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Page:United States Statutes at Large Volume 91.djvu/1219

 PUBLIC LAW 95-142—OCT. 25, 1977

91 STAT. 1185

" (C) such practitioners have a person (who may himself be a practitioner) — " (i) who is in charge of, controls, manages, or super^dses subsitantial aspects of the arrangement or operation for the delivery of health or medical services at such common physical location, other than the direct furnishing of professional health care services by the practitioners to their patients; or " ( i i) who makes available to such practitioners the services of supporting staff who are not employees of such practitioners; and who is compensated in whole or in part, for the use of such common physical location or support services pertaining thereto, on a basis related to amounts charged or collected for the services rendered or ordered at such location or on any basis clearly unrelated to the value of the services provided by the person; and " (D) at least one of such practitioners received payments on a fee-for-service basis under titles V, X VIII, and X IX in an amount exceeding $5,000 for any one month during the preceding 12 months or in an aggregate amount exceeding $40,000 during the preceding 12 months; except that such term does not include a provider of services (as defined in section 1861(u) of this Act), a health maintenance organization (as defined in section 1301(a) of the Public Health Service Act), a hospital cooperative shared services organization meeting the requirements of section 501(e) of the I n t e r n a l Revenue Code of 1954, or any public entity.". (d)(1) Section 1158 of such Act is amended by adding at the end thereof the following new subsection: " (c) Where a Professional Standard s Review Organization (whether designated on a conditional basis or otherwise) has been found competent by the Secretary to assume review responsibility with respect to specified types of health care services or specified providers or practitioners of such services and is performing such reviews, determinations made pursuant to paragraph s (1) and (2) of section 1155 (a) in connection with such reviews shall constitute the conclusive determination on those issues (subject to sections 1159, 1 1 7 1 (a)(1), and 1 1 7 1 (d)(3)) for purposes of payment under this Act, and no reviews with respect to those determinations shall be conducted, for purposes of payment, by agencies and organizations which are parties to agreements entered into by the Secretary pursuant to section 1816, carriers which are parties to contracts entered into by the Secretary pursuant to section 1842, or single State agencies administering or supervising the administration of State plans approved under title XIX.". (2)(A) Section 1152(b)(2) of such Act is amended by strikinj; out "submitted to him by the association, agency, or organization" and inserting in lieu thereof "which shall be developed and submitted by the association, agency, or organization in accordance with subsection (h) ". (B) Section 1152 of such Act is further amended by ndding at the end thereof the following new subsection: " (h)(1) During the development and preparation by an organization of its formal plan under subsection (b)(2) or of any modification of such plan to include review of services in skilled nursing facilities (as defined in section 1861(j)) or intermediate care facilHies (as defined in section 1905(c)) or review of ambulatory care services, the organization shall consult with the single State agency responsible

42 USC 701, 1395, 1396.

42 USC 1395x. 42 USC 300e. 26 USC 501. eiaim payments review. 42 USC 1320C-7.

42 USC 1320C-4. 42 USC 1320C-8. Post, p. 1186.

42 USC 1395h. 42 USC 1395u. 42 USC 1320C-1.

State health care facility plans, preparation.

42 USC 1395x. 42 USC 1396<i.

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Page:United States Statutes at Large Volume 91.djvu/1220

 9 1 STAT. 1186

42 USC 1396.

Evaluation procedures. Ante, p. 1184.

Ante, p. 1185.

PUBLIC LAW 95-142—OCT. 25, 1977 for administering or supervising the administration of the State plan approved under title X IX for the State in which the organization is located. " (2) Such plan and any such modification shall be submitted to the Governor of such State, at the time of its submission to the Secretary, for his comments. " (3) The Secretary, before making the findings described in subsection (b)(2) or a finding regarding the organization's capability to perform review of such services (as the case may b e), shall consider any such comments submitted to him by such Governor before the end of the thirty-day period beginning on the date of submission of the plan or of any such modification (as the case may be). " (4) If, after considering such comments, the Secretary intends to make findings which are adverse to such comments, the Secretary shall provide the Governor making such comments with the opportunity to submit additional evidence and comments on such intended findings during a period of not less than thirty days ending before the findings became effective.". (C) Section 1154 of such Act (as amended by subsection (b)(2) of this section) is further amended by adding after subsection (d) the following new subsection: " (e) I n determining whether an organization designated on a conditional basis as the Professional Standard s Review Organization for any area is substantially carrying out its duties in a satisfactory manner and should be considered a qualified organization, the Secretary shall follow the procedures specified in section 1152(h) (concerning the Secretary's consideration of comments of the Governor of the State in which the organization is located).". (D) Part B of title X I of such Act is amended by adding after section 1170 the following new section: MEMORANDUMS OF UNDERSTANDING; FEDERAL-STATE RELATIONS GENERALLY

42 USC

" SEC. 1171. (a)(1) Except as provided in paragraph (2), no determination made by a Professional Standard s Review Organization 1320C-20. 42 USC 1320c-^. pursuant to paragraph s (1) and (2) of section 1155(a) in connection with reviews shall constitute conclusive determinations under section Ante, p. 1185. 1158(c) for purposes of payment under title X IX, unless such orga42 USC 1396. nization has entered into a memorandum of understanding, approved by the Secretary, with the single State agency responsible for administering or supervising the administration of the State plan approved under title X IX for the State in which the organization is located (hereinafter in this section referred to as the 'State agency') for the purpose of delineating the relationship between the organization and ,,... '. ( ».- ] the State agency and of providing for the exchange of data or information, and for administrative procedures, coordination mechanisms, and modification of the memorandum at any time that additional responsibility for review by the organization is authorized by the Secretary. Waiver. " (2) The requirement of paragraph (1) may be waived by the Secretary if (A) the State agency indicates to the Secretary that it does not wish to enter into a memorandum of understanding with the organization involved, or (B) the Secretary finds that the State agency has refused to negotiate in good faith or in a timely manner with the organization involved.

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license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


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Page:United States Statutes at Large Volume 91.djvu/1221

 PUBLIC LAW 95-142—OCT. 25, 1977 "(b)(1) The State agency may request a Professional Standards Keview Organization which is entering into such a memorandum of understanding with the agency to include in the memorandum a specification of review goals or methods (additional to any such goals or methods contained in the organization's formal plan) for the performance of the organization's duties and functions under this part. "(2) If the agency and the organization cannot reach agreement regarding the inclusion of any such requested specification, the Secretary shall review such specification and shall require that the specification be included in the memorandum to the extent that the Secretary determines that such specification of goals or methods (A) is consistent with the functions of the organization under this part and with the provisions of title X IX and the State's plan approved under such title, and (B) does not seriously impact on the effectiveness and uniformity of the organization's review of health care services paid for under title X VIII and title X IX of this Act. "(c) Notwithstanding any other provision of this Act, the State agency may contract with any Professional Standards Keview Organization located in the State for the performance of review responsibilities in addition to those performed pursuant to this part (and the cost of performance of such additional responsibilities is reimbureable as an expense of the State agency under section 1903(a)) if— "(1) the State agency formally requests the performance of such additional responsibilities, and "(2) the performance of such additional responsibilities is not inconsistent with this part and is provided for in an amendment to the State's plan which is approved by the Secretary under title X IX. " (d)(1) Each State agency may monitor the performance of review responsibilities by Professional Standards Review Organizations located within the State, in accordance with a State monitoring plan which is developed after review and comment by such organizations and is approved by the Secretary. The costs of activities of the State agency under and in accordance with such plan are reimbursable as an expense of the State agency under section 1903(a). "(2) A monitoring plan developed and approved under paragraph (1) may include a specification of performance criteria for judging the effectiveness of the review performance of the Professional Standards Review Organizations. If the State agency and the Professional Standards Review Organizations cannot reach agreement regarding such criteria, the Secretary shall assist the agency and organizations in resolving the matters in dispute. "(3)(A) Whenever a State agency monitoring the performance of review responsibilities by a Professional Standards Review Organization under a plan developed and approved under paragraph (1) submits to the Secretary reasonable documentation that the review determinations of such organization have caused an unreasonable and detrimental impact on total State expenditures under title X IX and on the appropriateness of care received by individuals under the State's plan approved under such title, and requests the Secretary to act, the Secretary shall, within thirty days from the date of receipt of the documentation, make a determination as to the reasonableness of the allegation by the State agency. If the Secretary determines that the review determinations of such organization have caused an unreasonable and detrimental impact on total State expenditures under title X IX and on the appropriateness of care received by individuals under the State's plan approved under such title, unless the Secretary determines that

91 STAT. 1187 Review goals and methods, specification.

42 USC 1396.

42 USC 1395. Additional State review requests!.

42 USC 1396b.

State monitoring plans.

Review organization's authority, suspension.

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Page:United States Statutes at Large Volume 91.djvu/1222

 91 STAT. 1188

Ante, p. 1185. 42 USC 1396. 42 USC 1395.

Notification of congressional committees.

Procedures and mechanisms, development.

Review committees of hospitals and other health care facilities. 42 USC 1320C-4. Post, p. 1207. 42 USC 1396d.

