
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)[321(a)]]
[Document affected by Public Law 106-554 Section 1(a)(6)[321(e)]]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)[321(b)]]
[Document affected by Public Law 106-554 Section 1(a)(6)[321(c)]]
[Document affected by Public Law 106-554 Section 1(a)(6)[322(b)]]
[Document affected by Public Law 106-554 Section 1(a)(6)[507(b)]]
[CITE: 42USC1395f]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
        Part A--Hospital Insurance Benefits for Aged and Disabled
 
Sec. 1395f. Conditions of and limitations on payment for 
        services
        

(a) Requirement of requests and certifications

    Except as provided in subsections (d) and (g) of this section and in 
section 1395mm of this title, payment for services furnished an 
individual may be made only to providers of services which are eligible 
therefor under section 1395cc of this title and only if--
        (1) written request, signed by such individual, except in cases 
    in which the Secretary finds it impracticable for the individual to 
    do so, is filed for such payment in such form, in such manner, and 
    by such person or persons as the Secretary may by regulation 
    prescribe, no later than the close of the period of 3 calendar years 
    following the year in which such services are furnished (deeming any 
    services furnished in the last 3 calendar months of any calendar 
    year to have been furnished in the succeeding calendar year) except 
    that where the Secretary deems that efficient administration so 
    requires, such period may be reduced to not less than 1 calendar 
    year;
        (2) a physician, or, in the case of services described in 
    subparagraph (B), a physician, or a nurse practitioner or clinical 
    nurse specialist who does not have a direct or indirect employment 
    relationship with the facility but is working in collaboration with 
    a physician, certifies (and recertifies, where such services are 
    furnished over a period of time, in such cases, with such frequency, 
    and accompanied by such supporting material, appropriate to the case 
    involved, as may be provided by regulations, except that the first 
    of such recertifications shall be required in each case of inpatient 
    hospital services not later than the 20th day of such period) that--
            (A) in the case of inpatient psychiatric hospital services, 
        such services are or were required to be given on an inpatient 
        basis, by or under the supervision of a physician, for the 
        psychiatric treatment of an individual; and (i) such treatment 
        can or could reasonably be expected to improve the condition for 
        which such treatment is or was necessary or (ii) inpatient 
        diagnostic study is or was medically required and such services 
        are or were necessary for such purposes;
            (B) in the case of post-hospital extended care services, 
        such services are or were required to be given because the 
        individual needs or needed on a daily basis skilled nursing care 
        (provided directly by or requiring the supervision of skilled 
        nursing personnel) or other skilled rehabilitation services, 
        which as a practical matter can only be provided in a skilled 
        nursing facility on an inpatient basis, for any of the 
        conditions with respect to which he was receiving inpatient 
        hospital services (or services which would constitute inpatient 
        hospital services if the institution met the requirements of 
        paragraphs (6) and (9) of section 1395x(e) of this title) prior 
        to transfer to the skilled nursing facility or for a condition 
        requiring such extended care services which arose after such 
        transfer and while he was still in the facility for treatment of 
        the condition or conditions for which he was receiving such 
        inpatient hospital services;
            (C) in the case of home health services, such services are 
        or were required because the individual is or was confined to 
        his home (except when receiving items and services referred to 
        in section 1395x(m)(7) of this title) and needs or needed 
        skilled nursing care (other than solely venipuncture for the 
        purpose of obtaining a blood sample) on an intermittent basis or 
        physical or speech therapy or, in the case of an individual who 
        has been furnished home health services based on such a need and 
        who no longer has such a need for such care or therapy, 
        continues or continued to need occupational therapy; a plan for 
        furnishing such services to such individual has been established 
        and is periodically reviewed by a physician; and such services 
        are or were furnished while the individual was under the care of 
        a physician; or
            (D) in the case of inpatient hospital services in connection 
        with the care, treatment, filling, removal, or replacement of 
        teeth or structures directly supporting teeth, the individual, 
        because of his underlying medical condition and clinical status 
        or because of the severity of the dental procedure, requires 
        hospitalization in connection with the provision of such 
        services;

