
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC11151]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
   CHAPTER 117--ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES
 
                 SUBCHAPTER III--DEFINITIONS AND REPORTS
 
Sec. 11151. Definitions

    In this chapter:
        (1) The term ``adversely affecting'' includes reducing, 
    restricting, suspending, revoking, denying, or failing to renew 
    clinical privileges or membership in a health care entity.
        (2) The term ``Board of Medical Examiners'' includes a body 
    comparable to such a Board (as determined by the State) with 
    responsibility for the licensing of physicians and also includes a 
    subdivision of such a Board or body.
        (3) The term ``clinical privileges'' includes privileges, 
    membership on the medical staff, and the other circumstances 
    pertaining to the furnishing of medical care under which a physician 
    or other licensed health care practitioner is permitted to furnish 
    such care by a health care entity.
        (4)(A) The term ``health care entity'' means--
            (i) a hospital that is licensed to provide health care 
        services by the State in which it is located,
            (ii) an entity (including a health maintenance organization 
        or group medical practice) that provides health care services 
        and that follows a formal peer review process for the purpose of 
        furthering quality health care (as determined under regulations 
        of the Secretary), and
            (iii) subject to subparagraph (B), a professional society 
        (or committee thereof) of physicians or other licensed health 
        care practitioners that follows a formal peer review process for 
        the purpose of furthering quality health care (as determined 
        under regulations of the Secretary).

        (B) The term ``health care entity'' does not include a 
    professional society (or committee thereof) if, within the previous 
    5 years, the society has been found by the Federal Trade Commission 
    or any court to have engaged in any anti-competitive practice which 
    had the effect of restricting the practice of licensed health care 
    practitioners.
        (5) The term ``hospital'' means an entity described in 
    paragraphs (1) and (7) of section 1395x(e) of this title.
        (6) The terms ``licensed health care practitioner'' and 
    ``practitioner'' mean, with respect to a State, an individual (other 
    than a physician) who is licensed or otherwise authorized by the 
    State to provide health care services.
        (7) The term ``medical malpractice action or claim'' means a 
    written claim or demand for payment based on a health care 
    provider's furnishing (or failure to furnish) health care services, 
    and includes the filing of a cause of action, based on the law of 
    tort, brought in any court of any State or the United States seeking 
    monetary damages.
        (8) The term ``physician'' means a doctor of medicine or 
    osteopathy or a doctor of dental surgery or medical dentistry 
    legally authorized to practice medicine and surgery or dentistry by 
    a State (or any individual who, without authority holds himself or 
    herself out to be so authorized).
        (9) The term ``professional review action'' means an action or 
    recommendation of a professional review body which is taken or made 
    in the conduct of professional review activity, which is based on 
    the competence or professional conduct of an individual physician 
    (which conduct affects or could affect adversely the health or 
    welfare of a patient or patients), and which affects (or may affect) 
    adversely the clinical privileges, or membership in a professional 
    society, of the physician. Such term includes a formal decision of a 
    professional review body not to take an action or make a 
    recommendation described in the previous sentence and also includes 
    professional review activities relating to a professional review 
    action. In this chapter, an action is not considered to be based on 
    the competence or professional conduct of a physician if the action 
    is primarily based on--
            (A) the physician's association, or lack of association, 
        with a professional society or association,
            (B) the physician's fees or the physician's advertising or 
        engaging in other competitive acts intended to solicit or retain 
        business,
            (C) the physician's participation in prepaid group health 
        plans, salaried employment, or any other manner of delivering 
        health services whether on a fee-for-service or other basis,
            (D) a physician's association with, supervision of, 
        delegation of authority to, support for, training of, or 
        participation in a private group practice with, a member or 
        members of a particular class of health care practitioner or 
        professional, or
            (E) any other matter that does not relate to the competence 
        or professional conduct of a physician.

        (10) The term ``professional review activity'' means an activity 
    of a health care entity with respect to an individual physician--
            (A) to determine whether the physician may have clinical 
        privileges with respect to, or membership in, the entity,
            (B) to determine the scope or conditions of such privileges 
        or membership, or
            (C) to change or modify such privileges or membership.

        (11) The term ``professional review body'' means a health care 
    entity and the governing body or any committee of a health care 
    entity which conducts professional review activity, and includes any 
    committee of the medical staff of such an entity when assisting the 
    governing body in a professional review activity.
        (12) The term ``Secretary'' means the Secretary of Health and 
    Human Services.
        (13) The term ``State'' means the 50 States, the District of 
    Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and 
    the Northern Mariana Islands.
        (14) The term ``State licensing board'' means, with respect to a 
    physician or health care provider in a State, the agency of the 
    State which is primarily responsible for the licensing of the 
    physician or provider to furnish health care services.

(Pub. L. 99-660, title IV, Sec. 431, Nov. 14, 1986, 100 Stat. 3792.)

                  Section Referred to in Other Sections

    This section is referred to in sections 1396r-2, 11111 of this 
title.