PUBLIC LAW 95-142—OCT. 25, 1977 the organization has taken appropriate corrective action, he shall immediately suspend such organization's authority in whole or in part under section 1158(c) to make conclusive determinations for purposes of payment under title X IX (and he may suspend such authority for purposes of payment under title X VIII) until he (i) reevaluates such organization's performance of the responsibilities involved and determines that such performance does not have such unreasonahle and detrimental impact, or (ii) determines that the organization has taken appropriate corrective action. Any determination made by the Secretary under this subparagraph shall be final and shall not be subject to judicial review. "(B) The Secretary shall notify the State agency submitting such documentation, and the organization involved, in writing, of his determination, any subsequent actions taken, and the basis thereof, and shall notify the appropriate committees of the United States House of Representatives and the Senate of any such documentation submitted and the actions taken. "(e)(1) The Secretary shall in a timely manner establish procedures and mechanisms to govern his relationships with State agencies under this part (specifically including his relationships with such agencies in connection with their respective functions under the preceding provisions of this section). Such mechanisms shall include periodic consultation by the Secretary with State agency representatives and representatives of Professional Standards Review Organizations regarding relationships between such agencies and such organizations (including the appropriate exchange of data and information between such agencies and such organizations) and other problems of mutual concern, and such procedures shall permit the State agency to be represented on any project assessments conducted by the Secretary with respect to a Professional Standards Review Organization located within its State. "(2) Each Professional Standards Review Organization shall provide to the State agency for the State in which it is located, upon request, data or information which the Secretary requires such organizations to report to him routinely on a periodic basis, and such other data or information as the Secretary authorizes to be disclosed.". (3)(A) Section 1155(e)(1) of such Act is amended by striking out "of a hospital or other operating health care facility or organization" and inserting in lieu thereof "of a hospital (including any skilled nursing facility, as defined in section 1861(j), or intermediate care facility, as defined in section 1905(c), which is also a part of such hospital) or other operating health care facility or organization (other than such a skilled nursing facility or intermediate care facility which is not a part of a hospital)". (B) Section 1155(a) of such Act is amended— (i) by inserting "(except as provided in paragraph (7)) " in paragraph (1) after "institutional and noninstitutional providers of health care services"; and (ii) by inserting after paragraph (6) the following new paragraph: "(7)(A) Except as provided in subparagraph (B), a Professional Standards Review Organization located in a State has the function and duty to assume responsibility for the review under paragraph (1) of professional activities in intermediate care facilities (as defined in section 1905(c)) and in public institutions for the mentally retarded (described in section 1905(d)(1)) only if (i) the Secretary finds, on the basis of such documentation as he may require from the State, that

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Page:United States Statutes at Large Volume 91.djvu/1223

 PUBLIC LAW 95-142—OCT. 25, 1977

91 STAT. 1189

the single State agency which administers or supervises the administration of the State plan approved under title X IX for that State is not performing effective review of the quality and necessity of health care services provided in such facilities and institutions, or (ii) the State requests such organization to assume such responsibility. "(B) A Professional Standards Review Organization located in a State has the function and duty to assume responsibility for the review under paragraph (1) of professional activities in intermediate care facilities in the State that are also skilled nursing facilities (as defined in section 1861(j)), to the extent that the Secretary finds that the performance of such function by the single State agency (described in subparagraph (A)) for that State is inefficient.". (e) Section 1160(b)(1) of such Act is amended by striking out "practitioner or provider" and inserting in lieu thereof "health care practitioner or hospital, or other health care facility, agency, or organization" each time it appeare therein, (f) Section 1163(a)(2) of such Act is amended to read as follows: "(2) Members of the Council shall be appointed for a term of three years, except that the Secretary may provide, in the case of any terms scheduled to expire after January 1, 1978, for such shorter terms as will ensure that (on a continuing basis) the terms of no more than four members expire in any year. Members of the Council shall be eligible for reappointment.". (g) Section 1163 of such Act is amended by striking out subsection (f). (h) Section 1166 of such Act is amended— (1) by striking out "or (2)" in subsection (a) and inserting inlieuthereof ", (2)"; (2) by inserting the following immediately before the period at the end of subsection (a): ", or (3) in accordance with subsection (b) "; (3) by redesignating subsection (b) as subsection (c); (4) by inserting the following new subsection immediately after subsection (a); " (b) A Professional Standards Review Organization shall provide, in accordance with procedures established by the Secretary, data and information— "(1) to assist Federal and State agencies recognized by the Secretary as having responsibility for identifying and investigating cases or patterns of fraud or abuse, which data and information shall be provided by such organization to such agencies at the request of such agencies at the discretion of such Organization on the basis of its findings with respect to evidence of fraud or abuse; and " (2) to assist the Secretary, and such Federal and State agencies recognized by the Secretary as having health planning or related responsibilities under Federal or State law (including health systems agencies and State health planning and development agencies), in carrying out appropriate health care planning and related activities, which data and information shall be provided in such format and manner as may be prescribed by the Secretary or agreed upon by the responsible Federal and State agencies and such Organization, and shall be in the form of aggregate statistical data (without identifying any individual) on a geographic, institutional, or other basis reflecting the volume and frequency of services furnished, as well as the demographic characteristics of the population subject to review by such Organization.

42 USC 1396.

Post, ^p. 1207. 42 USC 1320C-9.

42 USC 1320C-12.

Data and information.

42 USC

1320C-15.

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Page:United States Statutes at Large Volume 91.djvu/1224

 91 STAT. 1190

Patient records, nondisclosure.

42 USC

1320C-15.

Payment.

42 USC

1320C-16.

42 USC 1320C-4.

42 USC 1320C-17.

Annual report to Congress. Ante, p. 1186.

PUBLIC LAW 95-142—OCT. 25, 1977 The penalty provided in subsection (c) shall not apply to the disclosure of any data and information received under this subsection, except that such penalty shall apply to the disclosure (by the agency receiving such data and information) of any such data and information described in paragraph (1) unless such disclosure is made in a judicial, administrative, or other formal legal proceeding resulting from an investigation conducted by the agency receiving the data and information."; and (5) by inserting after subsection (c) (as so redesignated) the following new subsection: "(d) No patient record in the possession of a Professional Standards Review Organization, a Statewide Professional Standards Review Council, or the National Professional Standards Review Council shall be subject to subpena or discovery proceedings in a civil action.". (i) Section 1167 of such Act is amended by adding the following new subsection at the end thereof: "(d) The Secretary shall make payment to a Professional Standards Review Organization, whether conditionally designated or qualified, or to any member or employee thereof, or to any person who furnishes legal counsel or services to such organization, in an amount equal to the reasonable amount of the expenses incurred, as determined by the Secretary, in connection with the defense of any suit, action, or proceeding brought against such organization, member, or employee related to the performance of any duty or function of such organization, member, or employee (as described in section 1155).". (j) Section 1168 of such Act is amended by adding at the end thereof the following new sentence: "The Secretary shall make payments to Professional Standards Review Organizations (whether designated on a conditional basis or otherwise) from funds described in the first sentence of this section (without any requirement for the contribution of funds by any State or political subdivision thereof) for expenses incurred in the performance of duties by such Orgnizations.". (k) Part B of title XT of such Act (as amended by subsection (d) (2)(D) of this section) is further amended by adding after section 1171 the following new section: ((A N N U A L

42 USC 1320C-21.

42 USC 701, 1301, 1395, 1396.

REPORTS

"SEC. 1172. The Secretary shall submit to the Congress not later than April 1, 1978, and not later than April 1 of each year thereafter, a full and complete report on the administration, impact, and cost of the program under this part during the preceding fiscal year, including data and information on— "(1) the number, status (conditional or otherwise), and service areas of, and review methodologies employed by, all Professional Standards Review Organizations participating in the program; "(2) the number of health care institutions and practitioners whose services are subject to review by Professional Standards Review Organizations, and the number of beneficiaries and recipients who received services subject to such review during such year; "(3) the imposition of penalties and sanctions under this title for violations of law and for failure to comply with the obligations imposed by this part; "(4) the total costs incurred under titles V, XI, XVIII, and X IX of this Act in the implementation and operation of all pro-

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Page:United States Statutes at Large Volume 91.djvu/1225

 PUBLIC LAW 95-142—OCT. 25, 1977

91 STAT. 1191

cedures required by such titles for the review of services to determine their medical necessity, appropriateness of use, and quality; " (5) changes in utilization rates and patterns, and changes in medical procedures and practices, attributable to the activities of Professional Standard s Review Organizations; " (6) the results of program evaluation activities, including the operation of data collection systems and the status of Professional Standard s Review Organization data policy and implementation; " (7) the extent to which Professional Standard s Review Organizations are performing reviews of services for other governmental or private health insurance program s; and " (8) recommendations for legislative changes.". (1)(1) Title X I of such Act (as amended by subsections (d)(2)(D) ^«««. P- 1190. and (k) of this section) is further amended by adding after section 1172 the following new section: ' M E D I C A L OFFICERS I N AMERICAN SAMOA, THE NORTHERN MARIANA ISLANDS, AND THE TRUST TERRITORY OF THE PACIFIC ISLANDS TO BE INCLUDED I N THE PROFESSIONAL STANDARDS REVIEW PROGRAM

" SEC. 1173. For purposes of applying this part (except sections 1155(c) and 1163) to American Samoa, the Northern Mariana Islands, and the T r u s t T e r r i to r y of the Pacific Islands, individuals licensed to practice medicine in those places shall be considered to be physicians and doctors of medicine.". (2) The second sentence of section 1101(a)(1) of such Act is amended by inserting " and in part B of this title" after "title V". (m) Section 1861(w)(2) of such Act is amended by inserting " part B of this title or under " immediately after "entitled to have payment made for such services under". (n) Section 1167 of such Act is amended— (1) by inserting "or to any Statewide Professional Standard s Review Council" in subsection (a) after "Professional Standard s Review Organization"; (2) by inserting "or such Council" in subsection (a) after "such Organization"; (3) by inserting "or of any Statewide Professional Standard s Review Council" in subsection (b)(1) after "Professional Standards Review Organization"; (4) by inserting "or council" in subsection (b)(1) after "organization"; (5) by inserting "or of Statewide Professional Standard s Review Councils" in subsection (b)(1) after "Review Organizations"; and

42 USC

1320C-22. 42 USC 1320C-4, 1320C-12. 42 USC 1301. 42 USC 1395x.