        (3) with respect to inpatient hospital services (other than 
    inpatient psychiatric hospital services) which are furnished over a 
    period of time, a physician certifies that such services are 
    required to be given on an inpatient basis for such individual's 
    medical treatment, or that inpatient diagnostic study is medically 
    required and such services are necessary for such purpose, except 
    that (A) such certification shall be furnished only in such cases, 
    with such frequency, and accompanied by such supporting material, 
    appropriate to the cases involved, as may be provided by 
    regulations, and (B) the first such certification required in 
    accordance with clause (A) shall be furnished no later than the 20th 
    day of such period;
        (4) in the case of inpatient psychiatric hospital services, the 
    services are those which the records of the hospital indicate were 
    furnished to the individual during periods when he was receiving (A) 
    intensive treatment services, (B) admission and related services 
    necessary for a diagnostic study, or (C) equivalent services;
        (5) with respect to inpatient hospital services furnished such 
    individual after the 20th day of a continuous period of such 
    services, there was not in effect, at the time of admission of such 
    individual to the hospital, a decision under section 1395cc(d) of 
    this title (based on a finding that utilization review of long-stay 
    cases is not being made in such hospital);
        (6) with respect to inpatient hospital services or post-hospital 
    extended care services furnished such individual during a continuous 
    period, a finding has not been made (by the physician members of the 
    committee or group, as described in section 1395x(k)(4) of this 
    title, including any finding made in the course of a sample or other 
    review of admissions to the institution) pursuant to the system of 
    utilization review that further inpatient hospital services or 
    further post-hospital extended care services, as the case may be, 
    are not medically necessary; except that, if such a finding has been 
    made, payment may be made for such services furnished before the 4th 
    day after the day on which the hospital or skilled nursing facility, 
    as the case may be, received notice of such finding;
        (7) in the case of hospice care provided an individual--
            (A)(i) in the first 90-day period--
                (I) the individual's attending physician (as defined in 
            section 1395x(dd)(3)(B) of this title), and
                (II) the medical director (or physician member of the 
            interdisciplinary group described in section 1395x(dd)(2)(B) 
            of this title) of the hospice program providing (or 
            arranging for) the care,

        each certify in writing at the beginning of the period, that the 
        individual is terminally ill (as defined in section 
        1395x(dd)(3)(A) of this title), and
            (ii) in a subsequent 90- or 60-day period, the medical 
        director or physician described in clause (i)(II) recertifies at 
        the beginning of the period that the individual is terminally 
        ill.
            (B) a written plan for providing hospice care with respect 
        to such individual has been established (before such care is 
        provided by, or under arrangements made by, that hospice 
        program) and is periodically reviewed by the individual's 
        attending physician and by the medical director (and the 
        interdisciplinary group described in section 1395x(dd)(2)(B) of 
        this title) of the hospice program; and
            (C) such care is being or was provided pursuant to such plan 
        of care; and

        (8) in the case of inpatient critical access hospital services, 
    a physician certifies that the individual may reasonably be expected 
    to be discharged or transferred to a hospital within 96 hours after 
    admission to the critical access hospital.

