42 U.S.C. § 1395ff — Determinations; appeals
submitted 91 years ago by Pub. L. 89-97 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 8,002 words · no verdicts yet
This section sets the process for making Medicare Part A and Part B benefit decisions and appealing them. It covers initial decisions, reconsideration, hearings, judicial review, coverage decisions, reviewer qualifications, prior decisions about certain physician services, and mediation of local coverage disputes.
(a) Initial determinations: (1) The Secretary* must issue regulations* and make initial decisions about Part A and Part B benefits. These decisions include whether a person* is entitled to benefits, how much the person can receive, and any other initial decision on a benefit claim. The last category includes a decision that Medicare cannot pay, or can no longer pay, for an item or service; a decision by a quality improvement organization under section 1320c–3(a)(2); and a decision by an entity under a contract with the Secretary to administer this subchapter or subchapter XI, except a contract under section 1395w–22. (2) Subject to (B), an initial decision must be finished within 45 days after the fiscal intermediary or carrier receives the claim, and notice must be mailed to the person who filed the claim before that period ends. (B) This 45-day rule does not apply to a claim covered by the requirements of section 1395h(c)(2) or 1395u(c)(2). (3) The regulations must allow a fiscal intermediary or carrier to reconsider a claim denied in whole or in part. (A) The intermediary or carrier must make that reconsideration. (B)(i) An initial decision cannot be reconsidered or appealed under (b) until that reconsideration occurs. (ii) The person who made the initial decision cannot make the reconsideration. (C)(i) The person must request reconsideration within 120 days after receiving notice of the initial decision, unless the Secretary allows more time. (ii) The reconsideration must be finished, and notice mailed, within 60 days after the intermediary or carrier receives the request. (D) For the later parts of this section, a reconsideration is treated as part of the initial decision. (4) If an initial decision denies a claim, its written notice must give the reasons, including whether a local medical review policy or local coverage determination was used; explain how to get more information, including the information described in (B); and explain the right to request reconsideration or another appeal and how to start it. The notice must be printed and written so the person entitled to Part A or enrolled in Part B can understand it. On request, the person may obtain the specific policy, manual, or regulation provision used. (5) If a reconsideration denies a claim, its written notice must give the specific reasons; when appropriate, summarize the clinical or scientific evidence used; explain how to get more information; and explain the right to appeal and how to start the appeal. The notice must be printed and understandable. On request, the person may obtain the specific policy, manual, or regulation provision used.
(b) Appeal rights: (1)(A) Subject to (D), a person dissatisfied with an initial decision under (a)(1) is entitled to reconsideration. Subject to (D) and (E), the person is also entitled to a Secretary hearing to the same extent as under section 405(b), and, subject to paragraph (2), judicial review of the Secretary’s final decision as provided in section 405(g). References in section 405(g) or (l) to the Commissioner of Social Security or the Social Security Administration* mean the Secretary or the Department of Health and Human Services. (B)(i) Sections 406(a), 1302, and 1395hh do not authorize the Secretary to stop a person who supplies services or items to the beneficiary, directly or indirectly, from representing that beneficiary solely because of that relationship. (ii) A person who supplied the services or items may represent the beneficiary on the issue described in section 1395pp(a)(2) only after waiving all rights to payment from the beneficiary for those services or items. (iii) Such a representative may not impose financial liability on the beneficiary for the representation. (iv) The claimant-representation rules in section 405(j) and section 406, other than section 406(a)(4), apply to these appeals in the same way. (C) The beneficiary may assign the appeal right for an item or service to its provider or supplier* by written consent on the Secretary’s standard form. (D)(i) A reconsideration request must be filed within 180 days after the person receives the reconsideration notice, unless the Secretary allows more time. (ii) The Secretary must set regulatory deadlines for requesting a hearing, consistent with sections 405 and 406. (E)(i) A Secretary hearing is unavailable if the amount in controversy is under $100. Judicial review is unavailable if it is under $1,000. (ii) Regulations must allow two or more appeals to be combined when they concern similar or related services for one person, or common legal and factual issues arising from services supplied to two or more people by one or more providers or suppliers. (iii) For a hearing or judicial-review request made after 2004, each dollar threshold is increased by the percentage increase in the medical-care component of the Consumer Price Index for all urban consumers from July 2003 to the July before the year of the request. A resulting amount that is not a multiple of 10 is rounded to the nearest multiple of 10. (F)(i) A person may request an expedited decision or expedited reconsideration, orally or in writing, when a provider gives notice that it plans to end the person’s services and a physician* certifies that continuing them is likely necessary to avoid a significant health risk, or when the provider plans to discharge the person. The Secretary must provide the expedited process. (ii) Rules for expedited access to court are in paragraph (2). (G) The Secretary may reopen or revise an initial or reconsidered decision under regulatory guidelines.
(b)(2) Expedited access to judicial review: (A) The Secretary must create a process allowing a provider, supplier, or beneficiary who has filed an appeal under paragraph (1), other than an expedited appeal under (F)(i), to reach court early. A review entity must find that the Departmental Appeals Board lacks authority to decide the relevant legal or regulatory question and that no material factual issue is disputed. An appellant may make this request only once for a particular legal or regulatory question in a specific dispute. (B) After, or at the same time as, properly requesting an administrative hearing, the appellant may ask the review entity for this determination. The request must include the required documents. The entity must decide in writing within 60 days after receiving the request and documents. The decision is final and cannot be reviewed by the Secretary. (C)(i) The appellant may sue if the entity finds no material factual dispute and only an issue of law or regulation that the Board cannot decide, or if the entity misses the 60-day deadline. (ii) The lawsuit must be filed within 60 days after the entity’s decision, or within 60 days after the missed-deadline period ends. (iii) It must be filed in the federal district where the appellant is located; if several appellants sue together, it may be filed where the greatest number are located; it may also be filed in the District of Columbia. (iv) If a provider or supplier receives this judicial review, the disputed amount earns yearly interest starting on the first day of the first month after the 60-day filing period. The rate is the rate on obligations issued for purchase by the Federal Supplementary Medical Insurance Trust Fund in the month the lawsuit begins. The court awards the interest to the winning party. It is not treated as income or cost when provider or supplier reimbursement is calculated. (D) A “review entity” means up to three administrative law judges or Departmental Appeals Board members selected to make these decisions. (3) A provider or supplier may not present in an appeal evidence that it did not present at the qualified independent contractor’s reconsideration, unless good cause prevented earlier presentation.
