104 STAT. 1388-114 PUBLIC LAW 101-508—NOV. 5, 1990 under section 1156G3)(1) with respect to a physician whom the board is responsible for licensing;". 42 USC 1320C-3 (C) EFFECTIVE DATE. —The amendments made by this "°*®- paragraph shall apply to notices of proposed sanctions issued more than 60 days after the date of the enactment of this Act. (2) NOTICE TO STATE MEDICAL BOARDS WHEN ADVERSE ACTIONS TAKEN BY SECRETARY.— (A) IN GENERAL.— Section 1156(b) (42 U.S.C. 1320c-5(b)) is amended by adding at the end the following new paragraph: "(6) When the Secretary effects an exclusion of a physician under paragraph (2), the Secretary shall notify the State board responsible for the licensing of the physician of the exclusion.". 42 USC 1320C-5 (B) EFFECTIVE DATE.—The amendments made by this "°*®- paragraph shall apply to sahctions effected more than 60 days after the date of the enactment of this Act. (e) CONFIDENTIALITY OF PEER REVIEW DELIBERATIONS.— (1) IN GENERAL.— Section 1160(d) (42 U.S.C. 1320c-9(d)) is amended by adding at the end the following: "No document or other information produced by such an organization in connection with its deliberations in making determinations under section 1154(a)(1)(B) or 1156(a)(2) shall be subject to subpena or discovery in any administrative or civil proceeding; except that such an organization shall provide, upon request of a practitioner or other person adversely affected by such a determination, a summary of the organization's findings and conclusions in making the determination.". 42 USC 1320C-9 (2) EFFECTIVE DATE.— The amendments made by paragraph (1) "°**- shall apply to all proceedings as of the date of the enactment of this Act. (f) CLARIFICATION OF LIMITATION ON LIABILITY.—Section 1157(b) (42 U.S.C. 1320c-6(b)) is amended— (1) by inserting "organization having a contract with the Secretary under this part and no" after "No", (2) by striking "by him", and (3) by striking "he has exercised due care" and inserting "due care was exercised in the performance of such duty, function, or activity". (g) MISCELLANEOUS AND TECHNICAL AMENDMENTS RELATING TO PEER REVIEW ORGANIZATIONS. — (1) CLARIFICATION OF PATIENT NOTIFICATION REQUIREMENTS FOR DENIAL OF PAYMENT BY PRO. — (A) IN GENERAL.— Section 1154(a)(3)(E) (42 U.S.C. 1320c- 3(a)(3)(E)) is amended— (i) by striking "(E)" and inserting "(E)(i)"; (ii) by inserting after "items" the following: "provided by a physician that were"; (iii) by striking "physician and hospital." and inserting "physician. "; and (iv) by adding at the end the following new clause: "(ii) In the case of services or items provided by an entity or practitioner other than a physician, the Secretary may substitute the entity or practitioner which provided the services or items for the term 'physician' in the notice described in clause (i).".