§ 478.102 Membership.

(a) Composition, terms and qualifications. (1) Each Advisory Group shall have a minimum of seven and a maximum of eleven members.

(2) Advisory Group members shall be appointed for terms of one year. An appointed member shall not be eligible to serve more than three consecutive full terms. To the extent practicable, no more than one-half of the members of the Advisory Group shall be appointed for an initial term in any year subsequent to the first year.

(3) The membership of each Advisory Group shall consist of representatives of health care practitioners (other than physicians of hospitals and of other health care facilities which provide within the State health care services for which payment, in whole or in part, may be made under Titles V, XVIII or XIX of the Act and who are knowledgeable about the types of health care services being reviewed in the State. In addition, the membership of each Advisory Group shall meet the following requirements:

(i) Representatives of health care practitioners (other than physicians). At least one-half of the members of each Advisory Group shall be representatives of health care practitioners (other than physicians). For purposes of this subpart, health care practitioners (other than physicians) are those health professionals who do not hold a Doctor of Medicine or Doctor of Osteopathy degree, meet all applicable

State or Federal requirements for practice of their profession, and are actively involved in the delivery of patient care or services which are directly or indirectly paid for under Titles V, XVIII and/or XIX of the Act. Each such representative shall practice his or her profession in the State.

(ii) Representatives of hospitals. One or more members of each Advisory Group shall be representatives of hospitals. Each such representative shall be actively involved in the administration of or provision of services in a hospital which is located in the State and which has in effect arrangements for reimbursement for services under Titles V, XVIII and/or XIX of the Act.

(iii) Representatives of other health care facilities. One or more members of each Advisory Group shall be representatives of health care facilities other than hospitals. At least one such member shall be a representative of a skilled nursing facility (as defined in section 1861(j) of the Act) or an intermediate care facility (as defined in 42 CFR 449.10(b)(15)). Each such representative shall be actively involved in the administration of or provision of, services in a health care facility other than a hospital which is located in the State and which has in effect arrangements for reimbursement for services under Titles V, XVIII and/or XIX of the Act.

(b) Selection procedures. (1) Each Statewide Council shall have a standing committee, called the Advisory Group Nominating Committee, which shall solicit recommendations and nominate persons for Advisory Group membership. Each Advisory Group Nominating Committee shall have no fewer than five members and shall include at least one representative of each of the three membership categories set forth in section 1162(b)(1), (2) and (3) of the Act.

(2) Each Statewide Council shall develop a written plan for the selection of Advisory Group members. Such plan shall be submitted to the Secretary no later than 90 days after the date of execution of an agreement between the Secretary and the Statewide Council under section 1162(d) of the Act and must be approved by the Sec

§ 478.103 Organizational requirements.

(a) Each Statewide Council shall convene the first meeting of the Advisory Group no later than 120 days after approval of the described plan in § 478.102(b)(2).

(b) Each Advisory Group shall establish its own organizational structure, elect its own chairperson, and develop written operating procedures, consistent with this subpart.

(c) Each Advisory Group shall report directly to its Statewide Council.

(d) Each Advisory Group shall meet as a whole at least quarterly.

(e) Meetings, or any portion thereof, of the Advisory Group shall be open to the public, except when the meeting concerns review of:

(i) Sanction reports or recommendations forwarded to the Statewide Council pursuant to section 1157 of the Act;

(ii) Review of PSRO reconsiderations pursuant to section 1159(a) of the Act;

(iii) Internal personnel rules and practices of the Statewide Council;

(iv) Trade secrets and commercial or financial information obtained from a person and privileged or confidential;

(v) Matters prohibited from disclosure by statute;

(vi) Information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy; and

(vii) Information the premature disclosure of which would be likely to significantly frustrate implementation of a Statewide Council action except where the Statewide Council has already disclosed to the public the content or nature of the action, or where the Statewide Council is required by law to make such disclosure on its own

initiative prior to taking final

Statewide Council action.

(f) Minutes shall be recorded for all Advisory Group meetings and shall be available to the public consistent, as appropriate with regulations to be issued by the Secretary concerning confidentiality.