(c) Conduct of reconsiderations by independent contractors: (1) The Secretary must contract with qualified independent contractors to reconsider initial decisions under (a)(1)(B) and (C). The first contract term is three years and later terms may be renewed every three years. (2) A “qualified independent contractor” is an entity independent of every organization under contract with the Secretary to make initial decisions under (a)(1), and that meets the Secretary’s requirements under paragraph (3). (3)(A) The contractor must perform the duties the Secretary requires and must have enough medical, legal, and other expertise, including knowledge of this program, and enough staff to conduct reconsiderations. (B)(i) It must review initial decisions. If the issue is whether an item or service is reasonable and necessary to diagnose or treat illness or injury under section 1395y(a)(1)(A), a panel of physicians or other appropriate health professionals must consider the facts and circumstances. The decision must rely on applicable information, including the person’s medical records, clinical experience, and medical, technical, and scientific evidence. (ii)(I) A national coverage determination made by the Secretary binds the contractor. (II) A local coverage determination does not bind it, but it must consider that determination. (III) Without either type of determination, it must decide from applicable information, including clinical experience and medical, technical, and scientific evidence. (C)(i) Except for (iii) and (iv), it must finish reconsideration and mail notice within 60 days after a timely request. (ii) If it misses that deadline, or the notice deadline for an expedited reconsideration under (iii), the requesting party may ask for a Secretary hearing even without a completed reconsideration. (iii) It must handle an expedited reconsideration under (b)(1)(F) within the time limits in this subparagraph, including a decision within 72 hours, subject to (iv). (iv) If the case involves review of whether services should end or a person should be discharged, the expedited deadline is 72 hours, but the parties may agree to a longer period. The contractor must notify the parties of the decision as required by regulation. (D) The contractor must meet the other contract, quality, and reporting requirements the Secretary establishes, including requirements for handling appeals, explaining decisions, and providing information needed for later review.
(d) Deadlines for hearings by the Secretary; notice: The Secretary must conduct a hearing and issue a decision within 90 days after the hearing request, unless the applicable rules provide another period. The Secretary must mail notice of the decision to the parties. The notice must explain the decision, the reasons, and the right to further appeal.
(e) Administrative provisions: The Secretary must provide staff and procedures needed to carry out this section. The Secretary must comply with section 1395hh and must give providers, suppliers, and beneficiaries information about appeal rights and answers to their questions. Regulations must provide for recording or otherwise preserving hearing proceedings and for making the record available as required for later review.
(f) Review of coverage determinations: (1)(A) National coverage determinations have these limits. (i) An administrative law judge may not review one. (ii) It may not be held unlawful or set aside because the publication or public-comment requirements of section 553 of title 5 or section 1395hh(b) were not met. (iii) An aggrieved party may complain to the Departmental Appeals Board. The Board must review the record and allow discovery and evidence if the record is incomplete or lacks enough information to support the decision; may consult scientific and clinical experts; and must defer only to the Secretary’s reasonable factual findings, reasonable legal interpretations, and reasonable applications of facts to law. (iv) The Secretary must carry out the Board’s decision within 30 days. (v) The Board’s decision is final agency action and may be reviewed by a court. (B) A “national coverage determination” is the Secretary’s decision about whether a particular item or service is covered nationally under this subchapter. It does not include deciding which code is assigned to a covered item or service or deciding its payment amount. (2)(A) A local coverage determination may be reviewed by an administrative law judge after an aggrieved party complains. The judge must use the same record, discovery, evidence, expert-consultation, and deference rules described above. The Departmental Appeals Board must review the judge’s decision after a complaint. The Secretary must implement the judge’s or Board’s decision within 30 days. A Board decision is final agency action and may be reviewed by a court. (B) A “local coverage determination” is a fiscal intermediary’s or carrier’s decision under Part A or B about whether an item or service is covered across that intermediary’s or carrier’s area, under section 1395y(a)(1)(A). (C) Rules for local coverage decisions about clinical diagnostic laboratory tests are in section 1395m–1(g). (3) If the moving party says there is no material factual dispute and the only legal issue is the Constitution’s validity of a provision of this subchapter, or the invalidity of a Secretary regulation, determination, or ruling, the party may go directly to a court with authority without filing the complaint or exhausting other administrative remedies. (4)(A) If the Secretary has not made a national coverage or noncoverage determination for an item or class, an aggrieved person described in paragraph (5) may ask the Secretary to make one. Within 90 days after receiving the request, even if new evidence arrives, the Secretary must issue a national coverage decision with or without limits; issue a national noncoverage decision; decide that no national decision is appropriate at that time; or issue a notice saying review is incomplete, listing remaining steps and a deadline. (B) If the Secretary misses that stated deadline, the Secretary is deemed to have decided that no national coverage or noncoverage decision is appropriate at that time. (C) A decision must explain its basis. Except for the incomplete-review notice, it is treated as a national coverage determination for review under (1). (5) Only a person entitled to Part A or enrolled in Part B, who needs the item or service involved, may seek this review. (6) Each Secretary-hearing decision about a national coverage determination must be made public on the Department of Health and Human Services Medicare website, with information identifying a person, provider, or supplier removed. (7)(A) By December 1 each year beginning in 2001, the Secretary must report to Congress the actual time needed to complete and fully implement national coverage determinations made in the previous fiscal year for items, services, or devices not previously covered. For each new item, service, or device, the report must state* the time used for coverage, coding, and payment decisions and each significant step. (B) The Secretary must publish each report on the Medicare website. (8) This subsection does not allow review that another law expressly prohibits or limits.
