42 U.S.C. 1395ff: Determinations; appeals

2014

• Pub. L. 113–93 added subpar. (C). (Protecting Access to Medicare Act of 2014) Law text · (f)

2011

• Pub. L. 112–40, §261(a)(3)(A), substituted "quality improvement" for "utilization and quality control peer review". Law text · (a)
• Pub. L. 112–40, §261(a)(3)(F), substituted "quality improvement organizations" for "peer review organizations". Law text · (c)

2003

• Pub. L. 108–173, §940(a)(1), substituted "60-day period" for "30-day period" in two places. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §933(c)(1), added pars. (4) and (5). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a), (5)
• Pub. L. 108–173, §932(a)(1)(A), inserted ", subject to paragraph (2)," before "to judicial review of the Secretary's final decision". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §940(b)(1), added cl. (iii). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §932(a)(2), amended heading and text of cl. (ii) generally. Prior to amendment, text read as follows: "In a hearing by the Secretary under this section, in which the moving party alleges that no material issues of fact are in dispute, the Secretary shall make… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §932(a)(1)(B), added par. (2). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §933(a)(1), added par. (3). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §933(d)(1)(A), substituted "sufficient medical, legal, and other expertise (including knowledge of the program under this subchapter) and sufficient staffing" for "sufficient training and expertise in medical science and legal matters". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §933(b), inserted "(including the medical records of the individual involved)" after "clinical experience". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §940(a)(2), substituted "60-day period" for "30-day period". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §933(d)(2)(A), amended heading and text of subpar. (D) generally, substituting provisions directing that subsec. (g) requirements be met for provisions prohibiting a physician or health care professional from reviewing a determination where such physician or heal… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §933(c)(2), inserted "be written in a manner calculated to be understood by the individual entitled to benefits under part A or enrolled under part B, or both, and shall include (to the extent appropriate)" after "in writing," and "and a notification of the right… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §948(b)(1)(A), substituted "determination" for "policy". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §948(b)(1)(B), substituted "coverage determinations" for "medical review policies". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §933(c)(4), substituted "submit" for "prepare" and struck out "with respect to a reconsideration to the Secretary for a hearing, including as necessary, explanations of issues involved in the decision and relevant policies" after "decision of the contractor". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §933(d)(1)(B), added subpar. (K). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §933(d)(3), substituted "a sufficient number of qualified independent contractors (but not fewer than 4 such contractors) to conduct reconsiderations consistent with the timeframes applicable under this subsection" for "not fewer than 12 qualified independent contra… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §933(c)(3)(A), inserted "; notice" after "Secretary" in heading. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (d)
• Pub. L. 108–173, §933(c)(3)(B), added par. (4). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (d)
• Pub. L. 108–173, §931(d), struck out "of the Social Security Administration" after "an administrative law judge" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• Pub. L. 108–173, §948(c)(1), substituted "clause (i), (ii), or (iii)" for "subclause (I), (II), or (III)". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• Pub. L. 108–173, §948(c)(2), substituted "subparagraph (A)(iv)" for "clause (i)(IV)" and "subparagraph (A)(iii)" for "clause (i)(III)". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• Pub. L. 108–173, §948(c)(3), substituted "subparagraph (A)" for "clause (i)" in two places, "clause (iv)" for "subclause (IV)", and "paragraph (1)(A)" for "subparagraph (A)". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• Pub. L. 108–173, §933(d)(2)(B), added subsec. (g). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (g)
• Pub. L. 108–173, §938(a), added subsec. (h). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §940A(a), added subsec. (i). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (i)

2000

• Pub. L. 106–554, §1(a)(6) [title V, §521(a)], amended section generally, completely revising and expanding provisions relating to determinations with respect to benefits under part A or part B of this subchapter, changing the structure of the section from two subsecs. lettered (a) and (b) to five s… (Consolidated Appropriations Act, 2001) Law text
• Pub. L. 106–554, §1(a)(6) [title V, §522(a)], added subsec. (f). (Consolidated Appropriations Act, 2001) Law text · (f)

1997

• Pub. L. 105–33 inserted "(or $100 in the case of home health services)" after "$500". (Balanced Budget Act of 1997) Law text · (b)

1994

• Pub. L. 103–296 inserted ", except that, in so applying such sections and in applying section 405(l) of this title thereto, any reference therein to the Commissioner of Social Security or the Social Security Administration shall be considered a reference to the Secretary or the Depa… · (b)

1987

• Pub. L. 100–203, §4085(i)(18), inserted "or a claim for benefits with respect to home health services under part B of this subchapter" before "shall". · (a)
• Pub. L. 100–203, §4085(i)(19), inserted "and (1)(D)" after "paragraph (1)(C)" in two places. · (b)
• Pub. L. 100–203, §4082(a), substituted "section 553" for "chapter 5". · (b)
• Pub. L. 100–203, §4082(b), added par. (5). · (b)
• Pub. L. 100–93 struck out subsec. (c) which read as follows: "Any institution or agency dissatisfied with any determination by the Secretary that it is not a provider of services, or with any determination described in section 1395cc(b)(2) of this title, shall be entitled to a hearing … · (c)

1986

• Pub. L. 99–509, §9341(a)(1)(A), inserted "or part B" after "amount of benefits under part A". · (a)
• Pub. L. 99–509, §9313(b)(1)(A), inserted "and any other determination with respect to a claim for benefits under part A of this subchapter" before "shall". · (a)
• Pub. L. 99–509, §9313(a)(1), in concluding provisions, inserted at end "Sections 406(a), 1302, and 1395hh of this title shall not be construed as authorizing the Secretary to prohibit an individual from being represented under this subsection by a person that furnishes or supplies t… · (b)
• Pub. L. 99–509, §9341(a)(1)(B), inserted "or part B". · (b)
• Pub. L. 99–509, §9313(b)(1)(B), added subpar. (D). · (b)
• Pub. L. 99–509, §9341(a)(1)(C), amended par. (2) generally. Prior to amendment, par. (2) read as follows: "Notwithstanding the provisions of subparagraph (C) of paragraph (1) of this subsection, a hearing shall not be available to an individual by reason of such subparagraph (C) if … · (b)
• Pub. L. 99–509, §9341(a)(1)(D), added pars. (3) and (4). · (b), (4)

1984

• Pub. L. 98–369 struck out the comma before "or section 1395i–2" and struck out ", or section 1819" after "section 1395i–2 of this title". · (b)

1972

• Pub. L. 92–603 redesignated existing provisions as par. (1), generally amended conditions under which a dissatisfied individual shall be entitled to a hearing by Secretary and to judicial review of final decision of Secretary after such hearing, and added par. (2). · (b)