Fed Regist. 1984 Jul 17;49(138):29041-50.
This proposed rule would implement that portion of the Peer Review Improvement Act of 1982 (Title I, Subtitle C of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248) addressing reconsiderations and appeals of PRO denial determinations. The proposed regulations would establish procedures for (1) a PRO to reconsider both its denial determinations regarding the medical necessity, reasonableness and appropriateness of health care service furnished or proposed to be furnished to a Medicare beneficiary in a health care institution and the application of the limitation of liability provision; (2) administrative appeals to the Department following a PRO reconsidered determination; and (3) judicial review following an administrative hearing.
本拟议规则将实施1982年《同行评审改进法案》（《1982年税收公平与财政责任法案》第I篇C分篇，公法97 - 248）中关于专业评审组织（PRO）拒绝决定的重新审议和上诉的部分内容。拟议法规将为以下事项制定程序：（1）专业评审组织重新审议其关于在医疗机构向医疗保险受益人提供或拟提供的医疗服务的医疗必要性、合理性和适当性的拒绝决定，以及责任限制条款的适用情况；（2）在专业评审组织重新审议决定之后向部门提出行政上诉；以及（3）在行政听证之后进行司法审查。