42 USC 1320C-16.

(6) by inserting "AND STATEWIDE PROFESSIONAL STANDARDS REVIEW

COUNCILS" in the heading of the section after "PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS".

(o)(1) Section 1152(b)(1)(A) of such Act is amended by striking 42 USC 1320C-1. out "subsection (c)(i) " and inserting in lieu thereof "subsection (c)(1)". (2) Section 1 1 5 5 (a)(1) of such Act is amended by striking out 42 USC 13200-1. "(subject to the provisions of subsection (g)) " in the matter preceding subparagraph (A). (3) Section 1160(b)(1) of such Act is amended by inserting " o r " Ante, p. 1189. after "permanently" in the matter following subparagraph (B).

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Page:United States Statutes at Large Volume 91.djvu/1226

 91 STAT. 1192 42 USC 1320C-4.

PUBLIC LAW 95-142—OCT. 25, 1977 (p) Section 1155(a)(5) of such Act is amended by striking out all that follows "Professional Standards Eeview Organization" and inserting in lieu thereof a period. ISSUANCE OF SUBPENAS BY COMPTROLLER GENERAL

Ante, p. 1177.

SEC. 6. Part A of title X I of the Social Security Act is amended by inserting after section 1124 (added by section 3(a) of this Act) the following new section: ISSUANCE OF SUBPENAS BY COMPTROLLER GENERAL

42 USC 1320a-4.

Noncompliance, penalty. Representation.

5 USC 101 et seq.

5 USC 5101, 5331, 5361. Personal medical records, nondisclosure.

"SEC. 1125. (a) For the purpose of any audit, investigation, examination, analysis, review, evaluation, or other function authorized by law with respect to any program authorized under this Act, the Comptroller General of the United States shall have powder to sign and issue subpenas to any person requiring the production of any pertinent books, records, documents, or other information. Subpenas so issued by the Comptroller General shall be served by anyone authorized by him (1) by delivering a copy thereof to the person named therein, or (2) by registered mail or by certified mail addressed to such person at his last dwelling place or principal place of business. A verified return by the person so serving the subpena setting forth the manner of service, or, in the case of service by registered mail or by certified mail, the return post office receipt therefor signed by the person so served, shall be proof of service. "(b) In case of contumacy by, or refusal to obey a subpena issued pursuant to subsection (a) of this section and duly served upon, any person, any district court of the United States for the judicial district in which such person charged with contumacy or refusal to obey is found or resides or transacts business, upon application by the Comptroller General, shall have jurisdiction to issue an order requiring such person to produce the books, records, documents, or other information sought by the subpena; and any failure to obey such order of the court may be punished by the court as a contempt thereof. In proceedings brought under this subsection, the Comptroller General shall be represented by attorneys employed in the General Accounting Office or by counsel whom he may employ without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and the provisions of chapter 51 and subchapters III and VI of chapter 53 of such title, relating to classification and General Schedule pay rates. "(c) No personal medical record in the possession of the General Accounting Office shall be subject to subpena or discovery proceedings in a civil action.". SUSPENSION OP PRACTITIONERS CONVICTED OP MEDICARE- OR MEDICAIDRELATED CRIMES

42 USC 1395y.

('tt! -yt

42 USC 1396.

SEC. 7. (a) Section 1862 of the Social Security Act is amended by adding at the end thereof the following new subsection: "(e)(1) Whenever the Secretary determines that a physician or other individual practitioner has been convicted (on or after the date of the enactment of this subsection, or within such period prior to that date as the Secretary shall specify in regulations) of a criminal offense related to such physician's or practitioner's involvement in the programs under this title or the program under title X IX, the Secretary

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Page:United States Statutes at Large Volume 91.djvu/1227

 PUBLIC LAW 95-142—OCT. 25, 1977 shall suspend such physician or practitioner from participation in the program under this title for such period as he may deem appropriate; and no payment may be made under this title with respect to any item or service furnished by such physician or practitioner during the period of such suspension. The provisions of paragraphs (2) and (3) of subsection (d) shall apply with respect to determinations made by the Secretary under this subsection. " (2) In any case where the Secretary under paragraph (1) suspends any physician or other individual practitioner from participation in the program under this title, he shall— "(A) promptly notify each single State agency which administers or supervises the administration of a State plan approved under title X IX of the fact, circumstances, and period of such suspension; and "(B) promptly notify the appropriate State or local agency or authority having responsibility for the licensing or certification of such physician or practitioner of the fact and circumstances of such suspension, request that appropriate investigations be made and sanctions invoked in accordance with applicable State law and policy, and request that such State or local agency or authority keep the Secretary and the Inspector General of the Department of Health, Education, and Welfare fully and currently informed with respect to any actions taken in response to such request.". (b) Section 1902(a) of such Act (as amended by section 2(b) and 3 (c) of this Act) is amended— (1) by striking out "and" at the end of paragraph (37); (2) by striking out the period at the end of paragraph (38) and inserting in lieu thereof "; and"; and (3) by inserting after paragraph (38) the following new paragraph: "(39) provide that, subject to subsection (g), whenever the single State agency which administers or supervises the administration of the State plan is notified by the Secretary under section 1862(e)(2)(A) that a physician or other individual practitioner has been suspended from participation in the program under title X VIII, the agency shall promptly suspend such physician or practitioner from participation in the plan for not less than the period specified in such notice, and no payment may be made under the plan with respect to any item or service furnished by such physician or practitioner during the period of the suspension under this title.". (c) Section 1902 of such Act is amended by adding after subsection (f) the following new subsection: "(g) The Secretary may waive suspension under subsection (a) (39) of a physician's or practitioner's participation in a State plan approved under this title and of the prohibition under such subsection of payment for any item or service furnished by him during the period of such suspension, if the single State agency which administers or supervises the administration of the plan submits a request to the Secretary for such waiver and if the Secretary approves such request.". (d) Section 332(c) of the Public Health Service Act (relating to considerations in.the designation of health manpower shortage areas) is amended by inserting after paragraph (2) the following new paragraph:

91 STAT. 1193

Notification of State or local agencies.

42 USC 1396.

Ante, pp. 1176, 1178.

Ante, p. 1192. 42 USC 1395.

Suspension, waiver. Supra.

42 USC 254e,

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Page:United States Statutes at Large Volume 91.djvu/1228

 91 STAT. 1194

42 USC 1395, 1396. Effective dates. 42 USC 254e note. 42 USC 1396a note. )

Ante, p. 1192.

PUBLIC LAW 95-142—OCT. 25, 1977 "(3) The extent to which individuals who are (A) residents of the area, members of the population group, or patients in the medical facility or other public facility under consideration for designation, and (B) entitled to have payment made for medical services under title X VIII or X IX of the Social Security Act, cannot obtain such services because of suspension of physicians from the programs under such titles.". (e)(1) The amendment made by subsection (d) shall apply with respect to determinations and designations made on and after the date of the enactment of this Act. (2) The amendment made by subsection (b) shall become effective on January 1, 1978. DISCLOSURE BY PROVIDERS OF OWNERS AND CERTAIN OTHER INDIVIDUALS CONVICTED OF CERTAIN OFFENSES

SEC 8. (a) Part A of title X I of the Social Security Act is amended by inserting after section 1125 (added by section 6 of this Act) the following new section: " D I S C L O S U R E BY INSTITUTIONS, ORGANIZATIONS, AND AGENCIES OF OWNERS AND CERTAIN OTHER INDIVIDUALS W H O HAVE BEEN CONVICTED OF CERTAIN OFFENSES

42 USC 1320a-5. 42 USC 1395, 1396, 1397.

"Managing' employee.

42 USC 1395cc.

"SEC. 1126. (a) As a condition of participation in or certification or recertification under the programs established by titles X VIII, X IX, and X X, any hospital, nursing facility, or other institution, organization, or agency shall be required to disclose to the Secretary or to the appropriate State agency the name of any person who— "(1) has a direct or indirect ownership or control interest of 5 percent or more in such institution, organization, or agency or is an officer, director, agent, or managing employee (as defined in subsection (b)) of such institution, organization, or agency, and "(2) has been convicted (on or after the date of the enactment of this section, or within such period prior to that date as the Secretary shall specify in regulations) of a criminal offense related to the involvement of such person in any of such programs. The Secretary or the appropriate State agency shall promptly notify the Inspector General in the Department of Health, Education, and Welfare of the receipt from any institution, organization, or agency of any application or request for such participation, certification, or recertification which discloses the name of any such person, and shall notify the Inspector General of the action taken with respect to such application or request. (b) For the purposes of this section, the term 'managing employee' means, with respect to an institution, organization, or agency, an individual, including a general manager, business manager, administrator, and director, who exercises operational or managerial control over the institution, organization, or agency, or who directly or indirectly conducts the day-to-day operations of the institution, organization, or agency.". (b)(1) Section 1866(a) of such Act is amended by adding at the end thereof the following new paragraph: "(3) The Secretary may refuse to enter into or renew an agreement under this section with a provider of services if any person who has a direct or indirect ownership or control interest of 5 percent or more in

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Page:United States Statutes at Large Volume 91.djvu/1229

