P.L. 99-509 (1) a preliminary report during the fourth year of the projects, which report shall include a description of the sites at which the projects are being conducted and the services being provided at the different sites, and (2) a final report upon completion of the projects, which report shall include recommendations for appropriate legislative changes. (f) 78 FUNDING.-Expenditures (not to exceed $58,000,000 for the projects and $5,000,000 for the evaluation of the projects) made for the demonstration projects shall be made from the Federal Supplementary Medical Insurance Trust Fund (established by section 1841 of the Social Security Act). Grants and payments under contracts may be made either in advance or by way of reimbursement, as may be determined by the Secretary, and shall be made in such installments and on such conditions as the Secretary finds necessary to carry out the purpose of this section. (g) WAIVER OF MEDICARE REQUIREMENTS.-The Secretary shall waive compliance with the requirements of title XVIII of the Social Security Act to the extent and for the period the Secretary finds necessary for the conduct of the demonstration projects. SEC. 9344. TECHNICAL AMENDMENTS AND MISCELLANEOUS PROVISIONS RELATING TO PART B. (2) [42 U.S.C. 1395w-1note] APPOINTMENT OF ADDITIONAL MEMBERS.-The Director of the Congressional Office of Technology Assessment shall appoint the two additional members of the Physician Payment Review Commission, as required by the amendment made by paragraph (1), no later than 60 days after the date of the enactment of this Act, for terms of 3 years, except that the Director may provide initially for such terms as will insure that (on a continuing basis) the terms of no more than five members expire in any one year. (4) [42 U.S.C. 1320c-3 note] SMALL-AREA ANALYSIS.-The Secretary of Health and Human Services shall provide, to at least 12 utilization and quality control peer review organizations with contracts under part B of title XI of the Social Security Act, data and data processing assistance to allow each of these organizations to review and analyze small-area variations, in the service area of the organization, in the utilization of hospital and other health care services for which payment is made under title XVIII of such Act. SEC. 9412. [None assigned] WAIVER AUTHORITY FOR CHRONICALLY MENTALLY ILL AND FRAIL ELDERLY. · (a) CHRONICALLY MENTALLY ILL DEMONSTRATION PROGRAM.— (1) The Secretary of Health and Human Services may, in accordance with this subsection, waive certain provisions of title XIX of the Social Security Act in order to allow States to implement demonstration programs to improve the continuity, quality, and cost-effectiveness of mental health services available to chronically mentally ill medicaid beneficiaries. (2) A waiver shall be granted under this subsection with respect to a demonstration program only if— (A) the demonstration program has been awarded a grant from the Robert Wood Johnson Foundation and the Department of Housing and Urban Development under their "Program for the Chronically Mentally Ill", 78 As in original. No subsection (e). P.L. 99-509 (B) the State provides assurances satisfactory to the Secretary that under such waiver (i) the average per capita expenditure estimated by the State in any fiscal year for medical assistance for mental health services provided with respect to individuals covered under the program does not exceed 100 percent of the average per capita expenditure that the State reasonably estimates would have been made in that fiscal year for expenditures under the State plan for such services for such individuals if the waiver had not been granted, and (ii) there will be no reduction or limitation in benefits to a medicaid beneficiary under the program. (3) The authority under this subsection extends only to the following, as they relate to the provision of mental health services: (A) A waiver of the requirements of sections 1902(a)(1), 1902(a)(10)(B), 1902(a)(23), and 1902(a)(30) and clauses (i) and (ii) of section 1903(m)(2) of the Social Security Act. (B) Including as "medical assistance" under the State plan case management services with respect to mentally ill patients, habilitation services (as defined in section 1915(c)(5) of such Act), day treatment or other partial hospitalization services, residential services (other than room and board), psychosocial rehabilitation services, clinic services (whether or not furnished in a facility), and such other services as the State may request and the Secretary may approve for individuals covered under the demonstration project. (4)(A) A waiver under this subsection shall be for an initial term of three years which may be extended for an additional two-year term. The request of a State for extension of such a waiver shall be deemed granted unless the Secretary denies such request in writing within 90 days after the date of its submission to the Secretary. (B) The authority to approve a waiver under this subsection extends only during the five-year period beginning on October 1, 1986. (5) Subsections (c)(6) and (e)(1) of section 1915 of the Social Security Act shall apply to a waiver under this subsection in the same manner as they apply to a waiver under that section. (6) The Secretary shall report, not later than January 1, 1993, to Congress on the cost, accessibility, utilization, and quality of services provided under waivers granted under this subsection. (b) FRAIL ELDERLY DEMONSTRATION PROJECT WAIVERS.