(g) Qualifications of reviewers: (1) A qualified independent contractor must ensure that each reviewer meets the rules below, that compensation is consistent with paragraph (3), and that a physician or other health-professional panel uses qualified professionals. If the claim concerns treatment* or items or services furnished by an allopathic or osteopathic physician, a panel professional must be such a physician. (2)(A) Unless (B) applies, each reviewer must not be a “related party,” must not have a material family, financial, or professional relationship with one, and must not otherwise have a conflict with one. (B) This does not prohibit review merely because the reviewer has a participation agreement with an intermediary, carrier, or contractor, if the reviewer is not involved in the case, the agreement is disclosed to the Secretary and the beneficiary or representative and neither objects, and the reviewer is not the contractor’s employee and does not work exclusively or mainly for it. It also does not prohibit a reviewer who has staff privileges at the institution where treatment occurred, if those privileges are disclosed and neither side objects, or compensation from a contractor that follows paragraph (3). “Participation agreement” means an agreement about the reviewer’s health-care services, not review services under this subsection. (3) Contractor compensation cannot depend on the reviewer’s decision. (4) Each reviewing professional must be an appropriately credentialed or licensed allopathic or osteopathic physician with suitable expertise, or a health professional legally authorized in a State to furnish the items or services and with suitable expertise. (5) A “related party” includes the Secretary, the Medicare administrative contractor*, and their relevant officers, directors, fiduciaries, and employees; the beneficiary or representative; the professional who supplied the item or service; the institution where it was supplied; the manufacturer of a drug* or other involved item; and any other party that regulations identify as having a substantial interest in the case.
(h) Prior determination process for certain items and services: (1)(A) For a Medicare administrative contractor that pays for physicians’ services under section 1395kk–1, the Secretary must establish a prior-coverage-decision process for eligible requesters. (B) Eligible requesters are a participating physician, with the consenting beneficiary’s permission, for services the physician plans to provide; and a beneficiary who received an advance beneficiary notice for a physician service under section 1395pp(a). (2) By regulation, the Secretary must set reasonable limits on which services may be submitted, considering the dollar amount, administrative burden, and other relevant factors. (3) Before the service is provided, an eligible requester may ask whether it will be covered consistently with the medical-necessity rule in section 1395y(a)(1)(A). The Secretary may require a service description, medical-necessity records, other documents, and, from a beneficiary requester, the advance notice. (4)(A) The contractor must give written notice saying the service is covered, is not covered, or cannot be decided because information is insufficient. (B) A noncoverage notice must briefly explain the basis, identify any national or local coverage or noncoverage decision used, and describe rights under (a). An insufficient-information notice must identify the additional information needed. (C) The notice is due within the time used for initial claim decisions under (a)(2)(A). (D) If a participating physician requested the decision, the beneficiary must be told of a noncoverage decision and of the right to receive the service and submit a claim. (5) A positive decision binds the contractor unless there was fraud or misrepresentation of the facts given to it. (6)(A) A negative or insufficient-information pre-service decision cannot be administratively or judicially appealed under this section or otherwise. (B) A beneficiary who does not request a prior decision, or who receives a negative one, may still receive the service, submit a claim, and use the ordinary administrative and judicial appeal rights. Not requesting a prior decision cannot be held against the beneficiary. (C) Once the service has been provided, no prior decision may be made for it.
(i) Mediation process for local coverage determinations: (1) The Secretary must establish a mediation process using a physician trained in mediation and employed by the Centers for Medicare & Medicaid Services. (2) The mediator handles disputes between groups representing providers and suppliers, and the Medicare administrative contractor’s medical director*, when the regional administrator* finds a systematic pattern and large volume of complaints, or when the contractor advisory committee’s co-chair complains to that administrator.
The Secretary* shall promulgate regulations and make initial determinations with respect to benefits under part A or part B in accordance with those regulations for the following:
The initial determination of whether an individual is entitled to benefits under such parts.
The initial determination of the amount of benefits available to the individual under such parts.
Any other initial determination with respect to a claim for benefits under such parts, including an initial determination by the Secretary that payment may not be made, or may no longer be made, for an item or service under such parts, an initial determination made by a quality improvement organization under section 1320c–3(a)(2) of this title, and an initial determination made by an entity pursuant to a contract (other than a contract under section 1395w–22 of this title) with the Secretary to administer provisions of this subchapter or subchapter XI.
Subject to subparagraph (B), in promulgating regulations under paragraph (1), initial determinations shall be concluded by not later than the 45-day period beginning on the date the fiscal intermediary or the carrier, as the case may be, receives a claim for benefits from an individual as described in paragraph (1). Notice of such determination shall be mailed to the individual filing the claim before the conclusion of such 45-day period.
Subparagraph (A) shall not apply with respect to any claim that is subject to the requirements of section 1395h(c)(2) or 1395u(c)(2) of this title.
In promulgating regulations under paragraph (1) with respect to initial determinations, such regulations shall provide for a fiscal intermediary or a carrier to make a redetermination with respect to a claim for benefits that is denied in whole or in part.
No initial determination may be reconsidered or appealed under subsection (b) unless the fiscal intermediary or carrier has made a redetermination of that initial determination under this paragraph.
No redetermination may be made by any individual involved in the initial determination.
A redetermination under subparagraph (A) shall be available only if notice is filed with the Secretary to request the redetermination by not later than the end of the 120-day period beginning on the date the individual receives notice of the initial determination under paragraph (2).
Redeterminations shall be concluded by not later than the 60-day period beginning on the date the fiscal intermediary or the carrier, as the case may be, receives a request for a redetermination. Notice of such determination shall be mailed to the individual filing the claim before the conclusion of such 60-day period.
For purposes of the succeeding provisions of this section a redetermination under this paragraph shall be considered to be part of the initial determination.
With respect to an initial determination insofar as it results in a denial of a claim for benefits—
the written notice on the determination shall include—
the reasons for the determination, including whether a local medical review policy or a local coverage determination was used;
the procedures for obtaining additional information concerning the determination, including the information described in subparagraph (B); and
notification of the right to seek a redetermination or otherwise appeal the determination and instructions on how to initiate such a redetermination under this section;
such written notice shall be provided in printed form and 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
the individual provided such written notice may obtain, upon request, information on the specific provision of the policy, manual, or regulation used in making the redetermination.
With respect to a redetermination insofar as it results in a denial of a claim for benefits—
the written notice on the redetermination shall include—
the specific reasons for the redetermination;
as appropriate, a summary of the clinical or scientific evidence used in making the redetermination;
a description of the procedures for obtaining additional information concerning the redetermination; and
notification of the right to appeal the redetermination and instructions on how to initiate such an appeal under this section;
such written notice shall be provided in printed form and 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
the individual provided such written notice may obtain, upon request, information on the specific provision of the policy, manual, or regulation used in making the redetermination.