 PUBLIC LAW 95-142—OCT. 25, 1977 such provider, or who is an officer, director, agent, or managing employee (as defined in section 1126(b)) of such provider, is a person described in section 1126(a).". (2) Section 1866(b)(2) of such Act is amended by inserting before the period at the end thereof the following: ", or (G) that such provider (at the time the agreement was entered into) did not fully and accurately make any disclosure required of it by section 1126(a)''. (c) Section 1903 of such Act is amended by adding after subsection (m) the following new subsection: "(n) The State agency may refuse to enter into any contract or agreement with a hospital, nursing home, or other institution, organization, or agency for purposes of participation under the State plan, or otherwise to approve an institution, organization, or agency for such purposes, if any person, who has a direct or indirect ownership or control interest of 5 percent or more in such institution, organization, or agency, or who is an officer, director, agent, or managing employee (as defined in section 1126(b)) of such institution, organization, or agency, is a person described in section 1126(a) (whether or not such institution, organization, or agency has in effect an agreement entered into with the Secretary pursuant to section 1866 or is subject to a suspension of payment order issued under subsection (]) of this section); and, notwithstanding any other provision of this section, the State agency may terminate any such contract, agreement, or approval if it determines that the institution, organization, or agency did not fully and accurately make any disclosure required of it by section 1126(a) at the time such contract or agreement was entered into or such approval was given.". (d) Section 2002(a) of such Act (as amended by section 3(d) of this Act) is further amended by adding at the end thereof the following new paragraph: " (16) Any State may refuse to enter into a contract or other arrangement with a provider of services for purposes of participation under the program established by this title, or otherwise to approve a provider for such purposes, if any person who has a direct or indirect ownership or control interest of 5 percent or more in such provider, or who is an officer, director, agent, or managing employee (as defined in section 1126(b)) of such provider, is a person described in section 1126 (a), and the State may terminate any such contract, arrangement, or approval if it determines that the provider did not fully and accurately make any disclosure required of it by section 1126(a) at the time the contract or arrangement was entered into or the approval was given.". (e) The amendments made by this section shall apply with respect to contracts, agreements, and arrangements entered into and approvals given pursuant to applications or requests made on and after the first day of the fourth month beginning after the date of the enactment of this Act.

91 STAT. 1195 Ante, p. 1194. 42 USC 1395CC.

42 USC 1396b.

•

^ l ^nt^, p- 1179,

Effective date. 42 USC 1320a-5 note.

FEDERAL ACCESS TO RECORDS

SEC. 9. Section 1902(a) (27)(B) of the Social Security Act is 42 USC 1396a. amended by inserting "or the Secretary" after "State agency" each place it appears. CLAIMS PROCESSING AND INFORMATION RETRIEVAL SYSTEMS FOR MEDICAID PROGRAMS

SEC. 10. (a) Section 1903(a)(3)(B) of the Social Security Act is 42 USC 1396b. amended by striking out "notice to each individual who is furnished services covered by the plan of the specific services so covered" and

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Page:United States Statutes at Large Volume 91.djvu/1230

 91 STAT. 1196

Effective date.

42 USC 1396b note.

PUBLIC LAW 95-142—OCT. 25, 1977

inserting in lieu thereof "notice to each individual who is furnished services covered by the plan, or to each individual in a sample group of individuals who are furnished such services, of the specific services (other than confidential services) so covered". (b) The amendment made by subsection (a) shall apply with respect to calendar quarters beginning after the date of the enactment of this Act. RESTRICTION ON FEDERAL MEDICAID P A Y M E N T S; ASSIGNMENT OF RIGHTS OF P A Y M E N T; INCENTIVE PAYMENTS

Ante, p. 1195.

/ii/hi.

SEC. 11. (a) Section 1903 of the Social Security Act is amended by adding after subsection (n) (added by section 8(c) of this Act) the following new subsections: "(o) Notwithstanding the preceding provisions of this section, no payment shall be made to a State under the preceding provisions of this section for expenditures for medical assistance provided for an individual under its State plan approved under this title to the extent that a private insurer (as defined by the Secretary by regulation) would have been obligated to provide such assistance but for a provision of its insurance contract which has the effect of limiting or excluding such obligation because the individual is eligible for or is provided medical assistance under the plan. " (p)(l) When a political subdivision of a State makes, for the State of which it is a political subdivision, or one State makes, for another State, the enforcement and collection of rights of support or payment assigned under section 1912, pursuant to a cooperative arrangement under such section (either within or outside of such State), there shall be paid to such political subdivision or such other State from amounts which would otherwise represent the Federal share of payments for medical assistance provided to the eligible individuals on whose behalf such enforcement and collection was made, an amount equal to 15 percent of any amount collected which is attributable to such rights of support or payment. "(2) Where more than one jurisdiction is involved in such enforcement or collection, the amount of the incentive payment determined under paragraph (1) shall be allocated among the jurisdictions in a manner to be prescribed by the Secretary.". (b) Title X IX of the Social Security Act is amended by adding at the end thereof the following new section: a ASSIGNMENT OF RIGHTS OF P A Y M E N T

42 USC 1396k.

"SEC. 1912. (a) For the purpose of assisting in the collection of medical support payments and other payments for medical care owed to recipients of medical assistance under the State plan approved under this title, a State plan for medical assistance may— "(1) provide that, as a condition of eligibility for medical assistance under the State plan to an individual who has the legal capacity to execute an assignment for himself, the individual is required— "(A) to assign the State any rights, of the individual or of any other person who is eligible for medical assistance under this title and on whose behalf the individual has the legal authority to execute an assignment of such rights, to support (specified as support for the purpose of medical care by a court or administrative order) and to payment for medical care from any third party; and

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Page:United States Statutes at Large Volume 91.djvu/1231

 91 STAT. 1197

PUBLIC LAW 95-142—OCT. 25, 1977

"(B) to cooperate with the State (i) in establishing the paternity of such person (referred to in subparagraph (A)) if the person is a child born out of Avedlock, and (ii) in obtaining support and payments (described in subparagraph (A)) for himself and for such person, unless (in either case) the individual is found to have good cause for refusing to cooperate as determined by the State agency in accordance with standards prescribed by the Secretary, which standards shall take into consideration the best interests of the individuals involved; and "(2) provide for entering into cooperative arrangements Cooperative (including financial arrangements), with any appropriate agency arrangements of any State (including, with respect to the enforcement and with State collection of rights of payment for medical care by or through a agencies. parent, with a State's agency established or designated under section 454(3)) and with appropriate courts and law enforcement 42 USC 654. officials, to assist the agency or agencies administering the State ->;; to support or payment assigned under this section and (B) any other maltters of common concern. "(b) Such part of any amount collected by the State under an Retainages. assignment made under the provisions of this section shall be retained by the State as is necessary to reimburse it for medical assistance payments made on behalf of an individual with respect to whom such assignment was executed (with appropriate reimbursement of the " Federal Government to the extent of its participation in the financing of such medical assistance), and the remainder of such amount collected shall be paid to such individual.". (c) The amendment made by subsection (a) shall apply with respect Effective date. to medical assistance provided, under a State plan approved under 42 USC 1396b note. title X IX of the Social Security Act, on and after January 1, 1978. 42 USC 1396.
 * J plan with respect to (A) the enforcement and collection of rights

STUDY AND REVIEW OF MEDICARE CLAIMS PROCESSING

SEC. 12. The Comptroller General of the United States shall conduct a comprehensive study and review of the administrative structure established for the processing of claims under title X VIII of the Social Security Act, for the purpose of determining whether and to what extent more efficient claims administration under such title could be achieved— (1) by reducing the number of participating intermediaries and carriers; (2) by making a single organization responsible for the processing of claims, under both part A and part B of such title, in a particular geographic area; (3) by providing for the performance of claims processing functions on the basis of a prospective fixed price; f (4) by providing incentive payments for the most efficitmt organizations; or (5) by other modifications in such structure and related procedures. The Comptroller General shall submit to the Congress no later than July 1, 1979, a complete report setting forth the results of such study and review, together with his findings and his recommendations with respect thereto. ABOLITION OF PROGRAM REVIEW TEAMS UNDER

42 USC 1395W °°t^42 USC 1395.

Report to Congress,

MEDICARE

SEC. 13. (a) Section 1862(d) of the Social Security Act is amended 42 USC 1395y. by striking out paragraph (4).

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Page:United States Statutes at Large Volume 91.djvu/1232

 91 STAT. 1198 42 USC 1395y.

42 USC 1320C-6.

42 USC 1395CC. ' 42 USC 1320C-6. Effective date. 42USei320c-6 note.

PUBLIC LAW 95-142—OCT. 25, 1977 (b)(1) Section 1862(d)(1)(B) of such Act is amended by striking out ", with the concurrence of the appropriate program review team appointed pursuant to paragraph (4),". (2) Section 1862(d)(1)(C) of such Act is amended to read as follows: "(C) has furnished services or supplies which are determined by the Secretary, on the basis of reports transmitted to him in accordance with section 1157 of this Act (or, in the absence of any such report, on the basis of such data as he acquires in the administration of the program under this title), to be substantially in excess of the needs of individuals or to be of a quality which fails to meet professionally recognized standards of health care.". (3) Clause (F) of section 1866(b)(2) of such Act is amended to read as follows: " (F) that such provider has furnished services or supplies which are determined by the Secretary to be substantially in excess of the needs of individuals or to be of a quality which fails to meet professionally recognized standards of health care.". (4) Section 1157 of such Act is amended by striking out the last sentence. (c) The amendments made by this section shall take effect on the date of the enactment of this Act. AMENDMENTS RELATING TO FISCAL