To the extent provided by regulations, the certification and 
recertification requirements of paragraph (2) shall be deemed satisfied 
where, at a later date, a physician, nurse practitioner, or clinical 
nurse specialist (as the case may be) makes certification of the kind 
provided in subparagraph (A), (B), (C), or (D) of paragraph (2) 
(whichever would have applied), but only where such certification is 
accompanied by such medical and other evidence as may be required by 
such regulations. With respect to the physician certification required 
by paragraph (2) for home health services furnished to any individual by 
a home health agency (other than an agency which is a governmental 
entity) and with respect to the establishment and review of a plan for 
such services, the Secretary shall prescribe regulations which shall 
become effective no later than July 1, 1981, and which prohibit a 
physician who has a significant ownership interest in, or a significant 
financial or contractual relationship with, such home health agency from 
performing such certification and from establishing or reviewing such 
plan, except that such prohibition shall not apply with respect to a 
home health agency which is a sole community home health agency (as 
determined by the Secretary). For purposes of the preceding sentence, 
service by a physician as an uncompensated officer or director of a home 
health agency shall not constitute having a significant ownership 
interest in, or a significant financial or contractual relationship 
with, such agency. For purposes of paragraph (2)(C), an individual shall 
be considered to be ``confined to his home'' if the individual has a 
condition, due to an illness or injury, that restricts the ability of 
the individual to leave his or her home except with the assistance of 
another individual or the aid of a supportive device (such as crutches, 
a cane, a wheelchair, or a walker), or if the individual has a condition 
such that leaving his or her home is medically contraindicated. While an 
individual does not have to be bedridden to be considered ``confined to 
his home'', the condition of the individual should be such that there 
exists a normal inability to leave home, that leaving home requires a 
considerable and taxing effort by the individual, and that absences of 
the individual from home are infrequent or of relatively short duration, 
or are attributable to the need to receive medical treatment.

(b) Amount paid to provider of services

    The amount paid to any provider of services (other than a hospice 
program providing hospice care, other than a critical access hospital 
providing inpatient critical access hospital services, and other than a 
home health agency with respect to durable medical equipment) with 
respect to services for which payment may be made under this part shall, 
subject to the provisions of sections 1395e \1\ 1395ww, and 1395fff of 
this title, be--
---------------------------------------------------------------------------
    \1\ So in original. Probably should be followed by a comma.
---------------------------------------------------------------------------
        (1) except as provided in paragraph (3), the lesser of (A) the 
    reasonable cost of such services, as determined under section 
    1395x(v) of this title and as further limited by section 
    1395rr(b)(2)(B) of this title, or (B) the customary charges with 
    respect to such services;
        (2) if such services are furnished by a public provider of 
    services, or by another provider which demonstrates to the 
    satisfaction of the Secretary that a significant portion of its 
    patients are low-income (and requests that payment be made under 
    this paragraph), free of charge or at nominal charges to the public, 
    the amount determined on the basis of those items (specified in 
    regulations prescribed by the Secretary) included in the 
    determination of such reasonable cost which the Secretary finds will 
    provide fair compensation to such provider for such services; or
        (3) if some or all of the hospitals in a State have been 
    reimbursed for services (for which payment may be made under this 
    part) pursuant to a reimbursement system approved as a demonstration 
    project under section 402 of the Social Security Amendments of 1967 
    or section 222 of the Social Security Amendments of 1972, if the 
    rate of increase in such hospitals in their costs per hospital 
    inpatient admission of individuals entitled to benefits under this 
    part over the duration of such project was equal to or less than 
    such rate of increase for admissions of such individuals with 
    respect to all hospitals in the United States during such period, 
    and if either the State has legislative authority to operate such 
    system and the State elects to have reimbursement to such hospitals 
    made in accordance with this paragraph or the system is operated 
    through a voluntary agreement of hospitals and such hospitals elect 
    to have reimbursement to those hospitals made in accordance with 
    this paragraph, then the Secretary may provide for continuation of 
    reimbursement to such hospitals under such system until the 
    Secretary determines that--
            (A) a third-party payor reimburses such a hospital on a 
        basis other than under such system, or
            (B) the aggregate rate of increase from January 1, 1981, to 
        the most recent date for which annual data are available in such 
        hospitals in costs per hospital inpatient admission of 
        individuals entitled to benefits under this part is greater than 
        such rate of increase for admissions of such individuals with 
        respect to all hospitals in the United States for such period.

