Page:United States Statutes at Large Volume 114 Part 5.djvu/577

From Wikisource
Jump to: navigation, search
This page needs to be proofread.


PUBLIC LAW 106-554—APPENDIX F 114 STAT. 2763A-537 to place the individual's health at significant risk, or "(11) to discharge the individual from the provider of services, the individual may request, in writing or orally, an expedited determination or an expedited reconsideration of an initial determination made under subsection (a)(1), as the case may be, and the Secretary shall provide such expedited determination or expedited reconsideration. "(ii) EXPEDITED HEARING.—In a hearing by the Secretary under this section, in which the moving party alleges that no material issues of fact are in dispute, the Secretary shall make an expedited determination as to whether any such facts are in dispute and, if not, shall render a decision expeditiously. "(G) REOPENING AND REVISION OF DETERMINATIONS.— The Secretary may reopen or revise any initial determination or reconsidered determination described in this subsection under guidelines established by the Secretary in regulations. "(c) CONDUCT OF RECONSIDERATIONS BY INDEPENDENT CON- TRACTORS. — "(1) IN GENERAL.— The Secretary shall enter into contracts with qualified independent contractors to conduct reconsiderations of initial determinations made under subparagraphs (B) and (C) of subsection (a)(1). Contracts shall be for an initial term of three years and shall be renewable on a triennial basis thereafter. "(2) QUALIFIED INDEPENDENT CONTRACTOR. — For purposes of this subsection, the term 'qualified independent contractor' means an entity or organization that is independent of any organization under contract with the Secretary that makes initial determinations under subsection (a)(1), and that meets the requirements established by the Secretary consistent with paragraph (3).

"(3) REQUIREMENTS. — Any qualified independent contractor j entering into a contract with the Secretary under this subi section shall meet all of the following requirements: "(A) IN GENERAL. —The qualified independent contrac- I tor shall perform such duties and functions and assume such responsibilities as may be required by the Secretary to carry out the provisions of this subsection, and shall have sufficient training and expertise in medical science and legal matters to make reconsiderations under this subsection. " (B) RECONSIDERATIONS.— "(i) IN GENERAL.— The qualified independent contractor shall review initial determinations. Where an initial determination is made with respect to whether an item or service is reasonable and necessary for the diagnosis or treatment of illness or injury (under section 1862(a)(1)(A)), such review shall include consideration of the facts and circumstances of the initial determination by a panel of physicians or other appropriate health care professionals and any decisions with respect to the reconsideration shall be based on 79-194O-00 - 19:QL3Part5