— (1) The Secretary of Health and Human Services shall grant waivers of certain requirements of titles XVIII and XIX of the Social Security Act to not more than 15 public or nonprofit private community-based organizations to enable such organizations to provide comprehensive health care services on a capitated basis to frail elderly patients at risk of institutionalization. (2)(A) Except as provided in subparagraph (B), the terms and conditions of a waiver granted pursuant to this subsection shall be substantially the same as the terms and conditions of the On Lok waiver (referred to in section 603(c) of the Social Security Amendments of 1983 and extended by section 9220 of the Consolidated Omnibus Budget Reconciliation Act of 1985), including permitting the organization to assume progressively (over the initial 3-year period of the waiver) the full financial risk. (B) In order to receive a waiver under this subsection, an organization must participate in an organized initiative to replicate the findings of the On Lok long-term care demonstration project (described in section 603(c)(1) of the Social Security Amendments of 1983). (C) Subject to subparagraph (B), any waiver granted pursuant to this subsection shall be for an initial period of 3 years. The Secretary may extend such waiver beyond such initial period for so long as the Secretary finds that the organization complies with the terms and conditions described in subparagraphs (A) and (B). (3) In the case of an organization receiving an initial waiver under this subsection on or after October 1, 1990, the Secretary (at the request of the organization) shall not require the organization to provide services under title XVIII P.L. 99-643 of the Social Security Act on a capitated or other risk basis during the first 2 years of the waiver. (4) Section 1924 of the Social Security Act shall apply to any individual receiving services from an organization receiving a waiver under this subsection. * SEC. 9415. [None assigned] INAPPLICABILITY OF PAPERWORK REDUCTION ACT. Notwithstanding any other provision of law, chapter 35 of title 44, United States Code, shall not apply to information required to carry out any provision of this part or the amendments made by this part. * SEC. 9442. [42 U.S.C. 679a] MATERNAL AND CHILD HEALTH AND ADOPTION CLEARINGHOUSE. The Secretary of Health and Human Services shall establish, either directly or by grant or contract, a National Adoption Information Clearinghouse. The Clearinghouse shall (1) collect, compile, and maintain information obtained from available research, studies, and reports by public and private agencies, institutions, or individuals concerning all aspects of infant adoption and adoption of children with special needs; (2) compile, maintain, and periodically revise directories of information concerning (A) crisis pregnancy centers, (B) shelters and residences for pregnant women, (C) training programs on adoption, (D) educational programs on adoption, (E) licensed adoption agencies, (F) State laws relating to adoption, (G) intercountry adoption, and (H) any other information relating to adoption for pregnant women, infertile couples, adoptive parents, unmarried individuals who want to adopt children, individuals who have been adopted, birth parents who have placed a child for adoption, adoption agencies, social workers, counselors, or other individuals who work in the adoption field; (3) disseminate the information compiled and maintained pursuant to paragraph (1) and the directories compiled and maintained pursuant to paragraph (2); and (4) upon the establishment of an adoption and foster care data collection system pursuant to section 479 of the Social Security Act, disseminate the data and information made available through that system. [Internal References.-S.S. Act §§215(i), 1833(1), and 1886(e) cite the Omnibus Budget Reconciliation Act of 1986 and S.S. Act titles XI, part B, XVIII, and §§479, and §§1876 catchlines and §§1833(1), 1842(j); 1876(f) and 1879(a) have footnotes referring to P.L. 99-509.] P.L. 99-643, Approved November 10, 1986 (100 Stat. 3574) * P.L. 99-643 SEC. 6. LOSS OF SSI BENEFITS UPON ENTITLEMENT TO CHILD'S INSURANCE BENEFITS BASED ON DISABILITY. (b) [42 U.S.C. 1383c note] STATE DETERMINATIONS.-Any determination required under section 1634(c) of the Social Security Act with respect to whether an individual would be eligible for benefits under title XVI of such Act in the absence of children's benefits (or an increase thereof) shall be made by the appropriate State agency. [Internal Reference.