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 the Act. Permits the patient to choose any qualified 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.

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1 official file

• Introduced in Senate

  summary · EN · 19 June 1985

  Open at official source

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