Editorial Notes
Prior Provisions
A prior section 1395zz, act Aug. 14, 1935, ch. 531, title XVIII, § 1889, as added Nov. 5, 1990, Pub. L. 101–508, title IV, § 4361(a), 104 Stat. 1388–141, related to medicare and medigap information by telephone, prior to repeal by Pub. L. 103–432, title I, § 171(j)(3), (l), Oct. 31, 1994, 108 Stat. 4451, effective as if included in the enactment of Pub. L. 101–508.
Another prior section 1395zz, act Aug. 14, 1935, ch. 531, title XVIII, § 1889, formerly § 1833(f), as added Jan. 2, 1968, Pub. L. 90–248, title I, § 132(b), 81 Stat. 850, and amended Oct. 30, 1972, Pub. L. 92–603, title II, § 245(d), 86 Stat. 1424; Oct. 25, 1977, Pub. L. 95–142, § 16(a), 91 Stat. 1200; renumbered § 1889 and amended July 18, 1984, Pub. L. 98–369, div. B, title III, § 2321(d), 98 Stat. 1084, provided for purchase of durable medical equipment, covering (a) lease-purchase basis or rental and determination by Secretary, (b) waiver of coinsurance amount in purchase of used equipment, (c) reimbursement procedures, and (d) encouragement of lease-purchase basis, prior to repeal by Pub. L. 100–203, title IV, § 4062(d)(5), (e), Dec. 22, 1987, 101 Stat. 1330–109, applicable to covered items (other than oxygen and oxygen equipment) furnished on or after Jan. 1, 1989, and to oxygen and oxygen equipment furnished on or after June 1, 1989.
Statutory Notes and Related Subsidiaries
Effective Date of 2003 Amendment
Pub. L. 108–173, title IX, § 921(d)(2), Dec. 8, 2003, 117 Stat. 2391, provided that:
“The amendment made by paragraph (1) [amending this section] shall take effect on October 1, 2004.”
Pub. L. 108–173, title IX, § 921(e)(2), Dec. 8, 2003, 117 Stat. 2391, provided that:
“The amendment made by paragraph (1) [amending this section] shall take effect on October 1, 2004.”
Pub. L. 108–173, title IX, § 921(f)(2), Dec. 8, 2003, 117 Stat. 2392, provided that:
“The amendment made by paragraph (1) [amending this section] shall take effect on the date of the enactment of this Act [Dec. 8, 2003].”
Small Provider Technical Assistance Demonstration Program
Pub. L. 108–173, title IX, § 922, Dec. 8, 2003, 117 Stat. 2392, provided that:
“(a) Establishment.—
“(1) In general.—
The
Secretary [of Health and Human Services] shall establish a demonstration program (in this section referred to as the ‘demonstration program’) under which technical assistance described in paragraph (2) is made available, upon request and on a voluntary basis, to small providers of services or
suppliers in order to improve compliance with the applicable requirements of the programs under
medicare program under title XVIII of the
Social Security Act [
42 U.S.C. 1395 et seq.] (including provisions of title XI of such Act [
42 U.S.C. 1301 et seq.] insofar as they relate to such title and are not administered by the Office of the Inspector General of the
Department of Health and Human Services).
“(2) Forms of technical assistance.—The technical assistance described in this paragraph is—
“(A)
evaluation and recommendations regarding billing and related systems; and
“(B)
information and assistance regarding policies and procedures under the medicare program, including coding and reimbursement.
“(3) Small providers of services or suppliers.—In this section, the term ‘small providers of services or suppliers’ means—
“(A)
a provider of services with fewer than 25 full-time-equivalent employees; or
“(B)
a
supplier with fewer than 10 full-time-equivalent employees.
“(b) Qualification of Contractors.—
In conducting the demonstration program, the
Secretary shall enter into contracts with qualified organizations (such as peer review [now “quality improvement”] organizations or entities described in section 1889(g)(2) of the
Social Security Act [
42 U.S.C. 1395zz(g)(2)], as inserted by section 921(f)(1)) with
appropriate expertise with billing systems of the full range of providers of services and
suppliers to provide the technical assistance. In awarding such contracts, the
Secretary shall consider any prior investigations of the entity’s work by the Inspector General of
Department of Health and Human Services or the Comptroller General of the
United States.
“(c) Description of Technical Assistance.—
The technical assistance provided under the demonstration program shall include a direct and in-
person examination of billing systems and internal controls of small providers of services or
suppliers to determine program compliance and to suggest more efficient or effective means of achieving such compliance.
“(d) GAO Evaluation.—
Not later than 2 years after the date the demonstration program is first implemented, the Comptroller General, in consultation with the Inspector General of the
Department of Health and Human Services, shall conduct an evaluation of the demonstration program. The evaluation shall include a determination of whether claims error rates are reduced for small providers of services or
suppliers who participated in the program and the extent of improper payments made as a result of the demonstration program. The Comptroller General shall submit a report to the
Secretary and the
Congress on such evaluation and shall include in such report recommendations regarding the continuation or extension of the demonstration program.
“(f) Authorization of Appropriations.—
There are authorized to be appropriated, from amounts not otherwise appropriated in the Treasury, such sums as may be necessary to carry out this section.”