In the case of any State which has had such a demonstration project 
reimbursement system in continuous operation since July 1, 1977, the 
Secretary shall provide under paragraph (3) for continuation of 
reimbursement to hospitals in the State under such system until the 
first day of the 37th month beginning after the date the Secretary 
determines and notifies the Governor of the State that either of the 
conditions described in subparagraph (A) or (B) of such paragraph has 
occurred. If, by the end of such 36-month period, the Secretary 
determines, based on evidence submitted by the Governor of the State, 
that neither of the conditions described in subparagraph (A) or (B) of 
paragraph (3) continues to apply, the Secretary shall continue without 
interruption payment to hospitals in the State under the State's system. 
If, by the end of such 36-month period, the Secretary determines, based 
on such evidence, that either of the conditions described in 
subparagraph (A) or (B) of such paragraph continues to apply, the 
Secretary shall (i) collect any net excess reimbursement to hospitals in 
the State during such 36-month period (basing such net excess 
reimbursement on the net difference, if any, in the rate of increase in 
costs per hospital inpatient admission under the State system compared 
to the rate of increase in such costs with respect to all hospitals in 
the United States over the 36-month period, as measured by including the 
cumulative savings under the State system based on the difference in the 
rate of increase in costs per hospital inpatient admission under the 
State system as compared to the rate of increase in such costs with 
respect to all hospitals in the United States between January 1, 1981, 
and the date of the Secretary's initial notice), and (ii) provide a 
reasonable period, not to exceed 2 years, for transition from the State 
system to the national payment system.

(c) No payments to Federal providers of services

    Subject to section 1395qq of this title, no payment may be made 
under this part (except under subsection (d) or subsection (h) of this 
section) to any Federal provider of services, except a provider of 
services which the Secretary determines is providing services to the 
public generally as a community institution or agency; and no such 
payment may be made to any provider of services for any item or service 
which such provider is obligated by a law of, or a contract with, the 
United States to render at public expense.

(d) Payments for emergency hospital services

    (1) Payments shall also be made to any hospital for inpatient 
hospital services furnished in a calendar year, by the hospital or under 
arrangements (as defined in section 1395x(w) of this title) with it, to 
an individual entitled to hospital insurance benefits under section 426 
of this title even though such hospital does not have an agreement in 
effect under this subchapter if (A) such services were emergency 
services, (B) the Secretary would be required to make such payment if 
the hospital had such an agreement in effect and otherwise met the 
conditions of payment hereunder, and (C) such hospital has elected to 
claim payments for all such inpatient emergency services and for the 
emergency outpatient services referred to in section 1395n(b) of this 
title furnished during such year. Such payments shall be made only in 
the amounts provided under subsection (b) of this section and then only 
if such hospital agrees to comply, with respect to the emergency 
services provided, with the provisions of section 1395cc(a) of this 
title.
    (2) Payment may be made on the basis of an itemized bill to an 
individual entitled to hospital insurance benefits under section 426 of 
this title for services described in paragraph (1) which are emergency 
services if (A) payment cannot be made under paragraph (1) solely 
because the hospital does not elect to claim such payment, and (B) such 
individual files application (submitted within such time and in such 
form and manner and by such person, and containing and supported by such 
information as the Secretary shall by regulations prescribe) for 
reimbursement.
    (3) The amounts payable under the preceding paragraph with respect 
to services described therein shall, subject to the provisions of 
section 1395e of this title, be equal to 60 percent of the hospital's 
reasonable charges for routine services furnished in the accommodations 
occupied by the individual or in semiprivate accommodations (as defined 
in section 1395x(v)(4) of this title), whichever is less, plus 80 
percent of the hospital's reasonable charges for ancillary services. If 
separate charges for routine and ancillary services are not made by the 
hospital, reimbursement may be based on two-thirds of the hospital's 
reasonable charges for the services received but not to exceed the 
charges which would have been made if the patient had occupied 
semiprivate accommodations. For purposes of the preceding provisions of 
this paragraph, the term ``routine services'' shall mean the regular 
room, dietary, and nursing services, minor medical and surgical supplies 
and the use of equipment and facilities for which a separate charge is 
not customarily made; the term ``ancillary services'' shall mean those 
special services for which charges are customarily made in addition to 
routine services.

