§ 1395oo. Provider Reimbursement Review Board

Legislative history

Reconstructed from this section’s Code source credit and amendment notes, resolved against the local Statutes at Large. Editorial notes are evidence, not the law that made the change.

1. 1935

   Social Security Amendments of 1972

   Pub. L. 92–603 title II § 243(a) · 86 Stat. 1329

   Enacted · 42 U.S.C. § 1395oo

   Aug. 14, 1935, ch. 531, title XVIII, § 1878, as added Pub. L. 92–603, title II, § 243(a), Oct. 30, 1972, 86 Stat. 1420

   Source evidence

   Code source credit
   Aug. 14, 1935, ch. 531, title XVIII, § 1878, as added Pub. L. 92–603, title II, § 243(a), Oct. 30, 1972, 86 Stat. 1420

   Enacted provision · exact public law section
   (a) Title XVIII of the Social Security Act is amended by adding at the end thereof (after the new sections added by section Ante, p. 1419. 226(a) and section 242 (b) of this Act) the following new section: “Sec. 1878. “provider reimbursement review board (a) Any provider of services which has filed a required Establishment. cost report within the time specified in regulations may obtain a hearing with respect, to such cost report by a Provider Reimbursement Review Board (hereinafter referred to as the ‘Board’) which shall be established by the Secretary in accordance with subsection (h), if— Conditions. “(1) such provider— “(A) is dissatisfied with a final determination of the organization serving as its fiscal intermediary pursuant to section 1816 as to the amount of total program reimbursement 42 USC 1395h. due the provider for the items and services furnished to individuals for which payment may be made under this title for the period covered by such report, “(B) has not received such final determination from such intermediary on a timely basis after filing such report., where such report complied with the rules and regulations of the Secretary relating to such report, or “(C) has not received such final determination on a timely basis after filing a supplementary cost report, where such cost report did not so comply and such supplementary cost report did so comply, “(2) the amount in controversy is $10,000 or more, and “(3) such provider files a request for a hearing within 180 days after notice of the intermediary’s final determination under paragraph (1) (A) or with respect to appeals pursuant to paragraph (1) (B) or (C), within 180 days after notice of such determination would have been received if such determination had been made on a timely basis. “(b) The provisions of subsection (a) shall apply to any group of Group appeal. providers of services if each provider of services in such group would, upon the filing of an appeal (but without regard to the $10,000 limitation), be entitled to such a hearing, but only if the matters in controversy involve a common question of fact or interpretation of law or regulations and the amount in controversy is, in the aggregate, $50,000 or more. “(c) At such hearing, the provider of services shall have the right to be represented by counsel, to introduce evidence, and to examine and cross-examine witnesses. Evidence may be received at any such hearing even though inadmissable under rules of evidence applicable to court procedure. “(d) A decision by the Board shall be based upon the record made at such hearing, which shall include the evidence considered by the intermediary and such other evidence as may be obtained or received by the Board, and shall be supported by substantial evidence when the record is viewed as a whole. The Board shall have the power to affirm, modify, or reverse a final determination of the fiscal intermediary with respect to a cost report and to make any other revisions on matters covered by such cost report, (including revisions adverse to the provider of services) even though such matters were not considered by the intermediary in making such final determination. “(e) The Board shall have full power and authority to make rules Rules and regulations. and establish procedures, not inconsistent with the provisions of this title or regulations of the Secretary, which are necessary or appropriate to carry out the provisions of this section. In the course of any hearing the Board may administer oaths and affirmations. The provisions of subsections (d), (e), and (f) of section 205 with respect to subpenas 42 USC 405. shall apply to the Board to the same extent as they apply to the Secretary 42 USC 401. Board decision, reviewability. with respect to title II. “(f) A decision of the Board shall be final unless the Secretary, on his own motion, and within 60 days after the provider of services is notified of the Board’s decision, reverses or modifies (adversely to such provider) the Board’s decision. In any case where such a reversal or modification occurs the provider of services may obtain a review of such decision by a civil action commenced within 60 days of the date he is notified of the Secretary’s reversal or modification. Such action shall be, brought in the district court of the United States for the judicial district in which the provider is located or in the District Court for the District of Columbia and shall be tried pursuant to the applicable 5 USC 701. provisions under chapter 7 of title 5, United States Code, notwithstanding 42 USC 405. any other provisions in section 205. “(g) The finding of a fiscal intermediary that no payment may be made under this title for any expenses incurred for items or services furnished to an individual because such items or services are listed in 42 USC 1395y. section 1862 shall not be reviewed by the Board, or by any court pursuant to an action brought under subsection (f). “(h) The Board shall be composed of five members appointed by the Secretary without regard to the provisions of title 5, United States 5 USC 101 et seq. Code, governing appointments in the competitive services. Two of such members shall be representative of providers of services. All of the members of the Board shall be persons knowledgeable in the field of cost reimbursement, and at least one of them shall be a certified Compensation. public accountant. Members of the Board shall be entitled to receive compensation at rates fixed by the Secretary, but not exceeding the rate specified (at the time the service involved is rendered by such members) for grade GS–18 in section 5332 of title 5, United States 5 USC 5332 note. Code. The term of office shall be three years, except that the Secretary shall appoint the initial members of the Board for shorter terms to the extent necessary to permit staggered terms of office. “(i) The Board is authorized to engage such technical assistance as may be required to carry out its functions, and the Secretary shall, in addition, make available to the Board such secretarial, clerical, and other assistance as the Board may require to carry out its functions.”

