Provider Payment Review Board Act

Summary

Provider Payment Review Board Act - Amends title XVIII (Medicare) of the Social Security Act to replace the Provider Reimbursement Review Board with the Provider Payment Review Board. Sets forth the composition of the Provider Payment Review Board. Permits the Board to establish its own divisions, to determine the character of cases to be heard initially by the Board or its divisions, and to review any decision rendered by one of its divisions. Permits a provider of Medicare services to obtain a hearing before the Board when the provider is dissatisfied with a refusal of its fiscal intermediary to reopen or revise its reimbursement decision. Adds to the requirements for appeals by groups of providers a requirement that the amount in controversy must be $50,000 or more for all cost reporting periods in dispute. Sets forth the rules regarding the parties to a hearing of the Board. Grants the right to obtain judicial review of a Board decision to any parties to the hearing other than the fiscal intermediary. Makes the final decision of the Board binding on all parties to the hearing for the cost reporting periods covered by the decision. Makes such decision binding on the Secretary of Health and Human Services and on the party intermediary with respect to all other parties for all subsequent cost reporting periods unless the Secretary promulgates a regulation inconsistent with the Board's decision. Provides, in the case of entities not parties to a hearing, that a final Board decision shall be binding on the Secretary of Health and Human Services and all fiscal intermediaries with respect to determinations for which the same issues and facts pertain. Requires the Board to provide for publication of its decisions and to submit an annual report on its activities to Congress. Permits judicial review of a regulation or instruction of the Secretary or of the Administrator of the Health Care Financing Administration if such action is brought within a certain period of time and if the regulation or instruction financially affects either a provider of services of $100,000 for any cost reporting period or a group of providers of services of $500,000 for any such period.

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

Timeline

No timeline events have been ingested for this record yet.

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 · 8 April 1981

  Open at official source

Sponsors

No sponsors or actors listed by the source.

Related records

No cross-record relationships stored yet.