this part shall provide in accordance with procedures and safeguard established by the Secretary, data and information (1) which may identify specific providers or practitioners & may be necessary (A) to assist Federal and State agencies recognized by the Secretary as having responsibility for identifying and in vestigating cases or patterns of fraud or abuse, which data and information shall be provided by the peer review organ zation to any such agency at the request of such agency relat ing to a specific case or pattern; (B) to assist appropriate Federal and State agencies recog nized by the Secretary as having responsibility for identifying cases or patterns involving risks to the public health, which data and information shall be provided by the peer revie organization to any such agency (i) at the discretion of the peer review organization at the request of such agency relating to a specific cas or pattern with respect to which such agency has made a finding, or has a reasonable belief, that there may be a substantial risk to the public health, or (ii) upon a finding by, or the reasonable belief of, the peer review organization that there may be a substan tial risk to the public health; and (C) to assist appropriate State agencies recognized by the Secretary as having responsibility for licensing or certifica tion of providers or practitioners, which data and inform tion shall be provided by the peer review organization to an such agency at the request of such agency relating to a specifi case, but only to the extent that such data and information is required by the agency in carrying out a function which within the jurisdiction of such agency under State law; and (2) to assist the Secretary, and such Federal and State agencie recognized by the Secretary as having health planning or relate responsibilities under Federal or State law (including health sys tems agencies and State health planning and developmen agencies), in carrying out appropriate health care planning and related activities, which data and information shall be provide in such format and manner as may be prescribed by the Secretary or agreed upon by the responsible Federal and State agencies and such organization, and shall be in the form of aggregate statistical data (without explicitly identifying any individual) on a geo graphic, institutional, or other basis reflecting the volume and frequency of services furnished, as well as the demographic char acteristics of the population subject to review by such organization. The penalty provided in subsection (c) shall not apply to the disclosure of any information received under this subsection, except that such penalty shall apply to the disclosure (by the agency receiving such information) of any such information described in paragraph (1) unless such disclosure is made in a judicial, administrative, or other formal legal proceeding resulting from an investigation conducted by the agency receiving the information. An organization may require payment of a reasonable fee for providing information under this subsection in response to a request for such information. (c) It shall be unlawful for any person to disclose any such information described in subsection (a) other than for the purposes provided in subsections (a) and (b), and any person violating the provisions of this section shall, upon conviction, be fined not more than $1,000, and imprisoned for not more than 6 months, or both, and shall be required to pay the costs of prosecution. (d) No patient record in the possession of an organization having a contract with the Secretary under this part shall be subject to subpena or discovery proceedings in a civil action. Annual Reports Sec. 1161. The Secretary shall submit to the Congres not later than April 1 of each year, a full and complete report on the administration, impact, and cost of the program under this part during the preceding fiscal year including data and information on (1) the number, status, and service areas of all utilization and quality control peer review organizations participating in the program; (2) the number of health care institutions and practitioners whose services are subject to review by such organizations, and the number of beneficiaries and recipients who received services subject to such review during such year; (3) the various methods of reimbursement utilized in contracts under this part, and the relative efficiency of each such method of reimbursement; (4) the imposition of penalties and sanctions under this title for violations of law and for failure to comply with the obligations imposed by this part; (5) the total costs incurred under titles XVIII and XIX of this Act in the implementation and operation of all procedures required by such titles for the review of services to determine their medical necessity, appropriateness of use, and quality; and (6) descriptions of the criteria upon which decisions are made, and the selection and relative weights of such criteria. Exemptions of Christian Science Sanatoriums Sec. 1162. The provisions of this part shall not apply with respect to a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts. Medical Officers in American Samoa, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands to be Included in the Utilization and Quality Control Peer Review Program Sec. 1163. For purposes of applying this part to American Samoa, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands, individuals licensed to practice medicine in those places shall be considered to be physicians and doctors of medicine. (Page 347 follows) (3)(A) Interest payable under paragraph (1) which was attributle to periods during any fiscal year shall be paid by the State to the cretary of the Treasury not later than the first day of the following cal year. If interest is payable under paragraph (1) on any advance ereinafter in this subparagraph referred to as the "first advance") by ason of another advance made to such State after September 30 of e calendar year in which the first advance was made, interest on ch first advance attributable to periods before such September 30 all be paid not later than the day after the date on which the other vance was made. (B) Notwithstanding subparagraph (A), in the case of any advance ade during the last 5 months of any fiscal year, interest on such vance attributable to periods during such fiscal year shall not be quired to be paid before the last day of the succeeding taxable year. ny interest the time for payment of which is deferred by the receding sentence shall bear interest in the same manner as if it ere an advance made on the day on which it would have been quired to be paid but for this subparagraph. (C) (i) In the case of any State which meets the requirements of use (ii) for any calendar year, any interest otherwise required to paid under this subsection during such calendar year shall be paid follows (I) 25 percent of the amount otherwise required to be paid on or before any day during such calendar year shall be paid on or before such day; and (II) 25 percent of the amount otherwise required to be paid on or before such day shall be paid on or before the corresponding day in each of the 3 succeeding calendar years. y interest the time for payment of which is deferred under this paragraph shall bear interest in the same manner as if it were advance made on the day on which it would have been required to be id but for this subparagraph. (ii) A State meets the requirements of this clause for any calendar ar if the rate of insured unemployment (as determined for purposes section 203 of the Federal-State Extended Unemployment Compen-ion Act of 1970) under the State law of the period consisting of the st 6 months of the preceding calendar year equaled or exceeded 7.5 cent.1 4) The interest rate determined under this paragraph with pect to any calendar year is a percentage (but not in excess of 10 cent) determined by dividing— (A) the aggregate amount credited under section 904 (e) to State accounts on the last day of the last calendar quarter of the immediately preceding calendar year, by Subpar. (C) was added by sec. 274 of P.L. 97-248, effective for interest required to be after December 31, 1982. -496 0 - 82 - 8 (B) the aggregate of the average daily balances of the State accounts for such quarter as determined under section 904 (e). (5) Interest required to be paid under paragraph (1) shall not be paid (directly or indirectly) by a State from amounts in its unemploy. | ment fund. If the Secretary of Labor determines that any State action results in the paying of such interest directly or indirectly (by an equivalent reduction in State unemployment taxes or otherwise) from such unemployment fund, the Secretary of Labor shall not certify such State's unemployment compensation law under section 3304 of the Internal Revenue Code of 1954. Such noncertification shall be made in accordance with section 3304 (c) of such Code. (6) (A) For purposes of paragraph (2), any voluntary repayment shall be applied against advances made under section 1201 on the last made first repaid basis. Any other repayment of such an advance shall be applied against advances on a first made first repaid basis. (B) For purposes of this paragraph, the term "voluntary repayment” means any repayment made under subsection (a). (7) This subsection shall only apply to advances made on or after April 1, 1982, and before January 1, 1988.1 Advances to Federal Unemployment Account Sec. 1203. There are hereby authorized to be appropriated to the Federal unemployment account, as repayable advances (without interest), such sums as may be necessary to carry out the purposes of this title. Whenever, after the application of sections 901 (f) (3) and 902 (a) with respect to the excess in the employment security administration account as of the close of any fiscal year, there remains any portion of such excess, so much of such remainder as does not exceed the balance of advances made pursuant to this section shall be transferred to the general fund of the Treasury and shall be credited against, and shall operate to reduce, such balance of advances. Definition of Governor Sec. 1204. When used in this title, the term "Governor" includes the Commissioners of the District of Columbia. TITLE XIII-RECONVERSION UNEMPLOYMENT [This title was added by the 1946 Amendment; however, the program provided by this title has expired.] subsec. (b) was added by sec. 2407 of P.L. 97–35. |