Professional Standards Review Amendments of 1981

Summary

Professional Standards Review Amendments of 1981 - Amends part B (Professional Standards Review) of title XI of the Social Security Act to direct the Secretary of Health and Human Services to undertake a consolidation of Professional Standards Review Organization (PSRO) areas. Directs the Secretary in carrying out the consolidation to take into account certain criteria including that each State should generally be designated as a single statewide PSRO area. Directs the Secretary to establish a Professional Standards Review Organization Advisory Group to assist the Secretary in developing criteria for consolidation, advise the Secretary in the selection of organizations to serve as PSRO's, and advise the Secretary with respect to terminating agreements with a PSRO. Prohibits a PSRO termination determination by the Secretary from being subject to judicial review. Requires each PSRO to focus its review activity on those cases, physicians, providers, procedures, and tests with respect to which inappropriate utilization is more likely to occur. States that no claimant shall be determined to be without fault in a particular claim if the PSRO has notified a claimant that a pattern of inappropriate utilization has occurred and the claimant has had a reasonable time to correct the inappropriate utilization. Authorizes the Secretary, upon request by a State, to exempt a State from the review requirements with respect to professional activities for which payment is made under Medicaid (title XIX of the Act), if the State chooses to use the PSROs designated to implement a State review plan in effect in such State, or the State has in effect any other review plan under its Medicaid plan.

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1 official file

• Introduced in Senate

  summary · EN · 21 May 1981

  Open at official source

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