42 USC 1395h.

INTERMEDIARIES

SEC. 14. (a) Section 1816 of the Social Security Act is amended— (1) by inserting "(and to providers assigned to such agency or organization under subsection (e)) " in the first sentence of subsection (a) after "to such providers" the second and third times it appears; Agreements. (2) by amending subsection (b) to read as follows: "(b) The Secretary shall not enter into or renew an agreement with any agency or organization under this section unless— " (1) he finds— " (A) after applying the standards, criteria, and proceJi^ dures developed under subsection (f), that to do so is consistent with the effective and efficient administration of this part, and > <J V "(B) that such agency or organization is willing and able to assist the providers to which payments are made through it under this part in the application of safeguards against unnecessary utilization of services furnished by them to individuals entitled to hospital insurance benefits under section 42 USC 426. 226, and the agreement provides for such assistance; and Information, "(2) such agency or organization agrees— availability. "(A) to furnish to the Secretary such of the information acquired by it in carrying out its agreement under this section, and "(B) to provide the Secretary with access to all such data, information, and claims processing operations, as the Secretary may find necessary in performing his functions under this part."; (3) by inserting "after applying the standards, criteria, and i^ra. j4 procedures developed under subsection (f) and" in subsection (e)(2) before "after reasonable notice"; (4) by redesignating subsections (e), (f), and (g) as subsections (g), (h), and (i), respectively; and

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 PUBLIC LAW 95-142—OCT. 25, 1977 (5) by inserting after subsection (d) the following new subsections: "(e)(1) Notwithstanding subsections (a) and (d), the Secretary, after taking into consideration any preferences of providers of services, may assign or reassign any provider of services to any agency or organization which has entered into an agreement with him under this section, if he determines, after applying the standards, criteria, and procedures developed under subsection (f), that such assignment or reassignment would result in the more effective and efficient administration of this part. "(2) Notwithstanding subsections (a) and (d), the Secretary may designate a national or regional agency or organization which has entered into an agreement with him under this section to perform functions under the agreement with respect to a class of providers of services in the Nation or region (as the case may be), if he determines, after applying the standards, criteria, and procedures developed under subsection (f), that such designation would result in more effective and efficient administration of this part. " (3)(A) Before the Secretary makes an assignment or reassignment under paragraph (1) of a provider of services to other than the agency or organization nominated by the provider, he shall furnish (i) the provider" and such agency or organization with a full explanation of the reasons for his determination as to the efficiency and effectiveness of the agency or organization to perform the functions required under this part with respect to the provider, and (ii) such agency or organization with opportunity for a hearing, and such determination shall be subject to judicial review in accordance with chapter 7 of title 5, United States Code. "(B) Before the Secretary makes a designation under paragraph (2) with respect to a class of providers of services, he shall furnish (i) such providers and the agencies and organizations adversely affected by such designation with a full explanation of the reasons for his determination as to the efficiency and effectiveness of such agencies and organizations to perform the functions required under this part with respect to such providers, and (ii) the agencies and organizations adversely affected by such designation with opportunity for a hearing, and such determination shall be subject to judicial review in accordance with chapter 7 of title 5, United States Code. "(f) In order to determine whether the Secretary should enter into. renew, or- terminate an agreement under this section with an agency or organization, whether the Secretary should assign or reassign a provider of services to an agency or organization, and whether the Secretary should designate an agency or organization to perform services with respect to a class of providers of services, the Secretary shall develop standards, criteria, and procedures to evaluate such agency's or organization's (1) overall performance of claims processing and "other related functions required to be performed by such an agency or organization under an agreement entered into under this section,' and (2) performance of such functions with respect to specific providers of services, and the Secretary shall establish, by regulation, standards and criteria with respect to the efficient and effective administration of this part. No agency or organization shall be found under such standards and criteria not to be efficient or effective or to be less efficient or effective solely on the ground that the agency or organization serves only providers located in a single State.".

91 STAT. 1199 42 USC 1395h.

Hearing, 5 USC 701.

Hearing,

Standards, development,

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Page:United States Statutes at Large Volume 91.djvu/1234

 91 STAT. 1200 42 USC 1395h note.

Effective dates.

42 USC 1395h note.

PUBLIC LAW 95-142—OCT. 25, 1977 (b) The Secretary of Health, Education, and Welfare shall develop the standards, criteria, and procedures described in subsection (f) of section 1816 of the Social Security Act (as added by subsection (a)(5)) not later than October 1, 1978. (c) The amendment made by paragraphs (2) and (3) of subsection (a) to the extent that they require application of standards, criteria, and procedures developed under section 1816(f) of the Social Security Act shall apply to the entering into, renewal, or termination of agreements on and after October 1, 1978. (d) Except as provided in subsection (c), the amendment made by subsection (a)(2) shall apply to agreements entered into or renewed on or after the date of enactment of this Act. DISCLOSURE BY PROVIDERS OF THE H I R I N G OF CERTAIN FORMER EMPLOYEES OF FISCAL INTERMEDIARIES

Agreements. 42 USC 1395CC.

Notification to Secretary.

Effective date. 42 USC 1395cc note.

SEC. 15. (a) Section 1866(a)(1) of the Social Security Act is amended— (1) by striking out the period at the end of subparagraph (C) and inserting in lieu thereof ", and"; and (2) by inserting after subparagraph (C) the following new subparagraph: "(D) to promptly notify the Secretary of its employment of an individual who, at any time during the year preceding such employment, was employed in a managerial, accounting, auditing, or similar capacity (as determined by the Secretary by regulation) by an agency or organization which serves as a fiscal intermediary or carrier (for purposes of part A or part B, or both, of this title) with respect to the provider.", (b) The amendments made by subsection (a) shall apply with respect to agreements entered into or renewed on and after the date of enactment of this Act. PAYMENT FOR DURABLE MEDICAL EQUIPMENT

42 USC 1395Z.

Used equipment, coinsurance

SEC. 16. (a) Section 1833(f) of the Social Security Act is amended to read as follows: "(f)(1) In the case of durable medical equipment to be furnished an individual as described in section 1861(s)(6), the Secretary shall determine, on the basis of such medical and other evidence as he finds appropriate (including certification by the attending physician with respect to expected duration of need), whether the expected duration of the medical need for the equipment warrants a presumption that purchase of the equipment would be less costly or more practical than rental. If the Secretary determines that such a presumption does exist, he shall require that the equipment be purchased, on a lease-purchase basis or otherwise, and shall make payment in accordance with the lease-purchase agreement (or in a lump sum amount if the equipment is purchased other than on a lease-purchase basis); except that the Secretary may authorize the rental of the equipment notwithstanding such determination if he determines that the purchase of the equipment would be inconsistent with the purposes of this title or would create an undue financial hardship on the individual who will use it. "(2) With respect to purchases of used durable medical equipment, the Secretary may waive the 20 percent coinsurance amount applicable under subsection (a) whenever the purchase price of the used equipment is at least 25 percent less than the reasonable charge for comparable new equipment.

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91 STAT. 1201

"(3) For purposes of paragraph (1), the Secretary may, pursuant Reimbursement to agreements made with suppliers of durable medical equipment, procedures. establish reimbursement procedures which he finds to be equitable, economical, and feasible. "(4) The Secretary shall encourage suppliers of durable medical equipment to make their equipment available to individuals entitled to benefits under this title on a lease-purchase basis whenever possible.". (b) The amendment made by subsection (a) shall apply with Effective date. respect to durable medical equipment purchased or rented on or after 42 USC 1395/ note. October 1, 1977. FUNDING OF STATE MEDICAID FRAUD CONTROL U N I T S

SEC. 17. (a) Section 1903(a) of the Social Security Act is amended by redesignating paragraph (6) as paragraph (7) and by inserting after paragraph (5) the following new paragraph: "(6) subject to subsection (b)(3), an amount equal to 90 per centum of the sums expended during each quarter beginning on . or after October 1, 1977, and ending before October 1, 1980, with respect to costs incurred during such quarter (as found necessary / by the Secretary for the elimination of fraud in the provision and administration of medical assistance provided under the State plan) which are attributable to the establishment and operation of (including the training of personnel employed by) a State medicaid fraud control unit (described in subsection (q)); plus". (b) Section 1903(b) of such Act is amended by inserting after paragraph (2) the following new paragraph: "(3) The amount of funds which the Secretary is otherwise obligated to pay a State during a quarter under subsection (a)(6) may not exceed the higher of— "(A) $125,000, or "CB) one-quarter of 1 per centum of the sums expended by the Federal, State, and local governments during the previous quarter in carrying out the State's plan under this title.". (c) Section 1903 of such Act is further amended by inserting after subsection (p) (added by section 11(a) of this Act) the following new subsection: " (Q) For the purposes of this section, the term 'State medicaid fraud control unit' means a single identifiable entity of the State government which the Secretary certifies (and annually recertifies) as meeting the following requirements: "(1) The entity (A) is a unit of the office of the State Attorney General or of another department of State government which possesses statewide authority to prosecute individuals for criminal violations, (B) is in a State the constitution of which does not provide for the criminal prosecution of individuals by a statewide • authority and has formal procedures, approved by the Secretary, that (i) assure its referral of suspected criminal violations relating to the program under this title to the appropriate authority or authorities in the State for prosecution and (ii) assure its assistance of, and coordination with, such authority or authorities in such prosecutions, or (C) has a formal working relationship with the office of the State Attorney General and has formal procedures (including procedures for its referral of suspected criminal violations to such office) which are approved by the Secretary

42 USC 13966.

"State medicaid fraud control unit." •

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Page:United States Statutes at Large Volume 91.djvu/1236

 91 STAT. 1202

Application and annual reports, submittal to Secretary.