Subject to subparagraph (D), any individual dissatisfied with any initial determination under subsection (a)(1) shall be entitled to reconsideration of the determination, and, subject to subparagraphs (D) and (E), a hearing thereon by the Secretary to the same extent as is provided in section 405(b) of this title and, subject to paragraph (2), to judicial review of the Secretary’s final decision after such hearing as is provided in section 405(g) of this title. For purposes of the preceding sentence, any reference to the “Commissioner of Social Security” or the “Social Security Administration*” in subsection (g) or (l) of section 405 of this title shall be considered a reference to the “Secretary” or the “Department of Health and Human Services”, respectively.
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 section by a person* that furnishes or supplies the individual, directly or indirectly, with services or items, solely on the basis that the person furnishes or supplies the individual with such a service or item.
Any person that furnishes services or items to an individual may not represent an individual under this section with respect to the issue described in section 1395pp(a)(2) of this title unless the person has waived any rights for payment from the beneficiary with respect to the services or items involved in the appeal.
If a person furnishes services or items to an individual and represents the individual under this section, the person may not impose any financial liability on such individual in connection with such representation.
The provisions of section 405(j) of this title and of section 406 of this title (other than subsection (a)(4) of such section) regarding representation of claimants shall apply to representation of an individual with respect to appeals under this section in the same manner as they apply to representation of an individual under those sections.
The right of an individual to an appeal under this section with respect to an item or service may be assigned to the provider of services or supplier of the item or service upon the written consent of such individual using a standard form established by the Secretary for such an assignment.
Reconsideration under subparagraph (A) shall be available only if the individual described in subparagraph (A) files notice with the Secretary to request reconsideration by not later than the end of the 180-day period beginning on the date the individual receives notice of the redetermination under subsection (a)(3), or within such additional time as the Secretary may allow.
The Secretary shall establish in regulations time limits for the filing of a request for a hearing by the Secretary in accordance with provisions in sections 405 and 406 of this title.
A hearing (by the Secretary) shall not be available to an individual under this section if the amount in controversy is less than $100, and judicial review shall not be available to the individual if the amount in controversy is less than $1,000.
In determining the amount in controversy, the Secretary, under regulations, shall allow two or more appeals to be aggregated if the appeals involve—
the delivery of similar or related services to the same individual by one or more providers of services or suppliers, or
common issues of law and fact arising from services furnished to two or more individuals by one or more providers of services or suppliers.
For requests for hearings or judicial review made in a year after 2004, the dollar amounts specified in clause (i) shall be equal to such dollar amounts increased by the percentage increase in the medical care* component of the consumer price index for all urban consumers (U.S. city average) for July 2003 to the July preceding the year involved. Any amount determined under the previous sentence that is not a multiple of $10 shall be rounded to the nearest multiple of $10.
In the case of an individual who has received notice from a provider of services that such provider plans—
to terminate services provided to an individual and a physician* certifies that failure to continue the provision of such services is likely to place the individual’s health at significant risk, or
to discharge the individual from the provider of services,
the individual may request, in writing or orally, an expedited determination or an expedited reconsideration of an initial determination made under subsection (a)(1), as the case may be, and the Secretary shall provide such expedited determination or expedited reconsideration.
For the provision relating to expedited access to judicial review, see paragraph (2).
The Secretary may reopen or revise any initial determination or reconsidered determination described in this subsection under guidelines established by the Secretary in regulations.
The Secretary shall establish a process under which a provider of services or supplier that furnishes an item or service or an individual entitled to benefits under part A or enrolled under part B, or both, who has filed an appeal under paragraph (1) (other than an appeal filed under paragraph (1)(F)(i)) may obtain access to judicial review when a review entity (described in subparagraph (D)), on its own motion or at the request of the appellant, determines that the Departmental Appeals Board does not have the authority to decide the question of law or regulation relevant to the matters in controversy and that there is no material issue of fact in dispute. The appellant may make such request only once with respect to a question of law or regulation for a specific matter in dispute in a case of an appeal.
If, after or coincident with appropriately filing a request for an administrative hearing, the appellant requests a determination by the appropriate review entity that the Departmental Appeals Board does not have the authority to decide the question of law or regulations relevant to the matters in controversy and that there is no material issue of fact in dispute, and if such request is accompanied by the documents and materials as the appropriate review entity shall require for purposes of making such determination, such review entity shall make a determination on the request in writing within 60 days after the date such review entity receives the request and such accompanying documents and materials. Such a determination by such review entity shall be considered a final decision and not subject to review by the Secretary.
If the appropriate review entity—
determines that there are no material issues of fact in dispute and that the only issues to be adjudicated are ones of law or regulation that the Departmental Appeals Board does not have authority to decide; or
fails to make such determination within the period provided under subparagraph (B),
then the appellant may bring a civil action as described in this subparagraph.
Such action shall be filed, in the case described in—
clause (i)(I), within 60 days of the date of the determination described in such clause; or
clause (i)(II), within 60 days of the end of the period provided under subparagraph (B) for the determination.
Such action shall be brought in the district court of the United States* for the judicial district in which the appellant is located (or, in the case of an action brought jointly by more than one applicant, the judicial district in which the greatest number of applicants are located) or in the District Court for the District of Columbia.
Where a provider of services or supplier is granted judicial review pursuant to this paragraph, the amount in controversy (if any) shall be subject to annual interest beginning on the first day of the first month beginning after the 60-day period as determined pursuant to clause (ii) and equal to the rate of interest on obligations issued for purchase by the Federal Supplementary Medical Insurance Trust Fund for the month in which the civil action authorized under this paragraph is commenced, to be awarded by the reviewing court in favor of the prevailing party. No interest awarded pursuant to the preceding sentence shall be deemed income or cost for the purposes of determining reimbursement due providers of services or suppliers under this subchapter.
For purposes of this subsection, the term “review entity” means an entity of up to three reviewers who are administrative law judges or members of the Departmental Appeals Board selected for purposes of making determinations under this paragraph.
A provider of services or supplier may not introduce evidence in any appeal under this section that was not presented at the reconsideration conducted by the qualified independent contractor under subsection (c), unless there is good cause which precluded the introduction of such evidence at or before that reconsideration.
The Secretary shall enter into contracts with qualified independent contractors to conduct reconsiderations of initial determinations made under subparagraphs (B) and (C) of subsection (a)(1). Contracts shall be for an initial term of three years and shall be renewable on a triennial basis thereafter.