(e) Payment for inpatient hospital services prior to notification of 
        noneligibility

    Notwithstanding that an individual is not entitled to have payment 
made under this part for inpatient hospital services furnished by any 
hospital, payment shall be made to such hospital (unless it elects not 
to receive such payment or, if payment has already been made by or on 
behalf of such individual, fails to refund such payment within the time 
specified by the Secretary) for such services which are furnished to the 
individual prior to notification to such hospital from the Secretary of 
his lack of entitlement, if such payments are precluded only by reason 
of section 1395d of this title and if such hospital complies with the 
requirements of and regulations under this subchapter with respect to 
such payments, has acted in good faith and without knowledge of such 
lack of entitlement, and has acted reasonably in assuming entitlement 
existed. Payment under the preceding sentence may not be made for 
services furnished an individual pursuant to any admission after the 6th 
elapsed day (not including as an elapsed day Saturday, Sunday, or a 
legal holiday) after the day on which such admission occurred.

(f) Payment for certain inpatient hospital services furnished outside 
        United States

    (1) Payment shall be made for inpatient hospital services furnished 
to an individual entitled to hospital insurance benefits under section 
426 of this title by a hospital located outside the United States, or 
under arrangements (as defined in section 1395x(w) of this title) with 
it, if--
        (A) such individual is a resident of the United States, and
        (B) such hospital was closer to, or substantially more 
    accessible from, the residence of such individual than the nearest 
    hospital within the United States which was adequately equipped to 
    deal with, and was available for the treatment of, such individual's 
    illness or injury.

    (2) Payment may also be made for emergency inpatient hospital 
services furnished to an individual entitled to hospital insurance 
benefits under section 426 of this title by a hospital located outside 
the United States if--
        (A) such individual was physically present--
            (i) in a place within the United States; or
            (ii) at a place within Canada while traveling without 
        unreasonable delay by the most direct route (as determined by 
        the Secretary) between Alaska and another State;

    at the time the emergency which necessitated such inpatient hospital 
    services occurred, and
        (B) such hospital was closer to, or substantially more 
    accessible from, such place than the nearest hospital within the 
    United States which was adequately equipped to deal with, and was 
    available for the treatment of, such individual's illness or injury.

    (3) Payment shall be made in the amount provided under subsection 
(b) of this section to any hospital for the inpatient hospital services 
described in paragraph (1) or (2) furnished to an individual by the 
hospital or under arrangements (as defined in section 1395x(w) of this 
title) with it if (A) the Secretary would be required to make such 
payment if the hospital had an agreement in effect under this subchapter 
and otherwise met the conditions of payment hereunder, (B) such hospital 
elects to claim such payment, and (C) such hospital agrees to comply, 
with respect to such services, with the provisions of section 1395cc(a) 
of this title.
    (4) Payment for the inpatient hospital services described in 
paragraph (1) or (2) furnished to an individual entitled to hospital 
insurance benefits under section 426 of this title may be made on the 
basis of an itemized bill to such individual if (A) payment for such 
services cannot be made under paragraph (3) solely because the hospital 
does not elect to claim such payment, and (B) such individual files 
application (submitted within such time and in such form and manner and 
by such person, and continuing and supported by such information as the 
Secretary shall by regulations prescribe) for reimbursement. The amount 
payable with respect to such services shall, subject to the provisions 
of section 1395e of this title, be equal to the amount which would be 
payable under subsection (d)(3) of this section.