2. 1974

   Pub. L. 93–484 § 3(a) · 88 Stat. 1459

   1. Redesignated · 42 U.S.C. § 1395oo(f)

      Pub. L. 93–484 redesignated existing provisions as par. (1)

   2. Inserted · 42 U.S.C. § 1395oo(f)

      Pub. L. 93–484 inserted provisions authorizing judicial review for providers of final decisions of Board and judicial review of any affirmance by Secretary

   3. Added · 42 U.S.C. § 1395oo(f)

      Pub. L. 93–484 added pars. (2) and (3)

   Source evidence

   Code amendment note
   Subsec. (f). Pub. L. 93–484 redesignated existing provisions as par. (1), inserted provisions authorizing judicial review for providers of final decisions of Board and judicial review of any affirmance by Secretary, and added pars. (2) and (3).

   Enacted provision · exact public law section
   (a) Section 1878(f) of the Social Security Act is amended Provider Reimbursement Review Board, decisions, review. 42 USC 1395oo. to read as follows: “(f) (1) A decision of the Board shall lie final unless the Secretary, on his own motion, and within 60 days after the provider of services is notified of the Board’s decision, reverses, affirms, or modifies the Board’s decision. Providers shall have the right to obtain judicial review of any final decision of the Board, or of any reversal, affirmance, or modification by the Secretary, by a civil action commenced within 60 days of the date on which notice of any final decision by the Board or of any reversal, affirmance, or modification by the Secretary is received. Such action shall be brought in the district court of the United States for the judicial district in which the provider is located or in the District Court for the District of Columbia and shall be tried pursuant to the applicable provisions under chapter 7 of title 5, United States Code, notwithstanding any other provisions 5 USC 701. 42 USC 405. in section 205. “(2) Where a provider seeks judicial review pursuant to paragraph Judicial review. (1), the amount in controversy shall be subject to annual interest beginning on the first day of the first month beginning after the 180-day period as determined pursuant to subsection (a)(3) and equal to the rate of return on equity capital established by regulation pursuant to section 1861 (v)(1) (B) and in effect at the time the civil action 42 USC 1395x. authorized under paragraph (1) is commenced, to be awarded by the reviewing court in favor of the prevailing party. “(3) No interest awarded pursuant to paragraph (2) shall be deemed income or cost for the purposes of determining reimbursement due providers under this Act.”

3. 1980

   Pub. L. 96–499 title IX § 955 · 94 Stat. 2599

   Inserted · 42 U.S.C. § 1395oo(f)(1)

   Pub. L. 96–499 inserted provision empowering providers of services to obtain judicial review of any action of a fiscal intermediary involving a question of law or regulations relevant to matters in controversy whenever Board determined that it was without authority to decide such matters in controversy

   Source evidence

   Code amendment note
   Subsec. (f)(1). Pub. L. 96–499 inserted provision empowering providers of services to obtain judicial review of any action of a fiscal intermediary involving a question of law or regulations relevant to matters in controversy whenever Board determined that it was without authority to decide such matters in controversy.

