PRO Due Process and Equity Amendments of 1987
This bill died when its Congress ended.
Bills don't carry over between Congresses. Without re-introduction in a new session, it cannot advance.
PRO Due Process and Equity Amendments of 1987 - Amends part B (Peer Review) of title XI of the Social Security Act to give Medicare (title XVIII of the Act) providers 30 days to request a hearing, and such time as is thereafter needed to exhaust administrative and judicial remedies, before the decision of the Secretary of Health and Human Services to exclude the provider from Medicare participation takes effect, provided that such delay does not pose a severe and immediate threat to the health of Medicare beneficiaries. Provides that where the Secretary finds such an immediate threat to exist, the provider shall be immediately excluded from Medicare participation and be given a hearing within 30 days. Directs the Secretary to act upon the recommendations regarding a provider's noncompliance with title XI requirements within five days of their submission if the PRO finds such noncompliance to pose an immediate threat to the health of Medicare beneficiaries, and, in any other case, within 120 days of the submittal of the recommendations. Entitles Medicare providers to a reconsideration by PRO of that organization's denial of payment for services provided, and to further review where such reconsideration is adverse to the provider and certain jurisdictional criteria are satisfied. Requires PROs to notify providers regarding any changes in the services reviewed or the review standards applied by PROs at least 30 days before such changes take effect. Requires the Secretary to emphasize PRO educational activities as much as its sanctioning activities when entering into, reviewing, or terminating PRO contracts. Directs PROs to make at least 50 percent of their review of small rural hospitals on-site reviews and take into account professionally recognized local health care standards as well as national and State standards in conducting such reviews. Prohibits the finalization of a provider payment denial until at least 30 days after the PRO gives the provider reasonable notice of the proposed denial and a reasonable opportunity to discuss such denial. Requires a PRO to include at least one hospital representative on its governing body. Requires the random review of physician care to be conducted so that there is an equal likelihood and intensity of review for each physician sampled.
Filed in the House
This house bill has been filed and is working its way through Congress. It will need to pass both the House and the Senate, then be signed by the President to become law.
Who introduced this
Ask AI About This Bill
Get plain-language answers with direct quotes from the bill text.
Your Representatives
Enter your address to see how your representatives voted on this bill.
Your address is only used to find your district and is never saved. See how it works
Votes
Public Opinion
No votes yet — be the first to weigh in.
to cast your vote
Your voice matters — let representatives know where you stand.
Comments
No comments yet. to be the first to weigh in.