-S.S. Act §1634(c) has a footnote referring to P.L. 99-643.] P.L. 99-660, Approved November 14, 1986 (100 Stat. 3743) Title IV-Health Care Quality Improvement Act of 1986 TITLE IV-ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES SEC. 401. [42 U.S.C. 11101 note] SHORT TITLE. This title may be cited as the "Health Care Quality Improvement Act of 1986". SEC. 402. [42 U.S.C. 11101] FINDINGS. The Congress finds the following: (1) The increasing occurrence of medical malpractice and the need to improve the quality of medical care have become nationwide problems that warrant greater efforts than those that can be undertaken by any individual State. (2) There is a national need to restrict the ability of incompetent physicians to move from State to State without disclosure or discovery of the physician's previous damaging or incompetent performance. (3) This nationwide problem can be remedied through effective professional peer review. (4) The threat of private money damage liability under Federal laws, including treble damage liability under Federal antitrust law, unreasonably discourages physicians from participating in effective professional peer review. (5) There is an overriding national need to provide incentive and protection for physicians engaging in effective professional peer review. PART A-PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES SEC. 411. [42 U.S.C. 11111] PROFESSIONAL REVIEW. (a) IN GENERAL.— (1) LIMITATION ON DAMAGES FOR PROFESSIONAL REVIEW ACTIONS.-If a professional review action (as defined in section 431(9)) of a professional review body meets all the standards specified in section 412(a), except as provided in subsection (b) (A) the professional review body, (B) any person acting as a member or staff to the body, (C) any person under a contract or other formal agreement with the body, and (D) any person who participates with or assists the body with respect to the action, shall not be liable in damages under any law of the United States or of any State (or political subdivision thereof) with respect to the action. The preceding sentence shall not apply to damages under any law of the United States or any State relating to the civil rights of any person or persons, including the Civil P.L. 99-660 Rights Act of 1964, 42 U.S.C. 2000e, et seq. and the Civil Rights Acts, 42 U.S.C. 1981, et seq. Nothing in this paragraph shall prevent the United States or any Attorney General of a State from bringing an action, including an action under section 4C of the Clayton Act, 15 U.S.C. 15C79, where such an action is otherwise authorized. (2) PROTECTION FOR THOSE PROVIDING INFORMATION TO PROFESSIONAL REVIEW BODIES.-Notwithstanding any other provision of law, no person (whether as a witness or otherwise) providing information to a professional review body regarding the competence or professional conduct of a physician shall be held, by reason of having provided such information, to be liable in damages under any law of the United States or of any State (or political subdivision thereof) unless such information is false and the person providing it knew that such information was false. (b) EXCEPTION.—If the Secretary has reason to believe that a health care entity has failed to report information in accordance with section 423(a), the Secretary shall conduct an investigation. If, after providing notice of noncompliance, an opportunity to correct the noncompliance, and an opportunity for a hearing, the Secretary determines that a health care entity has failed substantially to report information in accordance with section 423(a), the Secretary shall publish the name of the entity in the Federal Register. The protections of subsection (a)(1) shall not apply to an entity the name of which is published in the Federal Register under the previous sentence with respect to professional review actions of the entity commenced during the 3-year period beginning 30 days after the date of publication of the name. (c) TREATMENT UNDER STATE LAWS. (1) PROFESSIONAL REVIEW ACTIONS TAKEN ON OR AFTER OCTOBER 14, 1989.Except as provided in paragraph (2), subsection (a) shall apply to State laws in a State only for professional review actions commenced on or after October 14, 1989. (2) EXCEPTIONS.— (A) STATE EARLY OPT-IN.-Subsection (a) shall apply to State laws in a State for actions commenced before October 14, 1989, if the State by legislation elects such treatment. (B) EFFECTIVE DATE OF ELECTION.-An election under State law is not effective, for purposes of, 80 for actions commenced before the effective date of the State law, which may not be earlier than the date of the enactment of that law. SEC. 412. [42 U.S.C. 11112] STANDARDS FOR PROFESSIONAL REVIEW ACTIONS. (a) IN GENERAL.-For purposes of the protection set forth in section 411(a), a professional review action must be taken (1) in the reasonable belief that the action was in the furtherance of quality health care, (2) after a reasonable effort to obtain the facts of the matter, (3) after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances, and (4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph (3). A professional review action shall be presumed to have met the preceding standards necessary for the protection set out in section 411(a) unless the presumption is rebutted by a preponderance of the evidence. (b) ADEQUATE NOTICE AND HEARING.-A health care entity is deemed to have met the adequate notice and hearing requirement of subsection (a)(3) with respect to a physician if the following conditions are met (or are waived voluntarily by the physician): (1) NOTICE OF PROPOSED ACTION.-The physician has been given notice stating |