,,,,_,

,,,.3,,,,,.,,,, p,Rn.

Socerity so in ef5ect before flee effective date specireed in - Ausr. p es(

to the hem been desierd ender section gesade of tese e

tot les 8h====*

es provided ist solissetions Ibt, tel Odt, and '

'"*'~

set, tlee ernesedneente by tInio Act shell becessie effective at the -

saboretion est.

1

. end of tIse ". _ - ^_._, period bewwniing en the date of the enact-

- sment d this Act and shall not app 6y to sensinastrative

. __..? Aegreat is,1987.-

r. _, -

cosensented befisse el

• end et such period _

tbt Massenvoe, Messessess Exce.comens Ares.v Passenceives.v.-

Amer.p ese Section ll2mes3sBI et the Social Security Act too ensended by this

~ Acet, which reipsirve se enehseson of seat less then five years in the case of certosse esclusosas, shall seat apply to enclassens based on cosevictions securring before the date of the enactonent of this Act.

y ect Erescreve Data cose Osasecas sw Manscase law.~.41 The essendsmente smede by sections 5 and Rfl apply sencept as provided under peregraph (2N to payneente under title XIX ef flee Social 42 tsc tses.

Securit, Act for coisador guerters beginning snore then tleirty ecys seter time date d the enactaient d this Act, wethest eesord to -

whether er not final ressletsons to carry est such asiendneent have 123 In%*- 2 by such date.the case of a State plan for needical sumistence esader title been l

i mese ama temst l-

'a = ='= in XIX of the Social Sacerity Act which the Secretary d Health and l

Homesse Services decerneines segewes State legadetien tether thesi lepsistion ofpropristing feedst in enler for the plan to moret the

^

Isapened by the enneedsmente smede by this

^

Act, the State plan shell not be regarded as failing to conoply with the..,_._ J_ er each title estely en the basis of its failure to nieet three additional..,_.-./ hefere the Twet day of the first calender rpeter begisessing eRer the etene of the tirut segeler seemson et ihe State legislotere that begues eher the date of the l

.enactosesetof this Act.

l t3 Subsection Q) of section ll2BA of the Seeiel Seeerity Act les l

edded by section aft of this Act) tehen effect en the deee of the enactsment of this Act. -

tdt Pievesesan Messmenementavsesse.--Omunes (iil and fiiis d see.

I esa--

tiose ll25AleRINCI of time Seeiet Seeerity Act, se assiesided by sectiese Soul) of this Act, apply to clesnes premesited for services perforvened ese er ener tlee efErctive date specirsed in embeertson tel, witheast regard to the date the noisrepresentation of fiset was snede.

tel Chassescasseer ce Musecase Moseaveesves. ' tine sneendemente snede section 9 et this Act sheII apply as thousth they were inchsded in the enactsnent of section 2Nact of the Deficit t

Amer. p en5.

Ion Actd1994.

IJENERATTVE 90t! HURT-98 R. feed aS SSit 990tf!IE 9tEFORT5 fee tes eE. Pt. t eraamme. aus Busesy and Osmemmerece ame Pt. 2 vossess== Weye and sesessee.

SRseavE stEPORTS feo see-sen _

-[

tUnt:see5MetMeat.RSEXpeD.Vas 333 d9stfr,,3 est sh.en yimane,e.

>==-s.2.e d-dand,mm-dso t

Me 2's. commised and on-d seamen. emmended, an une et!L est.

J sy me, se, e.nr,,,,e 3,

e, e

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