Page:United States Statutes at Large Volume 110 Part 3.djvu/267

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PUBLIC LAW 104-191—AUG. 21, 1996 110 STAT. 1997 accordance with this section with eligible entities to carry out the activities described in subsection (b). "(b) ACTIVITIES DESCRIBED. —The activities described in this subsection are as follows: "(1) Review of activities of providers of services or other individuals and entities furnishing items and services for which pa3anent may be made under this title (including skilled nursing facilities and home heedth agencies), including medical and utilization review and fraud review (employing similar standards, processes, and technologies used by private health plans, including equipment and software technologies which surpass the capability of the equipment and technologies used in the review of claims under this title as of the date of the enactment of this section). "(2) Audit of cost reports. "(3) Determinations as to whether pa3anent should not be, or should not have been, made under this title by reason of section 1862(b), and recovery of payments that should not have been made. "(4) Education of providers of services, beneficiaries, and other persons with respect to payment integrity and benefit quality assurance issues. "(5) Developing (and periodically updating) a list of items of durable medical equipment in accordance with section 1834(a)(15) which are subject to prior authorization under such section. "(c) ELIGIBILITY OF ENTITIES. — An entity is eligible to enter into a contract under the Program to carry out any of the activities described in subsection (b) if— "(1) the entity has demonstrated capability to carry out such activities; "(2) in carrying out such activities, the entity agrees to cooperate with the Inspector General of the Department of Health and Human Services, the Attorney General, and other law enforcement agencies, as appropriate, in the investigation and deterrence of fraud and abuse in relation to this title and in other cases arising out of such activities; "(3) the entity complies with such conflict of interest standards as are generally applicable to Federal acquisition £m^d procurement; and "(4) the entity meets such other requirements as the Secretary may impose. In the case of the activity described in subsection (b)(5), an entity shall be deemed to be eligible to enter into a contract under the Program to carry out the activity if the entity is a carrier with a contract in effect under section 1842. "(d) PROCESS FOR ENTERING INTO CONTRACTS.— The Secretary Regulations. shall enter into contracts under the Program in accordance with such procedures as the Secretary shall by regulation establish, except that such procedures shall include the following: "(1) Procedures for identifying, evaluating, and resolving organizational conflicts of interest that are generally applicable to Federal acquisition and procurement. "(2) Competitive procedures to be used— "(A) when entering into new contracts under this section;