(g) Payments to physicians for services rendered in teaching hospitals

    For purposes of services for which the reasonable cost thereof is 
determined under section 1395x(v)(1)(D) of this title (or would be if 
section 1395ww of this title did not apply), payment under this part 
shall be made to such fund as may be designated by the organized medical 
staff of the hospital in which such services were furnished or, if such 
services were furnished in such hospital by the faculty of a medical 
school, to such fund as may be designated by such faculty, but only if--
        (1) such hospital has an agreement with the Secretary under 
    section 1395cc of this title, and
        (2) the Secretary has received written assurances that (A) such 
    payment will be used by such fund solely for the improvement of care 
    of hospital patients or for educational or charitable purposes and 
    (B) the individuals who were furnished such services or any other 
    persons will not be charged for such services (or if charged, 
    provision will be made for return of any moneys incorrectly 
    collected).

(h) Payment for specified hospital services provided in Department of 
        Veterans Affairs hospitals; amount of payment

    (1) Payments shall also be made to any hospital operated by the 
Department of Veterans Affairs for inpatient hospital services furnished 
in a calendar year by the hospital, or under arrangements (as defined in 
section 1395x(w) of this title) with it, to an individual entitled to 
hospital benefits under section 426 of this title even though the 
hospital is a Federal provider of services if (A) the individual was not 
entitled to have the services furnished to him free of charge by the 
hospital, (B) the individual was admitted to the hospital in the 
reasonable belief on the part of the admitting authorities that the 
individual was a person who was entitled to have the services furnished 
to him free of charge, (C) the authorities of the hospital, in admitting 
the individual, and the individual, acted in good faith, and (D) the 
services were furnished during a period ending with the close of the day 
on which the authorities operating the hospital first became aware of 
the fact that the individual was not entitled to have the services 
furnished to him by the hospital free of charge, or (if later) ending 
with the first day on which it was medically feasible to remove the 
individual from the hospital by discharging him therefrom or 
transferring him to a hospital which has in effect an agreement under 
this subchapter.
    (2) Payment for services described in paragraph (1) shall be in an 
amount equal to the charge imposed by the Secretary of Veterans Affairs 
for such services, or (if less) the amount that would be payable for 
such services under subsection (b) of this section and section 1395ww of 
this title (as estimated by the Secretary). Any such payment shall be 
made to the entity to which payment for the services involved would have 
been payable, if payment for such services had been made by the 
individual receiving the services involved (or by another private person 
acting on behalf of such individual).

(i) Payment for hospice care

    (1)(A) Subject to the limitation under paragraph (2) and the 
provisions of section 1395e(a)(4) of this title and except as otherwise 
provided in this paragraph, the amount paid to a hospice program with 
respect to hospice care for which payment may be made under this part 
shall be an amount equal to the costs which are reasonable and related 
to the cost of providing hospice care or which are based on such other 
tests of reasonableness as the Secretary may prescribe in regulations 
(including those authorized under section 1395x(v)(1)(A) of this title), 
except that no payment may be made for bereavement counseling and no 
reimbursement may be made for other counseling services (including 
nutritional and dietary counseling) as separate services.
    (B) Notwithstanding subparagraph (A), for hospice care furnished on 
or after April 1, 1986, the daily rate of payment per day for routine 
home care shall be $63.17 and the daily rate of payment for other 
services included in hospice care shall be the daily rate of payment 
recognized under subparagraph (A) as of July 1, 1985, increased by $10.
    (C)(i) With respect to routine home care and other services included 
in hospice care furnished on or after January 1, 1990, and on or before 
September 30, 1990, the payment rates for such care and services shall 
be 120 percent of such rates in effect as of September 30, 1989.
    (ii) With respect to routine home care and other services included 
in hospice care furnished during a subsequent fiscal year, the payment 
rates for such care and services shall be the payment rates in effect 
under this subparagraph during the previous fiscal year increased by--
        (I) for a fiscal year ending on or before September 30, 1993, 
    the market basket percentage increase (as defined in section 
    1395ww(b)(3)(B)(iii) of this title) for the fiscal year;
        (II) for fiscal year 1994, the market basket percentage increase 
    for the fiscal year minus 2.0 percentage points;
        (III) for fiscal year 1995, the market basket percentage 
    increase for the fiscal year minus 1.5 percentage points;
        (IV) for fiscal year 1996, the market basket percentage increase 
    for the fiscal year minus 1.5 percentage points;
        (V) for fiscal year 1997, the market basket percentage increase 
    for the fiscal year minus 0.5 percentage point;
        (VI) for each of fiscal years 1998 through 2002, the market 
    basket percentage increase for the fiscal year involved minus 1.0 
    percentage points; and
        (VII) for a subsequent fiscal year, the market basket percentage 
    increase for the fiscal year.

