Medicare Quality Assurance Reform Act of 1985

Summary

Medicare Quality Assurance Reform Act of 1985 - Amends part B (Peer Review of the Utilization and Quality of Health Care Services) of title XI of the Social Security Act to establish a National Council on Quality Assurance. Directs the Director of the Congressional Office of Technology Assessment to provide for the appointment of members of the Council. States that the general functions of the Council shall be to: (1) provide oversight on the operations of the quality assurance system under title XVIII (Medicare) of such Act; and (2) make recommendations annually to the Secretary of Health and Human Services and the Congress for improvements in the system. Sets forth the Council's function more specifically. Requires the Council to report annually to the Congress on the functioning and progress of the Council. Authorizes appropriations. Requires contracts with utilization and quality control peer review organizations to provide that: (1) at least one-half of the organizations' efforts must be on quality assurance activities; and (2) quality assurance activities shall be conducted with respect to all the different types of items and services covered by Medicare; and (3) the level of activity for each of the different types of services and items shall reasonably reflect the proportion of Medicare payments made for that type of services or items. Adds to the definition of the term "utilization and quality control peer review organization so as to require such an entity to: (1) include in its composition representatives of other individuals responsible for the provision of services and items for which the organization is responsible for conducting quality assurance activities; and (2) have a consumer advisory board. Defines a "consumer advisory board." Requires any utilization and quality control peer review organization to: (1) educate Medicare beneficiaries; (2) provide for a toll-free 24 hour telephone number, which shall be provided to Medicare beneficiaries for the purpose of receiving questions and complaints from Medicare beneficiaries; (3) assist in resolving any such complaints that are legitimate; (4) make available to its consumer advisory boards appropriate information received from the telephone service; and (5) train members of its consumer advisory board. Appropriates funds, in addition to any other amounts appropriated to carry out part B of title XI, from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund for distribution to utilization and quality control peer review organizations. Sets forth study and reporting requirements.

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1 official file

• Introduced in House

  summary · EN · 3 April 1985

  Open at official source

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