Medicare and Medicaid programs; utilization and quality control peer review organization (PRO); assumption of responsibilities and Medicare review functions and coordination of Medicaid with peer review organization--HCFA. Proposed rule.
This proposal would implement portions of the Peer Review Improvement Act of 1982 (Title I, Subtitle C of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), Pub. L. 97-248) and the Social Security Act Amendments of 1983 (Pub. L 98-21) by establishing the review functions to be performed by a Utilization and Quality Control Peer Review Organization (PRO). The 1983 amendments to the Social Security Act amended TEFRA by requiring that effective October 1, 1983, hospitals receiving payment under the Medicare prospective payment system (PPS) are required to maintain an agreement with a PRO if there is one for the area. Effective October 1, 1984, hospitals are required to have an agreement with a PRO in order to receive Medicare payments. These proposed regulations outline the relationships among PROs, Medicare fiscal intermediaries and carriers, providers, practitioners, and beneficiaries upon the PRO's assumption of conduct of review for those hospitals under PPS and for all other facilities. The proposal would also describe the relationship between PROs and State Medicaid agencies that contract with PROs to perform review.
D014487:Centers for Medicare and Medicaid Services, U.S.; D008484:Medicaid / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence*; D011366:Professional Review Organizations / Q000331:legislation & jurisprudence*; D014481:United States