42 USC 1395b-l.

42 USC 1305. Effective date.

42 USC 1396b note. Regulations.

PUBLIC LAW 95-142—OCT. 25, 1977

and which provide effective coordination of activities between the entity and such office with respect to the detection, investigation, and prosecution of suspected criminal violations relating to the program under this title. "(2) The entity is separate and distinct from the single State • agency that administers or supervises the administration of the State plan under this title. "(3) The entity's function is conducting a statewide program for the investigation and prosecution of violations of all applicable State laws regarding any and all aspects of fraud in connection with any aspect of the provision of medical assistance and the activities of providers of such assistance under the State plan under this title. " (4) The entity has procedures for reviewing complaints of the abuse and neglect of patients of health care facilities which receive payments under the State plan under this title, and, where appropriate, for acting upon such complaints under the criminal laws of the State or for referring them to other State agencies for action. "(5) The entity provides for the collection, or referral for collection to a single State agency, of overpayments that are made under the State plan to health care facilities and that are discovered by the entity in carrying out its activities. " (6) The entity employs such auditors, attorneys, investigators, and other necessary personnel and is organized in such a manner as is necessary to promote the effective and efficient conduct of the entity's activities. "(7) The entity submits to the Secretary an application and annual reports containing such information as the Secretary determines, by regulation, to be necessary to determine whether the entity meets the other requirements of this subsection.". (d) Section 402(a)(1) of the Social Security Amendments of 1967 (Public Law 90-248), as amended by section 222 of the Social Security Amendments of 1972 (Public Law 92-603), is amended— (1) by striking out "and" at the end of subparagraph (H); (2) by striking out the period at the end of subparagraph (I) and inserting in lieu thereof "; and"; and (3) by adding after subparagraph (I) the following new subparagraph: " (J) to develop or demonstrate improved methods for the investigation and prosecution of fraud in the provision of care or services under the health programs established by the Social Security Act.". (e)(1) The amendment made by subsection (a) shall apply with respect to calendar quarters beginning after September 30, 1977. (2) The Secretary of Health, Education, and Welfare shall establish such regulations, not later than ninety days after the date of enactment of this Act, as are necessary to carry out the amendments made by this section. REPORT ON HOME HEALTH AND OTHER I N - H O M E

Report to congressional committees.

42 USC 1395/Z note.

SERVICES

SEC. 18. (a) Not later than one year after the date of enactment of this Act, the Secretary of Health, Education, and Welfare shall submit to the appropriate committees of the Congress a report analyzing,

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Page:United States Statutes at Large Volume 91.djvu/1237

 91 STAT. 1203

PUBLIC LAW 95-142—OCT. 25, 1977

evaluating, and making recommendations with respect to, all aspects (including the availability, administration, provision, reimbursement procedures, and cost) of the delivery of home health and other in-home services authorized to be provided under titles X VIII, X IX, and X X of the Social Security Act. (b) Such report shall include an evaluation of the coordination of such services provided under the different titles, and shall also include recommendations for changes in regulations and legislation with respect to— (1) the scope and definition of such services provided under such titles; (2) the requirements for an individual to be eligible to receive such services under such titles; (3) the standards for certification of providers of such services under such titles and (as appropriate) the uniformity of such standards for the programs under the different titles; (4) procedures for control of utilization and assurance of quality of such services under such titles, including (as appropriate) the licensing and accreditation of agencies providing such services, a certificate of need program with respect to the offering of such services, and the development and use of norms and standards for review of the utilization and quality of such services; (5) methods of reimbursement for such services, including (A) methods of comparing costs incurred by different providers of such services in order to determine the reasonableness of such costs and (B) methods which provide for more uniform reimbursement "5 procedures under titles X VIII and X IX of the Social Security Act; and (6) the prevention of fraud and abuse in the delivery of such services under such titles, the reasons for such recommendations, an analysis of the impact of implementing such recommendations on the cost of such services and the demand for such services, and the methods of financing any recommended increased provision of such services under such titles. (c) In developing the report the Secretary shall consult with professional organizations, experts, and individual health professionals in the field of home health and other in-home services and with providers, private insurers, and consumers of such services.

42 USC 1395, 1396, 1397. Evaluation. Legislative recommendations.

Consultation.

ESTABLISHMENT OF UNIFORM REPORTING SYSTEMS FOR DIFFERENT TYPES OP H E A L T H SERVICES FACILITIES AND ORGANIZATIONS; M A K I N G OF REPORTS UNDER MEDICARE AND MEDICAID PROGRAMS I N ACCORDANCE W I T H SUCH SYSTEMS

SEC. 19. (a) Part A of title X I of this Social Security Act is amended by inserting after section 1120 the following new section: "UNIFORM

REPORTING

SYSTEMS

FOR

HEALTH

SERVICES

FACILITIES

AND

ORGANIZATIONS

"SEC. 1121. (a) For the purposes of reporting the cost of services provided by, of planning, and of measuring and comparing the efficiency of and effective use of services in, hospitals, skilled nursing facilities, intermediate care facilities, home health agencies, health maintenance organizations, and other types of health services facili-

Establishment, regulations. 42 USC 1320a.

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Page:United States Statutes at Large Volume 91.djvu/1238

 91 STAT. 1204

PUBLIC LAW 95-142—OCT. 25, 1977

ties and organizations to which payment may be made under this Act, the Secretary shall establish by regulation, for each such type of health services facility or organization, a uniform system for the reporting by a facility or organization of that type of the following information: " (1) The aggregate cost of operation and the aggregate volume of services. "(2) The costs and volume of services for various functional accounts and subaccounts. "(3) Rates, by category of patient and class of purchaser. "(4) Capital assets, as defined by the Secretary, including (as appropriate) capital funds, debt service, lease agreements used in lieu of capital funds, and the value of land, facilities, and equipment. "(5) Discharge and bill data. The uniform reporting system for a type of health services facility or organization shall provide for appropriate variation in the application of the system to different classes of facilities or organizations within that type and shall be established, to the extent practicable, consistent with the cooperative system for producing comparable and uniform health information and statistics described in section 306(e) (1) of the Public Health Service Act. In reporting under such a sys42 USC 242k. tem, hospitals shall employ such chart of accounts, definitions, principles, and statistics as the Secretary may prescribe in order to reach a uniform reconciliation of financial and statistical data for specified uniform reports to be provided to the Secretary. "(b) The Secretary shall— Duties. "(1) monitor the operation of the systems established under subsection (a); •' "(2) assist with and support demonstrations and evaluations of the effectiveness and cost of the operation of such systems and i encourage State adoption of such systems; and ^ "(3) periodically revise such systems to improve their effectiveness and diminish their cost. Information, "(c) The Secretary shall provide information obtained through availability. use of the uniform reporting systems described in subsection (a) in a useful manner and format to appropriate agencies and organizations, including health systems agencies (designated under section 1515 of 42 USC 300/-4. the Public Health Service Act) and State health planning and develop42 USC 300m. ment agencies (designated under section 1521 of such Act), as may be necessary to carry out such agencies' and organizations' functions.". (b)(1) Section 1861(v)(l) of the Social Security Act is amended 42 USC 1395x. by adding after subparagraph (E) the following new subparagraph: Reports. " (F) Such regulations shall require each provider of services (other than a fund) to make reports to the Secretary of information described in section 1121(a) in accordance with the uniform reporting system (established under such section) for that type of provider.". AnU, p. 1193. (2) Section 1902(a) of such Act (as amended by sections 2(b), 3(c), and 7 (b) of this Act) is amended— (A) by striking out "and" at the end of paragraph (38); (B) by striking out the period at the end of paragraph (39) and inserting in lieu thereof "; and"; and (C) by inserting after paragraph (39) the following new paragraph:

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91 STAT. 1205

"(40) require each health services facility or organization Reports - • which receives payments under the plan and of a type for which a uniform reporting system has been established under section 1121 (a) to make reports to the Secretary of information described in such section in accordance with the uniform reporting system „ (established under such section) for that type of facility or organization.". (c)(1) The Secretary of Health, Education, and Welfare shall Consultation. establish the systems described in section 1121(a) of the Social Secu- 42 USC 1320a rity Act (added by subsection (a) of this section) only after consulta- note. tion with interested parties and— (A) for hospitals, skilled nursing facilities, and intermediate care facilities, not later than the end of the one-year period, and (B) for other types of health services facilities and organizations, not later than the end of the two-year period, beginning on the date of enactment of this Act. (2)(A) The amendments made by subsection (b) shall apply with Effective dates. respect to operations of a hospital, skilled nursing facility, or inter- 42 USC 1396a mediate care facility, on and after the first day of its first fiscal year note. which begins after the end of the six-month period beginning on the date a uniform reporting system is established (under section 1121(a) of the Social Security Act) for that type of health services facility. (B) The amendments made by subsection (b) shall apply, with respect to the operation of a health services facility or organization which is neither a hospital, a skilled nursing facility, nor an intermediate care facility, on and after the first day of its first fiscal year which begins after such date as the Secretary of Health, Education, and Welfare determines to be appropriate for the implementation of the reporting requirement for that type of facility or organization. (C) Except as provided in subparagraphs (A) and (B), the amendments made by subsection (b)(2) shall apply, with respect to State plans approved under title X IX of the Social Security Act, on and 42 USC 1396 after October 1, 1977. DELAY I N, AND WARTER OF, I M P O S m O N OF REDUCTION OF FEDERAL MEDICAL ASSISTANCE PERCENTAGE DUE TO A S T A T E ' S FAILURE TO HAVE A N EFFECTIVE MEDICAID UTILIZATION CONTROL PROGRAM

S E C 20. (a) Section 1903(g) of the Social Security Act is amended— 42 USC 1396b. (1) by striking out "With respect to" in the first sentence of paragraph (1) and inserting in lieu thereof "Subject to paragraph ' (3), with respect to"; (2) by striking out "by.331^^^^^. centum thereof" in paragraph per .... (1) and inserting in lieu thereoi by a per centum thereof (determined under paragraph (5)) "; (3) by inserting "timely" in paragraph (2) before "sample onsite surveys"; and (4) by adding after paragraph (2) the following new paragraphs: " (3)(A) No reduction in the Federal medical assistance percentage of a State otherwise required to be imposed under this subsection shall take effect—