For purposes of this subsection, the term “qualified independent contractor” means an entity or organization that is independent of any organization under contract with the Secretary that makes initial determinations under subsection (a)(1), and that meets the requirements established by the Secretary consistent with paragraph (3).
Any qualified independent contractor entering into a contract with the Secretary under this subsection shall meet all of the following requirements:
The qualified independent contractor shall perform such duties and functions and assume such responsibilities as may be required by the Secretary to carry out the provisions of this subsection, and shall have sufficient medical, legal, and other expertise (including knowledge of the program under this subchapter) and sufficient staffing to make reconsiderations under this subsection.
The qualified independent contractor shall review initial determinations. Where an initial determination is made with respect to whether an item or service is reasonable and necessary for the diagnosis or treatment* of illness or injury (under section 1395y(a)(1)(A) of this title), such review shall include consideration of the facts and circumstances of the initial determination by a panel of physicians or other appropriate health care professionals and any decisions with respect to the reconsideration shall be based on applicable information, including clinical experience (including the medical records of the individual involved) and medical, technical, and scientific evidence.
If the Secretary has made a national coverage determination pursuant to the requirements established under the third sentence of section 1395y(a) of this title, such determination shall be binding on the qualified independent contractor in making a decision with respect to a reconsideration under this section.
If the Secretary has made a local coverage determination, such determination shall not be binding on the qualified independent contractor in making a decision with respect to a reconsideration under this section. Notwithstanding the previous sentence, the qualified independent contractor shall consider the local coverage determination in making such decision.
In the absence of such a national coverage determination or local coverage determination, the qualified independent contractor shall make a decision with respect to the reconsideration based on applicable information, including clinical experience and medical, technical, and scientific evidence.
Except as provided in clauses (iii) and (iv), the qualified independent contractor shall conduct and conclude a reconsideration under subparagraph (B), and mail the notice of the decision with respect to the reconsideration by not later than the end of the 60-day period beginning on the date a request for reconsideration has been timely filed.
In the case of a failure by the qualified independent contractor to mail the notice of the decision by the end of the period described in clause (i) or to provide notice by the end of the period described in clause (iii), as the case may be, the party requesting the reconsideration or appeal may request a hearing before the Secretary, notwithstanding any requirements for a reconsidered determination for purposes of the party’s right to such hearing.
The qualified independent contractor shall perform an expedited reconsideration under subsection (b)(1)(F) as follows:
Notwithstanding section 416(j) of this title and subject to clause (iv), not later than the end of the 72-hour period beginning on the date the qualified independent contractor has received a request for such reconsideration and has received such medical or other records needed for such reconsideration, the qualified independent contractor shall provide notice (by telephone and in writing) to the individual and the provider of services and attending physician* of the individual of the results of the reconsideration. Such reconsideration shall be conducted regardless of whether the provider of services or supplier will charge the individual for continued services or whether the individual will be liable for payment for such continued services.
In such reconsideration, the qualified independent contractor shall solicit the views of the individual involved.
A reconsideration of a discharge from a hospital shall be conducted under this clause in accordance with the provisions of paragraphs (2), (3), and (4) of section 1320c–3(e) of this title as in effect on the date that precedes December 21, 2000.
An individual requesting a reconsideration under this subparagraph may be granted such additional time as the individual specifies (not to exceed 14 days) for the qualified independent contractor to conclude the reconsideration. The individual may request such additional time orally or in writing.
The requirements of subsection (g) shall be met (relating to qualifications of reviewing professionals).
Any decision with respect to a reconsideration of a qualified independent contractor shall be in writing, 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) and shall include 1 a detailed explanation of the decision as well as a discussion of the pertinent facts and applicable regulations applied in making such decision, and 2 a notification of the right to appeal such determination and instructions on how to initiate such appeal under this section 3 and 3 in the case of a determination of whether an item or service is reasonable and necessary for the diagnosis or treatment of illness or injury (under section 1395y(a)(1)(A) of this title) 3 an explanation of the medical and scientific rationale for the decision.
Whenever a qualified independent contractor makes a decision with respect to a reconsideration under this subsection, the qualified independent contractor shall promptly notify the entity responsible for the payment of claims under part A or part B of such decision.
Each qualified independent contractor shall make available all decisions with respect to reconsiderations of such qualified independent contractors to fiscal intermediaries (under section 1395h of this title), carriers (under section 1395u of this title), quality improvement organizations (under part B of subchapter XI), Medicare+Choice organizations offering Medicare+Choice plans under part C, other entities under contract with the Secretary to make initial determinations under part A or part B or subchapter XI, and to the public. The Secretary shall establish a methodology under which qualified independent contractors shall carry out this subparagraph.
Each qualified independent contractor shall monitor its decisions with respect to reconsiderations to ensure the consistency of such decisions with respect to requests for reconsideration of similar or related matters.
Consistent with the requirements of clause (ii), a qualified independent contractor shall collect such information relevant to its functions, and keep and maintain such records in such form and manner as the Secretary may require to carry out the purposes of this section and shall permit access to and use of any such information and records as the Secretary may require for such purposes.
Each qualified independent contractor shall keep accurate records of each decision made, consistent with standards established by the Secretary for such purpose. Such records shall be maintained in an electronic database in a manner that provides for identification of the following:
Specific claims that give rise to appeals.
Situations suggesting the need for increased education for providers of services, physicians, or suppliers.
Situations suggesting the need for changes in national or local coverage determination.
Situations suggesting the need for changes in local coverage determinations.
Each qualified independent contractor shall submit annually to the Secretary (or otherwise as the Secretary may request) records maintained under this paragraph for the previous year.
The qualified independent contractor shall (i) submit such information as is required for an appeal of a decision of the contractor, and (ii) participate in such hearings as required by the Secretary.
Subject to clause (ii), a qualified independent contractor shall not conduct any activities in a case unless the entity—
is not a related party (as defined in subsection (g)(5));
does not have a material familial, financial, or professional relationship with such a party in relation to such case; and
does not otherwise have a conflict of interest with such a party.
Nothing in clause (i) shall be construed to prohibit receipt by a qualified independent contractor of compensation from the Secretary for the conduct of activities under this section if the compensation is provided consistent with clause (iii).
Compensation provided by the Secretary to a qualified independent contractor in connection with reviews under this section shall not be contingent on any decision rendered by the contractor or by any reviewing professional.
The Secretary shall enter into contracts with 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.