    (2)(A) The amount of payment made under this part for hospice care 
provided by (or under arrangements made by) a hospice program for an 
accounting year may not exceed the ``cap amount'' for the year (computed 
under subparagraph (B)) multiplied by the number of medicare 
beneficiaries in the hospice program in that year (determined under 
subparagraph (C)).
    (B) For purposes of subparagraph (A), the ``cap amount'' for a year 
is $6,500, increased or decreased, for accounting years that end after 
October 1, 1984, by the same percentage as the percentage increase or 
decrease, respectively, in the medical care expenditure category of the 
Consumer Price Index for All Urban Consumers (United States city 
average), published by the Bureau of Labor Statistics, from March 1984 
to the fifth month of the accounting year.
    (C) For purposes of subparagraph (A), the ``number of medicare 
beneficiaries'' in a hospice program in an accounting year is equal to 
the number of individuals who have made an election under subsection (d) 
of this section with respect to the hospice program and have been 
provided hospice care by (or under arrangements made by) the hospice 
program under this part in the accounting year, such number reduced to 
reflect the proportion of hospice care that each such individual was 
provided in a previous or subsequent accounting year or under a plan of 
care established by another hospice program.
    (D) A hospice program shall submit claims for payment for hospice 
care furnished in an individual's home under this subchapter only on the 
basis of the geographic location at which the service is furnished, as 
determined by the Secretary.
    (3) Hospice programs providing hospice care for which payment is 
made under this subsection shall submit to the Secretary such data with 
respect to the costs for providing such care for each fiscal year, 
beginning with fiscal year 1999, as the Secretary determines necessary.

(j) Elimination of lesser-of-cost-or-charges provision

    (1) The lesser-of-cost-or-charges provisions (described in paragraph 
(2)) will not apply in the case of services provided by a class of 
provider of services if the Secretary determines and certifies to 
Congress that the failure of such provisions to apply to the services 
provided by that class of providers will not result in any increase in 
the amount of payments made for those services under this subchapter. 
Such change will take effect with respect to services furnished, or cost 
reporting periods of providers, on or after such date as the Secretary 
shall provide in the certification. Such change for a class of provider 
shall be discontinued if the Secretary determines and notifies Congress 
that such change has resulted in an increase in the amount of payments 
made under this subchapter for services provided by that class of 
provider.
    (2) The lesser-of-cost-or-charges provisions referred to in 
paragraph (1) are as follows:
        (A) Clause (B) of paragraph (1) and paragraph (2) of subsection 
    (b) of this section.
        (B) Section 1395m(a)(1)(B) of this title.
        (C) So much of subparagraph (A) of section 1395l(a)(2) of this 
    title as provides for payment other than of the reasonable cost of 
    such services, as determined under section 1395x(v) of this title.
        (D) Subclause (II) of clause (i) and clause (ii) of section 
    1395l(a)(2)(B) of this title.

(k) Payments to home health agencies for durable medical equipment

    The amount paid to any home health agency with respect to durable 
medical equipment for which payment may be made under this part shall be 
the amount described in section 1395m(a)(1) of this title.

