Medicare program; Peer Review Organizations: revised scopes of work for the District of Columbia, Puerto Rico, the Virgin Islands, and all states except Delaware, Florida, Missouri, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Carolina, Washington, and Wyoming--HCFA. Final notice.
This notice describes requirements for the review activities of Utilization and Quality Control Peer Review Organizations (PROs) under contract extensions of the Scope of Work for the District of Columbia, Puerto Rico, the Virgin Islands and all States except Delaware, Florida, Missouri, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Carolina, Washington, and Wyoming. Section 1153(h)(1) of the Social Security Act requires us to publish any new policy or procedure adopted by the Secretary that affects substantially the performance of PRO contract obligations at least 30 days before the date the policy or procedure is to be used. Specifically, this notice describes the way in which PRO contract requirements are changed and explains significant changes in the PRO program (e.g., the way in which cases will be selected for review) and also describes continuing requirements. This notice also implements provisions of the Omnibus Budget Reconciliation Act of 1990.
D014487:Centers for Medicare and Medicaid Services, U.S.; D003284:Contract Services / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006278:Medicare / Q000331:legislation & jurisprudence*; D011366:Professional Review Organizations / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D014481:United States