(g) Each Statewide Council shall provide its Advisory Group with staff support sufficient to enable the Advisory Group to carry out its duties and functions under this subpart.

(h) Expenses reasonably and necessarily incurred, as determined by the Secretary, by an Advisory Group in carrying out its duties and functions under this subpart shall be considered to be expenses necessarily incurred by its Statewide Council.

(2) The membership of the Advisory Group Nominating Committee.

(3) The membership of the Advisory Group.

(4) The organization of the Advisory Group.

(5) The Advisory Group's activities for the year, including the number of meetings, and a description of specific projects, accomplishments, and recommendations made by the Advisory Group to its Statewide Council.

(b) Each Advisory Group shall prepare an annual report assessing the involvement of health care practitioners (other than physicians), and of hospitals and other health care facilities in

the Professional Standards Review Organization program in its State.

§ 478.105 Duties and functions.

Each Advisory Group shall advise and assist its Statewide Council in the performance of the Council's functions, specifically in the following areas and in any other areas considered appropriate by the Statewide Council:

(a) (1) In assuring maximum effective involvement of health care practitioners (other than physicians) in the Professional Standards Review Organization activities in its State.

(2) In developing effective relationships with organizations representing health care practitioners (other than physicians), hospitals and/or health care facilities within its State.

(3) In carrying out the functions of the Statewide Council under section 1160(c) of the Act as they relate to health care practitioners (other than physicians), hospitals and other health care facilities.

(4) In carrying out the Statewide Council's functions under section

1162(c) of the Act.

SOURCE: 41 FR 28687, July 12, 1976, unless otherwise noted. Redisignated at 42 FR 52826, Sept. 30, 1977.

§ 480.1 Scope.

Section 1162(e) of the Social Security Act (hereinafter termed "the Act") provides that each Professional Standards Review Organization in any State not having a Statewide Professional Standards Review Council shall be advised and assisted in carrying out its functions by an Advisory Group. This part establishes the requirements for Professional Standards Review Organizations to follow in establishing and utilizing such Advisory Groups.

§ 480.2 Membership.

(a) Composition, Terms and Qualifications. (1) Each Advisory Group shall have a minimum of seven and a maximum of eleven members.

(2) Advisory Group members shall be appointed for terms of one year. An appointed member shall not be eligible to serve more than three consecutive full terms. To the extent practicable, no more than one-half of the members of an Advisory Group shall be appoint

§ 478.106 Employment nondiscrimination. Attention is called to the requirements of Executive Order 11246 (42 U.S.C. 2000e) which prohibits discrimination against any employee or applicant for employment because of race, color, religion, sex or national origin. Regulations implementing such Executive Order 11246, which are applicable to Advisable Groups under this Subpart, have been issued by the Secretary of Labor (41 CFR Chapter 60).

PART 480-ADVISORY GROUPS TO PSRO's

Sec.

480.1 Scope.

480.2 Membership.

480.3 Organizationeal requirements.
480.4 Reporting requirements.
480.5 Duties and functions.

480.6 Employment nondiscrimination.

AUTHORITY: Sec. 1102 and 1162(e), Social Security Act (42 U.S.C. 1302, 1320c-11(e)).

sequent to the first year.

(3) The membership of each Advisory Group shall consist of representatives of health care practitioners (other than physicians), of hospitals and of other health care facilities which provide within the Professional Standards Review Organization area health care services for which payment, in whole or in part, may be made under titles V, XVIII, of XIX of the Act and who are knowledgeable about the types of health care services being reviewed in the Professional Standards Review Organization area. In addition, the membership of each Advisory Group shall meet the following requirements:

(i) Representatives of health care practitioners (other than physicians). At least one-half of the members of each Advisory Group shall be representatives of health care practitioners (other than physicians). For purposes of this part, health care practitioners (other than physicians) are those

health professionals who do not hold a Doctor of Medicine or Doctor of Osteopathy degree, meet all applicable State or Federal requirements for practice of their profession, and are actively involved in the delivery of patient care or services which are directly or indirectly paid for under titles V, XVIII and/or XIX of the Act. Each such representative shall practice his or her profession in the Professional Standards Review Organization area.

