Provider Payment Review Board Act
Latest action. Referred to House Committee on Interstate and Foreign Commerce.
Provider Payment Review Board Act - Amends title XVIII (Medicare) of the Social Security Act to replace the Provider Reimbursement Review Board with the Provider Payment Review Board. Sets forth the composition of the Provider Payment Review Board. Permits the Board to establish its own divisions, to determine the character of cases to be heard initially by the Board or its divisions, and to review any decision rendered by one of its divisions. Permits a provider of Medicare services to obtain a hearing before the Board when the provider is dissatisfied with a refusal of its fiscal intermediary to reopen or revise its reimbursement decision if the provider requested such reopening within a specified time or, if the request is made more than 180 days after the reimbursement decision, if the provider has presented new and material evidence. Adds to the requirements for appeals by groups of providers a requirement that the amount in controversy must be $50,000 or more for all cost reporting periods in dispute. Sets forth the rules regarding the parties to a hearing of the Board, the power of the Board to recognize persons representing parties to a hearing, and the power of the Board to issue subpoenas. Grants the right to obtain judicial review of a Board decision to any parties to the hearing other than the fiscal intermediary. Makes the final decision of the Board binding on all parties to the hearing for the cost reporting periods covered by the decision. Makes such decision binding on the Secretary of Health and Human Services and on the party intermediary with respect to all other parties for all subsequent cost reporting periods unless the Secretary promulgates a regulation inconsistent with the Board's decision. Binds by such decision the Secretary and all fiscal intermediaries with respect to determinations for which the same issues and facts pertain unless the Secretary publishes within 120 days of the decision a statement of nonacquiescence in such decision. Permits a provider of services to obtain judicial review of certain final decisions of the fiscal intermediary if the Board determines or is deemed to have determined that it is without authority to decide the question. Requires the Board to provide for publication of its decisions and to submit an annual report on its activities to Congress. Permits judicial review of a regulation or instruction of the Secretary or of the Administrator of the Health Care Financing Administration if such action is brought within a certain period of time and if the regulation or instruction financially affects either a provider of services of $100,000 for any cost reporting period reporting period or a group of providers of services of $500,000 for any such period.
Written by analysts at the Congressional Research Service and published on Congress.gov, not by Civibrief. Summarized at the "Introduced in House" stage on August 20, 1980. It describes the bill, it is not the legal text.
Where is it in the process, and what happens next?
4 steps remain before this bill could become law.
The record's latest action, on August 20, 1980: Referred to House Committee on Interstate and Foreign Commerce.
- Clearing the committees it was referred to, and being scheduled for a floor vote
- Passage by the House
- Passage by the Senate
- The President's signature. If the President vetoes it, two-thirds of both chambers must vote to override.
How likely is it to become law?
Civibrief does not forecast outcomes and this page has no opinion about this one. What the record supports is a base rate, which is a fact about the whole pile, not a prediction about this measure.
In the 96th Congress (1979-80), 613 of the 12,581 bills and joint resolutions introduced became law, about 4.9 percent. That count covers every measure at every stage, including the many that never left committee.
This one is not there yet: 4 steps are still outstanding, listed above.
Has anyone actually voted on it?
No. No roll call in this Congress cites this measure. That is the ordinary outcome: most measures never reach a recorded floor vote, and a committee ends most of them simply by not acting.
A vote is not the only thing that happens to a measure. Hearings, markups, and referrals are all recorded actions, and none of them is a vote of the full chamber.
Who is behind it?
CECIL HEFTEL (D-HI) introduced it on August 20, 1980, and 3 members have since signed on as cosponsors.
They come from both major parties: 1 Democrat, 2 Republicans.
Cosponsoring is a formal signature on the text. It is not a commitment to vote for the measure, it does not bind anyone's party, and a long list of cosponsors is a measure of attention rather than of prospects.
How long has it been in play?
It was introduced on August 20, 1980, 16869 days ago. The most recent recorded action was 16869 days ago, on August 20, 1980.
Measures do not carry over. Anything the 96th Congress has not finished by January 3, 1981 dies when the term ends, and has to be introduced again from the start in the next Congress.
Every answer above is assembled from this measure's own record on Congress.gov and from published counts of what Congress has passed before. Civibrief does not predict outcomes and takes no position on any measure.
Vote history
- HouseIn committee, no floor vote yet
- SenateAwaits House passage
- PresidentAwaits both chambers