   Enacted provision · exact public law section
   Sec. 955. provider reimbursement review board Section 1878(f)(1) of the Social Security Act is amended by 42 USC 1395oo. inserting the following after the second sentence thereof: “Providers shall also have the right to obtain judicial review of any action of the fiscal intermediary which involves a question of law or regulations relevant to the matters in controversy whenever the Board determines (on its own motion or at the request of a provider of services as described in the following sentence) that it is without authority to decide the question, by a civil action commenced within sixty days of the date on which such determination is rendered. If a provider of services may obtain a hearing under subsection (a) and has filed a request for such a hearing, such provider may file a request for a determination by the Board of its authority to decide the question of law or regulations relevant to the matters in controversy (accompanied by such documents and materials as the Board shall require for purposes of rendering such determination). The Board shall render such determination in writing within thirty days after the Board receives the request and such accompanying documents and materials, and the determination shall be considered a final decision and not subject to review by the Secretary. If the Board fails to render such determination within such period, the provider may bring a civil action (within sixty days of the end of such period) with respect to the matter in controversy contained in such request for a hearing.”.

4. 1983

   Pub. L. 98–21 § 602(h)(1)(A) · 97 Stat. 65

   Inserted · 42 U.S.C. § 1395oo(a)

   Pub. L. 98–21, § 602(h)(1)(A), inserted provision in introductory text that, except as provided in subsec. (g)(2) of this section, any hospital which receives payments in amounts computed under section 1395ww(b) or (d) of this title and which has submitted such reports within such time as Secretary may require in order to make payment under such section may obtain a hearing with respect to such payment by Board

   Source evidence

   Code amendment note
   Subsec. (a). Pub. L. 98–21, § 602(h)(1)(A), inserted provision in introductory text that, except as provided in subsec. (g)(2) of this section, any hospital which receives payments in amounts computed under section 1395ww(b) or (d) of this title and which has submitted such reports within such time as Secretary may require in order to make payment under such section may obtain a hearing with respect to such payment by Board.

   Enacted provision · exact public law section
   (A) by inserting “and (except as provided in subsection (g)(2)) any hospital which receives payments in amounts computed under subsection (b) or (d) of section 1886 and which has submitted such reports within such time as the Secretary may require in order to make payment under such section may obtain a hearing with respect to such payment by the Board” after “subsection (h)” in the matter before paragraph (1),

5. 1983

   Pub. L. 98–21 § 602(h)(1)(B) · 97 Stat. 65

   1. Amended · 42 U.S.C. § 1395oo(a)(1)(A)

      Pub. L. 98–21, § 602(h)(1)(B), (C), designated existing provisions as cl. (i)

   2. Added · 42 U.S.C. § 1395oo(a)(1)(A)

      Pub. L. 98–21, § 602(h)(1)(B), (C), added cl. (ii)

   Source evidence

   Code amendment note
   Subsec. (a)(1)(A). Pub. L. 98–21, § 602(h)(1)(B), (C), designated existing provisions as cl. (i) and added cl. (ii).

   Enacted provision · exact public law section
   (B) by inserting “(i)” after “(A)” in paragraph (1)(A),

6. 1983

   Pub. L. 98–21 § 602(h)(1)(D) · 97 Stat. 65

   Substituted · 42 U.S.C. § 1395oo(a)(3)

   Pub. L. 98–21, § 602(h)(1)(D), substituted “(1)(A)(i), or with respect to appeals under paragraph (1)(A)(ii), 180 days after notice of the Secretary’s final determination,” for “(1)(A)”

   Source evidence

   Code amendment note
   Subsec. (a)(3). Pub. L. 98–21, § 602(h)(1)(D), substituted “(1)(A)(i), or with respect to appeals under paragraph (1)(A)(ii), 180 days after notice of the Secretary’s final determination,” for “(1)(A)”.

   Enacted provision · exact public law section
   (D) by striking out “(1)(A)” in paragraph (3) and inserting in lieu thereof “(1)(A)(i), or with respect to appeals under paragraph (1)(A)(ii), 180 days after notice of the Secretary’s final determination,”.

