Medicare and Medicaid Second Opinion Act of 1985

Summary

Medicare and Medicaid Second Opinion Act of 1985 - Amends title XVIII (Medicare) of the Social Security Act to prohibit payment for a surgical procedure listed by the Secretary of Health and Human Services unless a second opinion regarding such surgery is obtained. Provides that the second opinion need not agree with the first opinion in order for payment to be made. Directs the Secretary to establish a list of at least ten surgical procedures to which the second opinion requirement applies. Directs the Secretary to enter into contracts with utilization and quality control peer review organizations under which such organizations serve as referral centers for the second opinions required by this Act. Permits the patient to choose any qualified physician, except one affiliated with the initial physician, to provide the second opinion. Provides that a second opinion need not be obtained: (1) if to delay surgery would be a risk to the patient; (2) if no physician is available, within reasonable limits, to provide the second opinion; and (3) if the surgery is to be performed on a patient who is a member of a health maintenance organization or competitive medical plan having a risk sharing contract with the Secretary. Requires physicians, hospitals, and ambulatory surgical centers to notify patients of the second opinion requirement. Sets forth sanctions for noncompliance. Directs the Secretary to notify physicians, hospitals, ambulatory surgical centers, and Medicare beneficiaries of the requirements of this Act. Waives the deductible and copayments with respect to the second opinion. Amends title XIX (Medicaid) of the Act to require second opinions. Provides for the application of the Medicare second opinion requirements to Medicaid. Sets forth effective date, regulations, and study provisions.

This text is taken from the official record. PoliticalRepo does not editorialize.

Timeline

1. 19 June 1985

   Introduced

   Introduced in House

   Source: IntroReferral

2. 19 June 1985

   Introduced

   Referred to House Committee on Energy and Commerce.

   Source: IntroReferral

3. 19 June 1985

   Introduced

   Introduced in House

   Source: IntroReferral

4. 24 June 1985

   Referred

   Referred to Subcommittee on Health and the Environment.

   Source: Committee

5. 1 August 1985

   Committee

   For Further Action See H.R.3101.

   Source: Committee

Votes

No vote records are attached yet.

Versions

No version snapshots stored. Document URLs remain at the source.

Documents

1 official file

• Introduced in House

  summary · EN · 19 June 1985

  Open at official source

Sponsors

• Rep. Kennelly, Barbara B. [D-CT-1] · D · Sponsor
• Rep. Hoyer, Steny H. [D-MD-5] · D · Sponsor
• Rep. Miller, Clarence E. [R-OH-10] · R · Cosponsor
• · hswm00 · Standing
• · hsif00 · Standing

Related records

• related to ← Medicare and Medicaid Budget Reconciliation Amendments of 1985
• related to ← Medicare and Medicaid Second Opinion Act of 1985