No qualified independent contractor having a contract with the Secretary under this subsection and no person who is employed by, or who has a fiduciary relationship with, any such qualified independent contractor or who furnishes professional services to such qualified independent contractor, shall be held by reason of the performance of any duty, function, or activity required or authorized pursuant to this subsection or to a valid contract entered into under this subsection, to have violated any criminal law, or to be civilly liable under any law of the United States or of any State* (or political subdivision thereof) provided due care was exercised in the performance of such duty, function, or activity.
Except as provided in subparagraph (B), an administrative law judge shall conduct and conclude a hearing on a decision of a qualified independent contractor under subsection (c) and render a decision on such hearing by not later than the end of the 90-day period beginning on the date a request for hearing has been timely filed.
The 90-day period under subparagraph (A) shall not apply in the case of a motion or stipulation by the party requesting the hearing to waive such period.
The Departmental Appeals Board of the Department of Health and Human Services shall conduct and conclude a review of the decision on a hearing described in paragraph (1) and make a decision or remand the case to the administrative law judge for reconsideration by not later than the end of the 90-day period beginning on the date a request for review has been timely filed.
In reviewing a decision on a hearing under this paragraph, the Departmental Appeals Board shall review the case de novo.
In the case of a failure by an administrative law judge to render a decision by the end of the period described in paragraph (1), the party requesting the hearing may request a review by the Departmental Appeals Board of the Department of Health and Human Services, notwithstanding any requirements for a hearing for purposes of the party’s right to such a review.
In the case of a failure by the Departmental Appeals Board to render a decision by the end of the period described in paragraph (2), the party requesting the hearing may seek judicial review, notwithstanding any requirements for a hearing for purposes of the party’s right to such judicial review.
Notice of the decision of an administrative law judge shall be in writing 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—
the specific reasons for the determination (including, to the extent appropriate, a summary of the clinical or scientific evidence used in making the determination);
the procedures for obtaining additional information concerning the decision; and
notification of the right to appeal the decision and instructions on how to initiate such an appeal under this section.
A regulation or instruction that relates to a method for determining the amount of payment under part B and that was initially issued before January 1, 1981, shall not be subject to judicial review.
The Secretary shall perform such outreach activities as are necessary to inform individuals entitled to benefits under this subchapter and providers of services and suppliers with respect to their rights of, and the process for, appeals made under this section. The Secretary shall use the toll-free telephone number maintained by the Secretary under section 1395b–2(b) of this title to provide information regarding appeal rights and respond to inquiries regarding the status of appeals.
The Secretary shall provide to each qualified independent contractor, and, in consultation with the Commissioner of Social Security, to administrative law judges that decide appeals of reconsiderations of initial determinations or other decisions or determinations under this section, such continuing education with respect to coverage of items and services under this subchapter or policies of the Secretary with respect to part B of subchapter XI as is necessary for such qualified independent contractors and administrative law judges to make informed decisions with respect to appeals.
The Secretary shall submit to Congress an annual report describing the number of appeals for the previous year, identifying issues that require administrative or legislative actions, and including any recommendations of the Secretary with respect to such actions. The Secretary shall include in such report an analysis of determinations by qualified independent contractors with respect to inconsistent decisions and an analysis of the causes of any such inconsistencies.
Not less frequently than every 5 years, the Secretary shall conduct a survey of a valid sample of individuals entitled to benefits under this subchapter who have filed appeals of determinations under this section, providers of services, and suppliers to determine the satisfaction of such individuals or entities with the process for appeals of determinations provided for under this section and education and training provided by the Secretary with respect to that process. The Secretary shall submit to Congress a report describing the results of the survey, and shall include any recommendations for administrative or legislative actions that the Secretary determines appropriate.
Review of any national coverage determination shall be subject to the following limitations:
Such a determination shall not be reviewed by any administrative law judge.
Such a determination shall not be held unlawful or set aside on the ground that a requirement of section 553 of title 5 or section 1395hh(b) of this title, relating to publication in the Federal Register or opportunity for public comment, was not satisfied.
Upon the filing of a complaint by an aggrieved party, such a determination shall be reviewed by the Departmental Appeals Board of the Department of Health and Human Services. In conducting such a review, the Departmental Appeals Board—
shall review the record and shall permit discovery and the taking of evidence to evaluate the reasonableness of the determination, if the Board determines that the record is incomplete or lacks adequate information to support the validity of the determination;
may, as appropriate, consult with appropriate scientific and clinical experts; and
shall defer only to the reasonable findings of fact, reasonable interpretations of law, and reasonable applications of fact to law by the Secretary.
The Secretary shall implement a decision of the Departmental Appeals Board within 30 days of receipt of such decision.
A decision of the Departmental Appeals Board constitutes a final agency action and is subject to judicial review.
For purposes of this section, the term “national coverage determination” means a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under this subchapter, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this subchapter or a determination with respect to the amount of payment made for a particular item or service so covered.
Review of any local coverage determination shall be subject to the following limitations:
Upon the filing of a complaint by an aggrieved party, such a determination shall be reviewed by an administrative law judge. The administrative law judge—
shall review the record and shall permit discovery and the taking of evidence to evaluate the reasonableness of the determination, if the administrative law judge determines that the record is incomplete or lacks adequate information to support the validity of the determination;
may, as appropriate, consult with appropriate scientific and clinical experts; and
shall defer only to the reasonable findings of fact, reasonable interpretations of law, and reasonable applications of fact to law by the Secretary.
Upon the filing of a complaint by an aggrieved party, a decision of an administrative law judge under clause (i) shall be reviewed by the Departmental Appeals Board of the Department of Health and Human Services.
The Secretary shall implement a decision of the administrative law judge or the Departmental Appeals Board within 30 days of receipt of such decision.
A decision of the Departmental Appeals Board constitutes a final agency action and is subject to judicial review.
For purposes of this section, the term “local coverage determination” means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts, in accordance with section 1395y(a)(1)(A) of this title.
For provisions relating to local coverage determinations for clinical diagnostic laboratory tests, see section 1395m–1(g) of this title.
In the case of a determination that may otherwise be subject to review under paragraph (1)(A)(iii) or paragraph (2)(A)(i), where the moving party alleges that—
there are no material issues of fact in dispute, and
the only issue of law is the constitutionality of a provision of this subchapter, or that a regulation, determination, or ruling by the Secretary is invalid,
the moving party may seek review by a court of competent jurisdiction without filing a complaint under such paragraph and without otherwise exhausting other administrative remedies.