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 91 STAT. 1206 .{rp:iiS:

PUBLIC LAW 95-142—OCT. 25, 1977

"(i) if such reduction is due to the State's unsatisfactory or invalid showing made with respect to a calendar quarter beginning before January 1, 1977; " (ii) before January 1, 1978; Notice to States. " (iii) unless a notice of such reduction has been provided to the State at least 30 days before the date such reduction takes effect; or " (iv) due to the State's unsatisfactory or invalid showing made with respect to a calendar quarter beginning after September 30, .„„, 1977, unless notice of such reduction has been provided to the State no later than the first day of the fourth calendar quarter following the calendar quarter with respect to which such showing was made. Waiver. "(I^) The Secretary shall waive application of any reduction in the Federal medical assistance percentage of a State otherwise required to be imposed under paragraph (1) because a showing by the State, made under such paragraph with respect to a calendar quarter ending after January 1, 1977, and before October 1, 1977, is determined to be either unsatisfactory under such paragraph or invalid under paragraph (2), if the Secretary determines that the State's showing made under paragraph (1) with respect to the calendar quarter ending on December 31, 1977, is satisfactory under such paragraph and is valid under paragraph (2). "(4)(A) The Secretary may not find the showing of a State, with respect to a calendar quarter under paragraph (1), to be satisfactory if the showing is submitted to the Secretary later than the 30th day after the last day of the calendar quarter, unless the State demonstrates to the satisfaction of the Secretary good cause for not meeting such deadline. "(B) The Secretary shall find a showing of a State, with respect to a calendar quarter under paragraph (1), to be satisfactory under such -: t?.1 r«3 I ' paragraph with respect to the requirement that the State conduct annual onsite inspections in mental hospitals, skilled nursing facilities, and intermediate care facilities under paragraph (26) and (31) 42 USC 1396a. of section 1902(a), if the showing demonstrates that the State has conducted such an onsite inspection during the 12-month period ending on the last date of the calendar quarter— "(i) in each of not less than 98 per centum of the number of ^= ' ' • such hospitals and facilities requiring such inspection, and "(ii) in every such hospital or facility which has 200 or more beds, and that, with respect to such hospitals and facilities not inspected within such period, the State has exercised good faith and due deligence in attempting to conduct such inspection, or if the State demonstrates to the satisfaction of the Secretary that it would have made such a showing but for failings of a technical nature only. " (5) In the case of a State's unsatisfactory or invalid showing made with respect to a type of facility or institutional services in a calendar quarter, the per centum amount of the reduction of the State's Federal medical assistance percentage for that type of services under paragraph (1) is equal to 331^ per centum multiplied by a fraction, the denominator of which is equal to the total number of patients receiving that type of services in that quarter under the State plan in facilities or institutions for which a showing was required to be made under this subsection, and the numerator of which is equal to the number of

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 PUBLIC LAW 95-142—OCT. 25, 1977 such patients receiving such type of services in that quarter in those facilities or institutions for which a satisfactory and valid showing was not made for that calendar quarter. "(6) The Secretary shall submit to Congress, not later than sixty days after the end of such calendar quarter, a report on— "(A) his determination as to whether or not each showing, made under paragraph (1) by a State with respect to the calendar quarter, has been found to be satisfactory under such paragraph; "(B) his review (through onsite surveys and otherwise) under paragraph (2) of the validity of showings previously submitted by a State; and "(C) any reduction in the Federal medical assistance percentage he has imposed on a State because of its submittal under paragraph (1) of an unsatisfactory or invalid showing.", (b) Section 1902(a) (26) of the Social Security Act is amended by inserting after "social service personnel" the following: ", or, in the case of skilled nursing facilities, composed of physicians or registered nurses and other appropriate health and social service personnel". (c)(1) Except as provided in paragraph (2), the amendments made by this section shall be effective on October 1, 1977, and the Secretary of Health, Education, and Welfare shall promptly adjust payments made to States under section 1903 of the Social Security Act to reflect the changes made by such amendments. (2) The amount of any reduction in the Federal medical assistance percentage of a State, otherwise required to be imposed under section 1903(g)(1) of the Social Security Act because of an unsatisfactory or invalid showing made by the State with respect to a calendar quarter beginning on or after January 1, 1977, shall be determined under such section as amended by this section. Subparagraph (B) of paragraph (4) of section 1905(g) of such Act, as added by this section, shall apply to any showing; made by a State under such section with respect to a calendar quarter beginning on or after January 1, 1977.

91 STAT. 1207

Report to Congress.

42 USC 1396a.

Effective date. 42 USC 1396b note. Payments, adjustment. 42 USC 13961).

PROTECTION OF P A T I E N T FUNDS

SEC. 21. (a) Section 1861(j) of the Social Security Act is amended by striking out "and" at the end of paragraph (13) and inserting immediately after such paragraph (13) the following new paragraph: "(14) establishes and maintains a system that (A) assures a full and complete accounting of its patients' personal funds, and (B) includes the use of such separate account for such funds as will preclude any commingling of such funds with facility funds or with the funds of any person other than another such patient; and", (b) The Secretary of Health, Education, and Welfare shall, by regulation, define those costs which may be charged to the personal funds of patients in skilled nursing facilities who are individuals receiving benefits under the provisions of title X VIII, or under a State plan approved under the provisions of title X IX, of the Social Security Act, and those costs which are to be included in the reasonable cost or reasonable chargre for extended care services as determined under the provisions of title X VIII, or for skilled nursing and intermediate care facility services as determined under the provisions of title X IX, of such Act.

Accounting system, establishment. 42 USC 1395x.

Costs, definition. 42 USC 1395x note.

42 USC 1395, 1396.

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 91 STAT. 1208 Effective date. Regulations.

PUBLIC LAW 95-142—OCT. 25, 1977 (c)(1) The amendments made by subsection (a) shall be effective on the first day of the first calendar quarter which begins more than six months after the date of enactment of this Act. (2) The Secretary of Health, Education, and Welfare shall issue the regulations required under subsection (b) within ninety days after the date of enactment of this Act. P A Y M E N T FOR INSTITUTIONAL CARE BEYOND DATE DETERMINED MEDICALLY NECESSARY

Ante, p. 1185.

SEC. 22. (a) Section 1158 of the Social Security Act is amended— (1) by inserting "and subsection (d) " in subsection (a) after "section 1159"; and (2) by adding after subsection (c) (as added by section 5(d) (1) of this Act) the following new subsection: "(d) In any case in which a Professional Standards Review Organization disapproves (under subsection (a)) of inpatient hospital services or posthospital extended care services, payment may be made for such services furnished before the second day after the day on which the provider received notice of such disapproval, or, if such organization determines that more time is required in order to arrange postdischarge care, payment may be made for such services furnished before the fourth day after the day on which the provider received notice of such disapproval.". Effective date. (b) The amendments made by subsection (a) shall be effective on 42 USC 1320C-7 the date of enactment of this Act. note.

PAYMENT UNDER THE MEDICARE PROGRAM FOR CERTAIN HOSPITAL SERVICES PROVIDED I N V E T E R A N S ' ADMINISTRATION HOSPITALS

42 USC 1395f.

SEC. 23. (a) Section 1814(c) of the Social Security Act is amended by inserting "or subsection (j) " after "subsection (d)". (b) Section 1814 of such Act is further amended by adding at the end thereof the following new subsection: .. t

42 USC 1395t. 42 USC 426.

,1";-'IN-

"Payment for Certain Hospital Services Provided in Veterans' Administration Hospitals

"(j)(1) Payments shall also be made to any hospital operated by the Veterans' Administration for inpatient hospital services furnished in a calendar year by the hospital, or under arrangements (as defined in section 1861(w)) with it, to an individual entitled to hospital benefits under section 226 even though the hospital is a Federal provider of services if (A) the individual was not entitled to have the services furnished to him free of charge by the hospital, (B) the individual was admitted to the hospital in the reasonable belief on the part of the admitting authorities that the individual was a person who was entitled to have the services furnished to him free of charge, (C) the authorities of the hospital, in admitting the individual, and the individual, acted in good faith, and (D) the services were furnished during a period ending with the close of the day on which the authorities operating the hospital first became aware of the fact that the individual was not entitled to have the services furnished to him by the hospital free of charge, or (if later) ending with the first day on which it was medically feasible to remove the individual from the hospital by discharging him therefrom or transferring him to a hospital which has in effect an agreement under this title.

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 PUBLIC LAW 95-142—OCT. 25, 1977

91 STAT. 1209

"(2) Payment for services described in paragraph (1) shall be in an amount equal to the charge imposed by the Veterans' Administration for such services, or (if less) the reasonable costs for such services (as estimated by the Secretary). Any such payment shall be made to the entity to which payment for the services involved would have been payable, if payment for such services had been made by the individual receiving the services involved (or by another private person acting on behalf of such individual).". i (c) The amendments made by this section shall apply to inpatient Effective date. hospital services furnished on and after July 1, 1974. ^2 USC 1395f Approved October 25, 1977.

LEGISLATIVE HISTORY: HOUSE REPORTS: No. 95-393, Pt. I (Comm. on Ways and Means), and Pt. II (Coram, on Interstate and Foreign Commerce) and No. 95-673 (Comm. of Conference). SENATE REPORT No. 95-453 accompanying S. 143 (Comm. on Finance). CONGRESSIONAL RECORD, Vol. 123 (1977): Sept. 22, 23, considered and passed House. Sept. 30, considered and passed Senate, amended, in lieu of S. 143. Oct. 13, House and Senate agreed to conference report. WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 13, No. 44: Oct. 25, Presidential statement.

