
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: 42USC1320c-4]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
   SUBCHAPTER XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE 
                             SIMPLIFICATION
 
 Part B--Peer Review of Utilization and Quality of Health Care Services
 
Sec. 1320c-4. Right to hearing and judicial review

    Any beneficiary who is entitled to benefits under subchapter XVIII 
of this chapter, and, subject to section 1320c-3(a)(3)(D) of this title, 
any practitioner or provider, who is dissatisfied with a determination 
made by a contracting peer review organization in conducting its review 
responsibilities under this part, shall be entitled to a reconsideration 
of such determination by the reviewing organization. Where the 
reconsideration is adverse to the beneficiary and where the matter in 
controversy is $200 or more, such beneficiary shall be entitled to a 
hearing by the Secretary (to the same extent as beneficiaries under 
subchapter II of this chapter are entitled to a hearing by the 
Commissioner of Social Security under section 405(b) of this title). For 
purposes of the preceding sentence, subsection (l) of section 405 of 
this title shall apply, except that any reference in such subsection to 
the Commissioner of Social Security or the Social Security 
Administration shall be deemed a reference to the Secretary or the 
Department of Health and Human Services, respectively. Where the amount 
in controversy is $2,000 or more, such beneficiary shall be entitled to 
judicial review of any final decision relating to a reconsideration 
described in this subsection.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1155, as added Pub. L. 97-248, 
title I, Sec. 143, Sept. 3, 1982, 96 Stat. 388; amended Pub. L. 101-239, 
title VI, Sec. 6224(b)(2), Dec. 19, 1989, 103 Stat. 2257; Pub. L. 103-
296, title I, Sec. 108(b)(14), Aug. 15, 1994, 108 Stat. 1485.)


                            Prior Provisions

    A prior section 1320c-4, act Aug. 14, 1935, ch. 531, title XI, 
Sec. 1155, as added Oct. 30, 1972, Pub. L. 92-603, title II, 
Sec. 249F(b), 86 Stat. 1433; amended Oct. 25, 1977, Pub. L. 95-142, 
Sec. 5(c)(1), (d)(3), (o)(2), (p), 91 Stat. 1184, 1188, 1191, 1192; Dec. 
5, 1980, Pub. L. 96-499, title IX, Secs. 924(b)-(d), 925-927(a), 931(g), 
94 Stat. 2629, 2630, 2634; Aug. 13, 1981, Pub. L. 97-35, title XXI, 
Secs. 2111, 2113(d), 2121(f), 95 Stat. 793, 794, 796, related to 
functions and duties of Professional Standards Review Organizations, 
prior to the general revision of this part by Pub. L. 97-248.


                               Amendments

    1994--Pub. L. 103-296 substituted ``(to the same extent as 
beneficiaries under subchapter II of this chapter are entitled to a 
hearing by the Commissioner of Social Security under section 405(b) of 
this title). For purposes of the preceding sentence, subsection (l) of 
section 405 of this title shall apply, except that any reference in such 
subsection to the Commissioner of Social Security or the Social Security 
Administration shall be deemed a reference to the Secretary or the 
Department of Health and Human Services, respectively. Where the amount 
in controversy is $2,000 or more, such beneficiary shall be entitled to 
judicial review of any final decision relating to a reconsideration 
described in this subsection.'' for ``(to the same extent as is provided 
in section 405(b) of this title), and, where the amount in controversy 
is $2,000 or more, to judicial review of the Secretary's final 
decision.''
    1989--Pub. L. 101-239 inserted ``, subject to section 1320c-
3(a)(3)(D) of this title,'' before ``any practitioner or provider''.


                    Effective Date of 1994 Amendment

    Amendment by Pub. L. 103-296 effective Mar. 31, 1995, see section 
110(a) of Pub. L. 103-296, set out as a note under section 401 of this 
title.


                    Effective Date of 1989 Amendment

    Amendment by Pub. L. 101-239 applicable to determinations by 
utilization and quality control peer review organizations with respect 
to which preliminary notifications were made under section 1320c-
3(a)(3)(B) of this title more than 30 days after Dec. 19, 1989, see 
section 6224(b)(3) of Pub. L. 101-239, set out as a note under section 
1320c-3 of this title.

                  Section Referred to in Other Sections

    This section is referred to in section 1320c-3 of this title.
