Development of medical evidence by the Secretary

Part C of the Black Lung Benefits Act (30 U.S.C. 931 et seq.) is amended by adding at the end the following: 435. Development of medical evidence by the Secretary (a) Complete pulmonary evaluation Upon request by a claimant for benefits under this title, the Secretary shall provide the claimant an opportunity to substantiate the claim through a complete pulmonary evaluation of the miner that shall include— (1) an initial report, conducted by a qualified physician on the list provided under subsection (e), and in accordance with subsection (e)(5) and sections 402(f)(1)(D) and 413(b); and (2) if the conditions under subsection (c) are met, any supplemental medical evidence described in subsection (d). (b) Authorizing chest scans In diagnosing whether there is complicated pneumoconiosis as a part of the complete pulmonary evaluation conducted under subsection (a), the Secretary shall authorize a high-quality, low-dose or standard computerized tomography scan where any or a combination of the following is found: (1) Any certified B reader of a chest radiograph associated with an exam conducted under section 413(b) finds pneumoconiosis (ILO category 2/1 or greater). (2) Any certified B reader of a chest radiograph associated with an exam conducted under section 413(b) finds a coalescence of small opacities. (c) Conditions for supplemental medical evidence The Secretary shall develop supplemental medical evidence, in accordance with subsection (d)— (1) for any claim in which the Secretary recommends an award of benefits based on the results of the initial report under subsection (a)(1) and a party opposing such award submits evidence that could be considered contrary to the findings of the Secretary; and (2) for any compensation case under this title heard by an administrative law judge, in which— (A) the Secretary has awarded benefits to the claimant; (B) the party opposing such award has submitted evidence not previously reviewed that could be considered contrary to the award under subparagraph (A); and (C) the claimant or, if the claimant is represented by an attorney, the claimant’s attorney consents to the Secretary developing supplemental medical evidence. (d) Process for supplemental medical evidence (1) In general Except as provided under paragraph (2), to develop supplemental medical evidence under conditions described in subsection (c), the Secretary shall request the physician who conducted the initial report under subsection (a)(1) to— (A) review any medical evidence submitted after such report or the most recent supplemental report, as appropriate; and (B) update his or her opinion in a supplemental report. (2) Alternative physician If such physician is no longer available or is unwilling to provide supplemental medical evidence under paragraph (1), the Secretary shall select another qualified physician from the list provided pursuant to subsection (e) to provide such evidence. (e) Qualified physicians for complete pulmonary evaluation and protections for suitability and potential conflicts of interest (1) Qualified physicians list The Secretary shall create and maintain a list of qualified physicians to be selected by a claimant to perform the complete pulmonary evaluation described in subsection (a). (2) Public availability The Secretary shall make the list under this subsection available to the public. (3) Annual evaluation Each year, the Secretary shall update such list by reviewing the suitability of the listed qualified physicians and assessing any potential conflicts of interest. (4) Criteria for suitability The Secretary shall include on the list under this subsection only those physicians whom the Secretary determines are qualified, capable, and willing to provide credible opinions consistent with the premises underlying this Act. In determining whether a physician is suitable to be on such list, the Secretary shall consult the National Practitioner Data Bank of the Department of Health and Human Services and assess reports of adverse licensure, certifications, hospital privilege, and professional society actions involving the physician. In no case shall such list include any physician— (A) who is not licensed to practice medicine in any State or any territory, commonwealth, or possession of the United States; (B) whose license is revoked by a medical licensing board of any State, territory, commonwealth, or possession of the United States; or (C) whose license is suspended by a medical licensing board of any State, territory, commonwealth, or possession of the United States. (5) Conflicts of interest The Secretary shall develop and implement policies and procedures to ensure that any actual or potential conflict of interest of qualified physicians on the list under this subsection, including both individual and organizational conflicts of interest, are disclosed to the Department, and to provide such disclosure to claimants. Such policies and procedures shall provide that a physician shall not be used to perform a complete pulmonary medical evaluation under subsection (a) that is reimbursed pursuant to subsection (g), if— (A) such physician is employed by, under contract to, or otherwise providing services to a private party opposing the claim, a law firm or lawyer representing such opposing party, or an interested insurer or other interested third party; or (B) such physician has been retained by a private party opposing the claim, a law firm or lawyer representing such opposing party, or an interested insurer or other interested third party in the previous 24 months. (f) Record Upon receipt of any initial report or supplemental report under this section, the Secretary shall enter the report in the record and provide a copy of such report to all parties to the proceeding. (g) Expenses All expenses related to obtaining the medical evidence under this section shall be paid for by the fund. If a claimant receives a final award of benefits, the operator liable for payment of benefits, if any, shall reimburse the fund for such expenses, which shall include interest..