section 1320c–3(a)(3)(D) of this titlesection 405(b) of this titlelsection 405 of this titleAny beneficiary who is entitled to benefits under subchapter XVIII, and, subject to , any practitioner or provider, who is dissatisfied with a determination made by a contracting quality improvement organization in conducting its review responsibilities under this part, shall be entitled to a reconsideration of such determination by the reviewing organization. Where the reconsideration is adverse to the beneficiary and where the matter in controversy is $200 or more, such beneficiary shall be entitled to a hearing by the Secretary (to the same extent as beneficiaries under subchapter II are entitled to a hearing by the Commissioner of Social Security under ). For purposes of the preceding sentence, subsection () of shall apply, except that any reference in such subsection to the Commissioner of Social Security or the Social Security Administration shall be deemed a reference to the Secretary or the Department of Health and Human Services, respectively. Where the amount in controversy is $2,000 or more, such beneficiary shall be entitled to judicial review of any final decision relating to a reconsideration described in this subsection.
Aug. 14, 1935, ch. 531Pub. L. 97–248, title I, § 14396 Stat. 388Pub. L. 101–239, title VI, § 6224(b)(2)103 Stat. 2257Pub. L. 103–296, title I, § 108(b)(14)108 Stat. 1485Pub. L. 112–40, title II, § 261(a)(2)(C)125 Stat. 423(, title XI, § 1155, as added , , ; amended , , ; , , ; , , .)
Editorial Notes
Prior Provisions
act Aug. 14, 1935, ch. 531, title XI, § 1155Pub. L. 92–603, title II, § 249F(b)86 Stat. 1433Pub. L. 95–142, § 5(c)(1)o91 Stat. 1184Pub. L. 96–499, title IX94 Stat. 2629Pub. L. 97–35, title XXI95 Stat. 793Pub. L. 97–248A prior section 1320c–4, , as added , , ; amended , , (d)(3), ()(2), (p), , 1188, 1191, 1192; , , §§ 924(b)–(d), 925–927(a), 931(g), , 2630, 2634; , , §§ 2111, 2113(d), 2121(f), , 794, 796, related to functions and duties of Professional Standards Review Organizations, prior to the general revision of this part by .
Amendments
Pub. L. 112–402011— substituted “quality improvement” for “peer review”.
Pub. L. 103–296section 405(b) of this titlelsection 405 of this titlesection 405(b) of this title1994— substituted “(to the same extent as beneficiaries under subchapter II are entitled to a hearing by the Commissioner of Social Security under ). For purposes of the preceding sentence, subsection () of shall apply, except that any reference in such subsection to the Commissioner of Social Security or the Social Security Administration shall be deemed a reference to the Secretary or the Department of Health and Human Services, respectively. Where the amount in controversy is $2,000 or more, such beneficiary shall be entitled to judicial review of any final decision relating to a reconsideration described in this subsection.” for “(to the same extent as is provided in ), and, where the amount in controversy is $2,000 or more, to judicial review of the Secretary’s final decision.”
Pub. L. 101–239section 1320c–3(a)(3)(D) of this title1989— inserted “, subject to ,” before “any practitioner or provider”.
Statutory Notes and Related Subsidiaries
Effective Date of 2011 Amendment
Pub. L. 112–40section 261(e) of Pub. L. 112–40section 1320c of this titleAmendment by applicable to contracts entered into or renewed on or after , see , set out as a note under .
Effective Date of 1994 Amendment
Pub. L. 103–296section 110(a) of Pub. L. 103–296section 401 of this titleAmendment by effective , see , set out as a note under .
Effective Date of 1989 Amendment
Pub. L. 101–239section 1320c–3(a)(3)(B) of this titlesection 6224(b)(3) of Pub. L. 101–239section 1320c–3 of this titleAmendment by applicable to determinations by utilization and quality control peer review organizations with respect to which preliminary notifications were made under more than 30 days after , see , set out as a note under .