In the event the Secretary has not issued a national coverage or noncoverage determination with respect to a particular type or class of items or services, an aggrieved person (as described in paragraph (5)) may submit to the Secretary a request to make such a determination with respect to such items or services. By not later than the end of the 90-day period beginning on the date the Secretary receives such a request (notwithstanding the receipt by the Secretary of new evidence (if any) during such 90-day period), the Secretary shall take one of the following actions:
Issue a national coverage determination, with or without limitations.
Issue a national noncoverage determination.
Issue a determination that no national coverage or noncoverage determination is appropriate as of the end of such 90-day period with respect to national coverage of such items or services.
Issue a notice that states that the Secretary has not completed a review of the request for a national coverage determination and that includes an identification of the remaining steps in the Secretary’s review process and a deadline by which the Secretary will complete the review and take an action described in clause (i), (ii), or (iii).
In the case of an action described in subparagraph (A)(iv), if the Secretary fails to take an action referred to in such clause by the deadline specified by the Secretary under such clause, then the Secretary is deemed to have taken an action described in subparagraph (A)(iii) as of the deadline.
When issuing a determination under subparagraph (A), the Secretary shall include an explanation of the basis for the determination. An action taken under subparagraph (A) (other than clause (iv)) is deemed to be a national coverage determination for purposes of review under paragraph (1)(A).
An action under this subsection seeking review of a national coverage determination or local coverage determination may be initiated only by individuals entitled to benefits under part A, or enrolled under part B, or both, who are in need of the items or services that are the subject of the coverage determination.
Each decision of a hearing by the Secretary with respect to a national coverage determination shall be made public, and the Secretary shall publish each decision on the Medicare 4 Internet site of the Department of Health and Human Services. The Secretary shall remove from such decision any information that would identify any individual, provider of services, or supplier.
Not later than December 1 of each year, beginning in 2001, the Secretary shall submit to Congress a report that sets forth a detailed compilation of the actual time periods that were necessary to complete and fully implement national coverage determinations that were made in the previous fiscal year for items, services, or medical devices not previously covered as a benefit under this subchapter, including, with respect to each new item, service, or medical device, a statement of the time taken by the Secretary to make and implement the necessary coverage, coding, and payment determinations, including the time taken to complete each significant step in the process of making and implementing such determinations.
The Secretary shall publish each report submitted under clause (i) on the medicare Internet site of the Department of Health and Human Services.
Nothing in this subsection shall be construed as permitting administrative or judicial review pursuant to this section insofar as such review is explicitly prohibited or restricted under another provision of law.
In reviewing determinations under this section, a qualified independent contractor shall assure that—
each individual conducting a review shall meet the qualifications of paragraph (2);
compensation provided by the contractor to each such reviewer is consistent with paragraph (3); and
in the case of a review by a panel described in subsection (c)(3)(B) composed of physicians or other health care professionals (each in this subsection referred to as a “reviewing professional”), a reviewing professional meets the qualifications described in paragraph (4) and, where a claim is regarding the furnishing of treatment by a physician (allopathic or osteopathic) or the provision of items or services by a physician (allopathic or osteopathic), a reviewing professional shall be a physician (allopathic or osteopathic).
Subject to subparagraph (B), each individual conducting a review in a case shall—
not be a related party (as defined in paragraph (5));
not have a material familial, financial, or professional relationship with such a party in the case under review; and
not otherwise have a conflict of interest with such a party.
Nothing in subparagraph (A) shall be construed to—
prohibit an individual, solely on the basis of a participation agreement with a fiscal intermediary, carrier, or other contractor, from serving as a reviewing professional if—
the individual is not involved in the provision of items or services in the case under review;
the fact of such an agreement is disclosed to the Secretary and the individual entitled to benefits under part A or enrolled under part B, or both, or such individual’s authorized representative, and neither party objects; and
the individual is not an employee of the intermediary, carrier, or contractor and does not provide services exclusively or primarily to or on behalf of such intermediary, carrier, or contractor;
prohibit an individual who has staff privileges at the institution where the treatment involved takes place from serving as a reviewer merely on the basis of having such staff privileges if the existence of such privileges is disclosed to the Secretary and such individual (or authorized representative), and neither party objects; or
prohibit receipt of compensation by a reviewing professional from a contractor if the compensation is provided consistent with paragraph (3).
For purposes of this paragraph, the term “participation agreement” means an agreement relating to the provision of health care services by the individual and does not include the provision of services as a reviewer under this subsection.
Compensation provided by a qualified independent contractor to a reviewer in connection with a review under this section shall not be contingent on the decision rendered by the reviewer.
Each reviewing professional shall be—
a physician (allopathic or osteopathic) who is appropriately credentialed or licensed in one or more States to deliver health care services and has medical expertise in the field of practice that is appropriate for the items or services at issue; or
a health care professional who is legally authorized in one or more States (in accordance with State law or the State regulatory mechanism provided by State law) to furnish the health care items or services at issue and has medical expertise in the field of practice that is appropriate for such items or services.
For purposes of this section, the term “related party” means, with respect to a case under this subchapter involving a specific individual entitled to benefits under part A or enrolled under part B, or both, any of the following:
The Secretary, the medicare administrative contractor* involved, or any fiduciary, officer, director*, or employee of the Department of Health and Human Services, or of such contractor.
The individual (or authorized representative).
The health care professional that provides the items or services involved in the case.
The institution at which the items or services (or treatment) involved in the case are provided.
The manufacturer of any drug* or other item that is included in the items or services involved in the case.
Any other party determined under any regulations to have a substantial interest in the case involved.
With respect to a medicare administrative contractor that has a contract under section 1395kk–1 of this title that provides for making payments under this subchapter with respect to physicians’ services (as defined in section 1395w–4(j)(3) of this title), the Secretary shall establish a prior determination process that meets the requirements of this subsection and that shall be applied by such contractor in the case of eligible requesters.
For purposes of this subsection, each of the following shall be an eligible requester:
A participating physician, but only with respect to physicians’ services to be furnished to an individual who is entitled to benefits under this subchapter and who has consented to the physician making the request under this subsection for those physicians’ services.