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 9 1 STAT. 1210

PUBLIC LAW 95-143—OCT. 26, 1977

Public Law 95-143 95th Congress

-..,.,...-.^...,..:.,.,.,^..,..,.,..,-.- ..... An Act

Oct. 26, 1977 [H.R. 6415] Export-Import Bank Act of 1945, amendment. Export financing international agreements. 12 USC 635. Human rights.

Nuclear safeguards, violations. Report to congressional committees and Board of Directors.

Exports, credit support, limitation. Presidential determination, report to Congress.

To extend and amend the Export-Import Bank Act of 1945. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. Section 2(b)(1)(A) of the E x p o r t - I m p o r t B a n k Act of 1945 is amended by inserting before the period at the end of the t h i r d sentence the following: "and shall, in cooperation with other appropriate United States Government agencies, seek to reach international agreements to reduce government subsidized export financing". SEC. 2. The last sentence of section 2(b)(1)(B) of the E x p o r t I m p o r t B a n k Act of 1945 is amended by inserting before the period at the end thereof the following: ", and shall also take into account,, in consultation with the Secretary of State, the observance of and respect for human rights in the country to receive the exports supported by a loan or financial guarantee and the effect such exports may have on human rights in such country". SEC. 3. (a) The first sentence of section 2(b)(3) of the E x p o r t I m p o r t B a n k Act of 1945 is amended— (1) by inserting " (i) " immediately after "No loan or financial guarantee or combination thereof"; (2) by striking out "shall be finally approved by the Board of Directors of the Bank, and no loan or financial guarantee or combination thereof" and inserting in lieu thereof ", (ii) in an a m o u n t "; and (3) by inserting immediately after "Union of Soviet Socialist Republics" the following: ", or (iii) for the export of technology, fuel, equipment, materials, or goods or services to be used in the construction, alteration, operation, or maintenance of nuclear power, enrichment, reprocessing, research, or heavy water production facilities,". (b) Section 2(b) of the E x p o r t - I m p o r t B a n k Act of 1945 is amended by redesignating paragraph s (4) through (6) as paragraph s (5) through (7), respectively, and by inserting immediately after paragraph (3) the following new paragraph: " (4) The Secretary of State shall report to the a p p r o p r i a t e committees of Congress and to the Board of Directors of the E x p o r t I m p o r t B a n k if he determines that any country that has agreed to International Atomic Energy Agency nuclear safeguards materially violates, abrogates, or terminates, after the date of enactment of this paragraph, such safeguards or that any country that has entered into an agreement for cooperation concerning the civil use of nuclear energy with the United States materially violates, abrogates, or terminates, after the date of enactment of this paragraph, any guarantee or other undertaking to the United States made in such agreement or that any country that is not a nuclear-weapons state (as defined in article IX (3) of the T r e a t y on the Non-Proliferation of Nuclear Weapons) detonates, after the date of enactment of this paragraph, a nuclear explosive device. The Secretary shall specify which country or countries he has determined to have so acted, and the Board shall not give approval to guarantee, insure, or extend credit, or participate

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 PUBLIC LAW 95-143—OCT. 26, 1977

91 STAT. 1211

in the extension of credit in support of United States exports to such country unless the President determines that it is in the national interest for the Bank to guarantee, insure, or extend credit, or participate in the extension of credit in support of United States exports to such country and such determination has been reported to the Congress not less than twenty-five days of continuous session of the Congress prior to the date of such approval. For the purpose of the preceding sentence, continuity of a session of the Congress shall be considered as broken only by an adjournment of the Congress sine die, and the days on which either House is not in session because of an adjournment of more than three days to a day certain shall be excluded in the computation of the twenty-five day period referred to in such sentence.". (c) The first sentence of section 2(b)(5) of the Export-Import Bank Act of 1945, as redesignated by subsection (b), is amended— ^«'e, p. 1210. (1) by striking out "or" immediately after "the United States,"; and (2) by inserting before the period at the end thereof the following: ". or (C) the purchase of any liquid metal fast breeder nuclear reactor or any nuclear fuel reprocessing facility". SEC. 4. Section 8 of the Export-Import Bank Act of 1945 is amended Extension, by striking out "June 30" and inserting in lieu thereof "September 30". ^^ ^^^ ^^^^• Approved October 26, 1977.

LEGISLATIVE HISTORY: HOUSE REPORTS: No. 95-235 (Coram, on Banking, Finance and Urban Affairs) and No. 95-627 (Comm. of Conference). SENATE REPORT No. 95-279 (Coram, on Banking, Housing, and Urban Affairs). CONGRESSIONAL RECORD, Vol. 123 (1977): May 3, considered and passed House. June 29, considered and passed Senate, amended. Sept. 23, Senate agreed to conference report. Oct. 14, House agreed to conference report.

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 91 STAT. 1212

PUBLIC LAW 95-144—OCT. 28, 1977

Public Law 9 5 - 1 4 4 95th Congress

An Act Oct. 28. 1977 [S. 1682] Treaties for the transfer of offenders to or from foreign countries. Implementation.

To provide for the implementation of treaties for the transfer of offenders to or from foreign countries. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That title 18, United States Code, is amended by inserting after chapter 305 the following new chapter: -i /, ' /; ',; . "Chapter 3 0 6 — TRANSFER TO OR FROM FOREIGN COUNTRIES "Sec. "4100. "4101. "4102. "4103. "4104. "4105. "4106. "4107. "4108. "4109. "4110. "4111. "4112. "4113. "4114. "4115.

18 USC 4100.

Scope and limitation of chapter. Definitions. Authority of the Attorney General. '••

Applicability of United States laws. Transfer of offenders on probation. Transfer of offenders serving sentence of imprisonment. Transfer of offenders on parole; parole of offenders transferred. Verification of consent of offender to transfer from the United States. Verification of consent of offender to transfer to the United States. Right to counsel, appointment of counsel. Transfer of juveniles. ' '" Prosecution barred by foreign conviction. Loss of rights, disqualification. Status of alien offender transferred to a foreign country. Return of transferred offenders. Execution of sentences imposing an obligation to make restitution or reparations.

"§ 4100. Scope and limitation of chapter

" (a) The provisions of this chapter relating to the transfer of offenders shall be applicable only when a treaty providing for such a transfer is in force, and shall only be applicable to transfers of offenders to and from a foreign country pursuant to such a treaty. A sentence imposed by a foreign country upon an offender who is subsequently transferred to the United States pursuant to a treaty shall be subject to being fully executed in the United States even though the treaty under which the offender was transferred is no longer in force. " (b) A n offender may be transferred from the United States pursuant to this chapter only to a country of which the offender is a citizen or national. Only an offender who is a citizen or national of the United Offender States may be transferred to the United States. A n offender may be transfer, consent. transferred to or from the United States only with the offender's consent, and only if the offense for which the offender was sentenced satisfies the requirement of double criminality as defined in this chapter. Once an offender's consent to transfer has been verified by a verifying officer, that consent shall be irrevocable. I f a t the time of transfer the offender is under eighteen years of age the transfer shall not be accomplished unless consent to the transfer be given by a p a r e n t or guardian or by an appropriate court of the sentencing country. " (c) A n offender shall not be transferred to or from the United States if a proceeding by way of appeal or of collateral attack upon the conviction or sentence be pending.

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 PUBLIC LAW 95-144—OCT. 28, 1977

91 STAT. 1213

"(d) The United States upon receiving notice from the country Pardons, which imposed the sentence that the offender has been granted a par- commutations, don, commutation, or amnesty, or that there has been an ameliorat- and amnesty. ing modification or a revocation of the sentence shall give the offender the benefit of the action taken by the sentencing country. "§4101. Definitions 18 USC 4101. "As used in this chapter the term— "(a) 'double criminality' means that at the time of transfer of an offender the offense for which he has been sentenced is still an offense in the transferring country and is also an offense in the receiving country. With regard to a country which has a federal form of government, an act shall be deemed to be an offense in that country if it is an offense under the federal laws or the laws of any state or province thereof; " (h) 'imprisonment' means a penalty imposed by a court under which the individual is confined to an institution; "(c)'juvenile'means— "(1) a person who is under eighteen years of age; or "(2) for the purpose of proceedings and disposition under chapter 403 of this title because of an act of juvenile delinquency, a person who is under twenty-one years of age; "(d) 'juvenile delinquency' means— "(1) a violation of the laws of the United States or a State thereof or of a foreign country committed by a juvenile which would have been a crime if committed by an adult; or ' "(2) noncriminal acts committed by a juvenile for which supervision or treatment by juvenile authorities of the United States, a State thereof, or of the foreign country concerned is authorized; "(e) 'offender' means a person who has been convicted of an ' offense or who has been adjudged to have committed an act of juvenile delinquency; "(f) 'parole' means any form of release of an offender from imprisonment to the community by a releasing authority prior to • ' the expiration of his sentence, subject to conditions imposed by the releasing authority and to its supervision; " (g) 'probation' means any form of a sentence to a penalty of imprisonment the execution of which is suspended and the offender is permitted to remain at liberty under supervision and subject to conditions for the breach of which the suspended penalty of imprisonment may be ordered executed; " (h) 'sentence' means not only the penalty imposed but also the judgment of conviction in a criminal case or a judgment of acquittal in the same proceeding, or the adjudication of delinquency in a juvenile delinquency proceeding or dismissal of allegations of delinquency in the same proceedings; "(i) 'State' means any State of the United States, the District of Columbia, the Commonwealth of Puerto Eico, and any territory or possession of the United States; "(j) 'transfer' means a transfer of an individual for the purpose of the execution in one country of a sentence imposed by the courts of another country; and " (k) 'treaty'means a treaty under which an offender sentenced in the courts of one country may be transferred to the country of which he is a citizen or national for the purpose of serving the sentence.

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