(ii) Representatives of hospitals. One or more members of each Advisory Group shall be representatives of hospitals. Each such representative shall be actively involved in the administration of or provision of services in a hospital which is located in the Professional Standards Review Organization area, and which has arrangements for reimbursement for services under titles V, XVIII and/or XIX of the Act.

(iii) Representatives of other health care facilities. One or more members of each Advisory Group shall be representatives of health care facilities other than hospitals. At least one such member shall be a representative of a skilled nursing facility (as defined in section 1861(j) of the Act) or of an intermediate care facility (as defined in 42 CFR 449.10(b)(15)). Each such representative shall be actively involved in the administration of or provision of services in a health care facility other than a hospital which is located in the Professional Standards Review Organization area and which has in effect arrangements for reimbursement for services under titles V, XVIII and/or XIX of the Act.

(b) Selection procedures. (1) Each Professional Standards Review Organization in a State not having a Statewide Professional Standards Review Council shall have a standing committee, called the Advisory Group Nominating Committee, which shall solicit recommendations and nominate persons for Advisory Group membership. Each Advisory Group Nominating Committee shall have no fewer than five members and shall include at least three members of the governing body of the Professional Standards Review Organization.

(2) Each Professional Standards Review Organization shall develop a written plan for the selection of Advisory Group members. Such plan shall be submitted to the Secretary no later than 90 days after the date of execution of an agreement between the Secretary and the Professional Standards Review Organization under section 1152(a) of the Act, and must be approved by the Secretary prior to the selection of any Advisory Group members. Such plan shall include the following provisions:

(i) Specification of the composition of the Advisory Group, including plans to rotate membership among practitioner and health care facility groups.

(ii) Specification of the organizations of health care practitioners (other than physicians), of hospitals, of other health care facilities and consumer and other interested groups from which recommendations will be sought by the Advisory Group Nominating Committee. If there are organizations comprised of practitioners or facilities within the Professional Standards Review Organization area, such organizations shall be included in those from which recommendations are sought.

(iii) Criteria and procedures for review of recommendations by the Advisory Group Nominating Committee.

(iv) Criteria and procedures for selection of Advisory Group members by the governing body of the Professional Standards Review Organization from nominations of the Advisory Group Nominating Committee.

§ 480.3 Organizational requirements.

(a) Each Advisory Group shall establish its own organizational structure, elect its own chairperson, and develop written operating procedures, consistent with this part.

(b) Each Advisory Group will report directly to the governing body of the Professional Standards Review Organization.

(c) Each Advisory Group shall meet as a whole at least quarterly.

(d) Minutes shall be recorded for all Advisory Group meetings and shall be available to the public consistent, as appropriate, with applicable regula

(2) The membership of the Advisory Group Nominating Committee.

(3) The membership of the Advisory Group.

(4) The organization of the Advisory Group.

(5) The Advisory Group's activities for the year, including the number of meetings, a description of specific projects, accomplishments, and recommendations made by the Advisory Group to its Professional Standards Review Organization.

(b) Each Advisory Group shall prepare an annual report assessing the involvement of health care practitioners (other than physicians), and of hospitals and other health care facilities in the Professional Standards Review Organization program in its Professional Standards Review Organization area.

§ 480.5 Duties and functions.

(a) Each Advisory Group shall advise and assist its Professional Standards Review Organization in the performance of its functions, specifically in the following areas and in any other areas considered appropriate by the Professional Standards Review Organization:

(1) In assuring maximum effective involvement of health care practitioners (other than physicians) in the Pro

fessional Standards Review Organization activities in its Professional Standards Review Organization area.

(2) In developing effective relationships with organizations representing health care practitioners (other than physicians), hospitals and/or health care facilities within the Professional Standards Review Organization area.

(3) In carrying out the functions of the Professional Standards Review Organization under section 1160(c) of the Act as they relate to health care practitioners (other than physicians), hospitals, and other health care facilities.

(4) In developing any modifications of the formal plan pursuant to section 1154 of the Act.

(b) An Advisory Group may undertake other activities with the approval of its Professional Standards Review Organization.