An individual entitled to benefits under this subchapter, but only with respect to a physicians’ service for which the individual receives, from a physician, an advance beneficiary notice under section 1395pp(a) of this title.
The Secretary shall establish by regulation reasonable limits on the physicians’ services for which a prior determination of coverage may be requested under this subsection. In establishing such limits, the Secretary may consider the dollar amount involved with respect to the physicians’ service, administrative costs and burdens, and other relevant factors.
Subject to paragraph (2), under the process established under this subsection an eligible requester may submit to the contractor a request for a determination, before the furnishing of a physicians’ service, as to whether the physicians’ service is covered under this subchapter consistent with the applicable requirements of section 1395y(a)(1)(A) of this title (relating to medical necessity).
The Secretary may require that the request be accompanied by a description of the physicians’ service, supporting documentation relating to the medical necessity for the physicians’ service, and any other appropriate documentation. In the case of a request submitted by an eligible requester who is described in paragraph (1)(B)(ii), the Secretary may require that the request also be accompanied by a copy of the advance beneficiary notice involved.
Under such process, the contractor shall provide the eligible requester with written notice of a determination as to whether—
the physicians’ service is so covered;
the physicians’ service is not so covered; or
the contractor lacks sufficient information to make a coverage determination with respect to the physicians’ service.
If the contractor makes the determination described in subparagraph (A)(ii), the contractor shall include in the notice a brief explanation of the basis for the determination, including on what national or local coverage or noncoverage determination (if any) the determination is based, and a description of any applicable rights under subsection (a).
If the contractor makes the determination described in subparagraph (A)(iii), the contractor shall include in the notice a description of the additional information required to make the coverage determination.
Such notice shall be provided within the same time period as the time period applicable to the contractor providing notice of initial determinations on a claim for benefits under subsection (a)(2)(A).
In the case of a request by a participating physician under paragraph (1)(B)(i), the process shall provide that the individual to whom the physicians’ service is proposed to be furnished shall be informed of any determination described in subparagraph (A)(ii) (relating to a determination of non-coverage) and the right (referred to in paragraph (6)(B)) to obtain the physicians’ service and have a claim submitted for the physicians’ service.
If the contractor makes the determination described in paragraph (4)(A)(i), such determination shall be binding on the contractor in the absence of fraud or evidence of misrepresentation of facts presented to the contractor.
Contractor determinations described in paragraph (4)(A)(ii) or (4)(A)(iii) (relating to pre-service claims) are not subject to further administrative appeal or judicial review under this section or otherwise.
Nothing in this subsection shall be construed as affecting the right of an individual who—
decides not to seek a prior determination under this subsection with respect to physicians’ services; or
seeks such a determination and has received a determination described in paragraph (4)(A)(ii),
from receiving (and submitting a claim for) such physicians’ services and from obtaining administrative or judicial review respecting such claim under the other applicable provisions of this section. Failure to seek a prior determination under this subsection with respect to physicians’ service shall not be taken into account in such administrative or judicial review.
Once an individual is provided physicians’ services, there shall be no prior determination under this subsection with respect to such physicians’ services.
The Secretary shall establish a mediation process under this subsection through the use of a physician trained in mediation and employed by the Centers for Medicare & Medicaid Services.
Under the process established in paragraph (1), such a mediator shall mediate in disputes between groups representing providers of services, suppliers (as defined in section 1395x(d) of this title), and the medical director for a medicare administrative contractor whenever the regional administrator* (as defined by the Secretary) involved determines that there was a systematic pattern and a large volume of complaints from such groups regarding decisions of such director or there is a complaint from the co-chair of the advisory committee* for that contractor to such regional administrator regarding such dispute.
Source credit: (Aug. 14, 1935, ch. 531, title XVIII, § 1869, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 330; amended Pub. L. 92–603, title II, § 299O(a), Oct. 30, 1972, 86 Stat. 1464; Pub. L. 98–369, div. B, title III, § 2354(b)(35), July 18, 1984, 98 Stat. 1102; Pub. L. 99–509, title IX, §§ 9313(a)(1), (b)(1), 9341(a)(1), Oct. 21, 1986, 100 Stat. 2002, 2037; Pub. L. 100–93, § 8(e), Aug. 18, 1987, 101 Stat. 694; Pub. L. 100–203, title IV, §§ 4082(a), (b), 4085(i)(18), (19), Dec. 22, 1987, 101 Stat. 1330–128, 1330–133; Pub. L. 103–296, title I, § 108(c)(5), Aug. 15, 1994, 108 Stat. 1485; Pub. L. 105–33, title IV, § 4611(c), Aug. 5, 1997, 111 Stat. 473; Pub. L. 106–554, § 1(a)(6) [title V, §§ 521(a), 522(a)], Dec. 21, 2000, 114 Stat. 2763, 2763A–534, 2763A–543; Pub. L. 108–173, title IX, §§ 931(d), 932(a), 933(a)(1), (b)–(d)(3), 938(a), 940(a), (b)(1), 940A(a), 948(b)(1), (c), Dec. 8, 2003, 117 Stat. 2399, 2402–2406, 2413, 2416, 2417, 2426; Pub. L. 112–40, title II, § 261(a)(3)(A), (F), Oct. 21, 2011, 125 Stat. 423; Pub. L. 113–93, title II, § 216(b)(2), Apr. 1, 2014, 128 Stat. 1060.)
- 1935Enacted · Pub. L. 89-97 · 79 Stat. 330
- 1972Amended · Pub. L. 92-603 · 86 Stat. 1464
- 1984Amended · Pub. L. 98-369 · 98 Stat. 1102
- 1986Amended · Pub. L. 99-509 · 100 Stat. 2002, 2037
- 1987Amended · Pub. L. 100-93 · 101 Stat. 694
- 1987Amended · Pub. L. 100-203 · 101 Stat. 1330
- 1994Amended · Pub. L. 103-296 · 108 Stat. 1485
- 1997Amended · Pub. L. 105-33 · 111 Stat. 473
- 2000Amended · Pub. L. 106-554 · 114 Stat. 2763, 2763
- 2003Amended · Pub. L. 108-173 · 117 Stat. 2399, 2402
- 2011Amended · Pub. L. 112-40 · 125 Stat. 423
- 2014Amended · Pub. L. 113-93 · 128 Stat. 1060
A history note hasn’t been published yet. The record shows enactment by Pub. L. 89-97 on 1935-08-14.
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