7. 1983

   Pub. L. 98–21 § 602(h)(2) · 97 Stat. 65

   Inserted · 42 U.S.C. § 1395oo(f)(1)

   Pub. L. 98–21, § 602(h)(2), inserted “(or, in an action brought jointly by several providers, the judicial district in which the greatest number of such providers are located)” after “the judicial district in which the provider is located”, and “Any appeal to the Board or action for judicial review by providers which are under common ownership or control must be brought by such providers as a group with respect to any matter involving an issue common to such providers.”

   Source evidence

   Code amendment note
   Subsec. (f)(1). Pub. L. 98–21, § 602(h)(2), inserted “(or, in an action brought jointly by several providers, the judicial district in which the greatest number of such providers are located)” after “the judicial district in which the provider is located”, and “Any appeal to the Board or action for judicial review by providers which are under common ownership or control must be brought by such providers as a group with respect to any matter involving an issue common to such providers.”

   Enacted provision · exact public law section
   (2) (A) The last sentence of section 1878(f)(1) of the Social Security Act is amended by inserting “(or, in an action brought jointly by several providers, the judicial district in which the greatest number of such providers are located)” after “the judicial district in which the provider is located”. (B) Section 1878(f)(1) of such Act is further amended by adding at the end thereof the following new sentence: “Any appeal to the Board or action for judicial review by providers which are under common ownership or control must be brought by such providers as a group with respect to any matter involving an issue common to such providers.”.

8. 1983

   Pub. L. 98–21 § 602(h)(3) · 97 Stat. 65

   1. Amended · 42 U.S.C. § 1395oo(g)

      Pub. L. 98–21, § 602(h)(3), designated existing provisions as par. (1)

   2. Added · 42 U.S.C. § 1395oo(g)

      Pub. L. 98–21, § 602(h)(3), added par. (2)

   Source evidence

   Code amendment note
   Subsec. (g). Pub. L. 98–21, § 602(h)(3), designated existing provisions as par. (1) and added par. (2).

   Enacted provision · exact public law section
   (3) Section 1878(g) of such Act is amended by inserting “(1)” after “(g)” and by adding at the end the following new paragraph: “(2) The determinations and other decisions described in section 1886(d)(7) shall not be reviewed by the Board or by any court pursuant to an action brought under subsection (f) or otherwise.”

9. 1983

   Pub. L. 98–21 § 602(h)(4) · 97 Stat. 65

   Substituted · 42 U.S.C. § 1395oo(h)

   Pub. L. 98–21, § 602(h)(4), substituted “payment of providers of services” for “cost reimbursement”

   Source evidence

   Code amendment note
   Subsec. (h). Pub. L. 98–21, § 602(h)(4), substituted “payment of providers of services” for “cost reimbursement”.

   Enacted provision · exact public law section
   (4) The third sentence of section 1878(h) of such Act is amended by striking out “cost reimbursement” and inserting in lieu thereof “payment of providers of services”.

10. 1984

    Spending Reduction Act of 1984

    Pub. L. 98–369 § 2354(b)(39) · 98 Stat. 494

    Substituted · 42 U.S.C. § 1395oo(c)

    Pub. L. 98–369, § 2354(b)(39), substituted “inadmissible” for “inadmissable”

    Source evidence

    Code amendment note
    Subsec. (c). Pub. L. 98–369, § 2354(b)(39), substituted “inadmissible” for “inadmissable”.

    Enacted provision · exact public law section
    (39) Section 1878(c) of such Act is amended by striking out “inadmissable” and inserting in lieu thereof “inadmissible”.

11. 1984

    Spending Reduction Act of 1984

    Pub. L. 98–369 § 2354(b)(40) · 98 Stat. 494

    Substituted · 42 U.S.C. § 1395oo(e)

    Pub. L. 98–369, § 2354(b)(40), substituted “and (e)” for “, (e), and (f)”

    Source evidence

    Code amendment note
    Subsec. (e). Pub. L. 98–369, § 2354(b)(40), substituted “and (e)” for “, (e), and (f)”.

    Enacted provision · exact public law section
    (40) Section 1878(e) of such Act is amended by striking out “, (e), and (f)” and inserting in lieu thereof “and (e)”.

