Medicare and Medicaid programs; utilization and quality control peer review organization (PRO): assumption of Medicare review functions and coordination with Medicaid--HCFA. Final rule

Abstract

This rule describes the review functions to be performed by a utilization and quality control peer review organization (PRO). It outlines the relationships that will be established among PROs, Medicare fiscal intermidiaries and carriers, providers, practitioners, and beneficiaries when a PRO assumes its review responsibilities. It also describes the relationship that should exist between PROs and State Medicaid agencies that contract with PROs to perform review. This rule implements portions of the following statutes: Peer Review Improvement Act of 1982 (Title I, Subtitle C of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248), Social Security Amendments of 1983 (Pub. L. 98-21), Deficit Reduction Act of 1984 (Pub. L. 98-369).