12. 1984

    Spending Reduction Act of 1984

    Pub. L. 98–369 § 2351(a)(1) · 98 Stat. 494

    Substituted · 42 U.S.C. § 1395oo(f)(1)

    Pub. L. 98–369, § 2351(a)(1), substituted “notification of such determination is received” for “such determination is rendered” in third sentence

    Source evidence

    Code amendment note
    Subsec. (f)(1). Pub. L. 98–369, § 2351(a)(1), substituted “notification of such determination is received” for “such determination is rendered” in third sentence.

    Enacted provision · exact public law section
    (1) The third sentence of section 1878(f)(1) of the Social Security Act is amended by striking out “such determination is rendered” and inserting in lieu thereof “notification of such determination is received”.

13. 1984

    Spending Reduction Act of 1984

    Pub. L. 98–369 § 2351(b)(1) · 98 Stat. 494

    Inserted · 42 U.S.C. § 1395oo(f)(1)

    Pub. L. 98–369, § 2351(b)(1), inserted “or which have obtained a hearing under subsection (b)” after “common ownership or control” in last sentence

    Target inherited from the preceding amendment note.

    Source evidence

    Code amendment note
    Pub. L. 98–369, § 2351(b)(1), inserted “or which have obtained a hearing under subsection (b)” after “common ownership or control” in last sentence.

    Enacted provision · exact public law section
    (1) The last sentence of section 1878(f)(1) of such Act is amended 42 USC 1395oo. by inserting “or which have obtained a hearing under subsection (b)” after “common ownership or control”.

14. 1990

    Omnibus Budget Reconciliation Act of 1990

    Pub. L. 101–508 § 4161(b)(4) · 104 Stat. 1388

    Inserted · 42 U.S.C. § 1395oo(j)

    Pub. L. 101–508, § 4161(b)(4), inserted “a rural health clinic and” after “includes”

    Source evidence

    Code amendment note
    Subsec. (j). Pub. L. 101–508, § 4161(b)(4), inserted “a rural health clinic and” after “includes”.

    Enacted provision · exact public law section
    (4) PRRB review of cost reports for rural health centers.— Section 1878(j) of the Social Security Act (42 U.S.C. 1395oo(j)), as added by subsection (a)(6), is amended by inserting “a rural health clinic and” after “includes”.

15. 1990

    Omnibus Budget Reconciliation Act of 1990

    Pub. L. 101–508 § 4161(a)(6) · 104 Stat. 1388

    Added · 42 U.S.C. § 1395oo(j)

    Pub. L. 101–508, § 4161(a)(6), added subsec. (j)

    Target inherited from the preceding amendment note.

    Source evidence

    Code amendment note
    Pub. L. 101–508, § 4161(a)(6), added subsec. (j).

    Enacted provision · exact public law section
    (6) PRRB review of cost reports for federally qualified health centers.— Section 1878 of the Social Security Act (42 U.S.C. 1395oo) is amended by adding at the end the following new subsection: “(j) In this section, the term ‘provider of services’ includes a Federally qualified health center.”.

16. 1993

    Omnibus Budget Reconciliation Act of 1993

    Pub. L. 103–66 title XIII § 13503(c)(1)(B) · 107 Stat. 312

    Substituted · 42 U.S.C. § 1395oo(f)(2)

    Pub. L. 103–66 substituted “the rate of interest on obligations issued for purchase by the Federal Hospital Insurance Trust Fund for the month in which” for “the rate of return on equity capital established by regulation pursuant to section 1395x(v)(1)(B) of this title and in effect at the time”

    Source evidence

    Code amendment note
    Subsec. (f)(2). Pub. L. 103–66 substituted “the rate of interest on obligations issued for purchase by the Federal Hospital Insurance Trust Fund for the month in which” for “the rate of return on equity capital established by regulation pursuant to section 1395x(v)(1)(B) of this title and in effect at the time”.

    Enacted provision · exact public law section
    (B) Section 1878(f)(2) (42 U.S.C. 1395oo(f)(2)) is amended by striking “the rate of return on equity capital established by regulation pursuant to section 1861(v)(1)(B) and in effect at the time” and inserting “the rate of interest on obligations issued for purchase by the Federal Hospital Insurance Trust Fund for the month in which”.

    Effective date note
    Amendment by Pub. L. 103–66 effective Oct. 1, 1993, see section 13503(c)(2) of Pub. L. 103–66, set out as a note under section 1395x of this title.

20 of 20 references resolved to an enrolled provision