(l) Payment for inpatient critical access hospital services

    The amount of payment under this part for inpatient critical access 
hospital services is the reasonable costs of the critical access 
hospital in providing such services.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1814, as added Pub. L. 89-87, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 294; amended Pub. L. 90-
248, title I, Secs. 126(a), 129(c)(5), (6)(A), 143(c), Jan. 2, 1968, 81 
Stat. 846, 848, 857; Pub. L. 92-603, title II, Secs. 211(a), 226(c)(1), 
227(b), 228(a), 233(a), 234(g)(1), 238(a), 247(a), 256(a), 278(a)(1)-
(3), (b)(4), (17), 281(e), Oct. 30, 1972, 86 Stat. 1382, 1404, 1405, 
1407, 1411, 1413, 1416, 1425, 1447, 1453, 1454, 1456; Pub. L. 93-233, 
Sec. 18(k)(1), (2), Dec. 31, 1973, 87 Stat. 970; Pub. L. 94-437, title 
IV, Sec. 401(a), Sept. 30, 1976, 90 Stat. 1408; Pub. L. 95-142, 
Sec. 23(a), (b), Oct. 25, 1977, 91 Stat. 1208; Pub. L. 95-292, 
Sec. 4(f), June 13, 1978, 92 Stat. 315; Pub. L. 96-499, title IX, 
Secs. 903(a), 930(e), (f), 931(b), 936(b), 941(a), (b), Dec. 5, 1980, 94 
Stat. 2614, 2631, 2633, 2640, 2641; Pub. L. 97-35, title XXI, 
Secs. 2121(b), 2122(a)(1), Aug. 13, 1981, 95 Stat. 796; Pub. L. 97-248, 
title I, Secs. 101(c)(1), 122(c)(1), (2), Sept. 3, 1982, 96 Stat. 335, 
357, 358; Pub. L. 97-448, title III, Sec. 309(b)(7), Jan. 12, 1983, 96 
Stat. 2409; Pub. L. 98-21, title VI, Secs. 601(d), 602(b), (c), Apr. 20, 
1983, 97 Stat. 152, 163; Pub. L. 98-90, Aug. 29, 1983, 97 Stat. 606; 
Pub. L. 98-369, div. B, title III, Secs. 2308(b)(2)(A), 2321(a), (f), 
2335(a), 2336(a), (b), 2354(b)(1), (c)(1)(A), July 18, 1984, 98 Stat. 
1074, 1084, 1085, 1090, 1091, 1100, 1102; Pub. L. 98-617, Secs. 1(a), 
3(a)(3), (b)(1), Nov. 8, 1984, 98 Stat. 3294, 3295; Pub. L. 99-272, 
title IX, Sec. 9123(b), Apr. 7, 1986, 100 Stat. 168; Pub. L. 100-203, 
title IV, Secs. 4008(b)(1), 4024(a), 4062(d)(1), Dec. 22, 1987, 101 
Stat. 1330-55, 1330-73, 1330-108; Pub. L. 100-360, title I, 
Sec. 104(d)(2), 102 Stat. 688; Pub. L. 101-234, title I, Sec. 101(a), 
Dec. 13, 1989, 103 Stat. 1979; Pub. L. 101-239, title VI, 
Secs. 6003(g)(3)(B)(ii), (iii), 6005(a), (b), 6028, Dec. 19, 1989, 103 
Stat. 2152, 2160, 2161, 2168; Pub. L. 101-508, title IV, Secs. 4006(b), 
4008(i)(3), (m)(3)(A), Nov. 5, 1990, 104 Stat. 1388-43, 1388-51, 1388-
53; Pub. L. 102-54, Sec. 13(q)(3)(A)(iii), (iv), (B)(iv), June 13, 1991, 
105 Stat. 279; Pub. L. 103-66, title XIII, Sec. 13504, Aug. 10, 1993, 
107 Stat. 579; Pub. L. 103-432, title I, Secs. 102(a)(3), (d), 
106(b)(1)(A), 110(d)(1), Oct. 31, 1994, 108 Stat. 4402, 4403, 4405, 
4408; Pub. L. 105-33, title IV, Secs. 4201(c)(1), (3), 4441, 4442(a), 
4443(b)(2), 4448, 4603(c)(1), 4615(a), Aug. 5, 1997, 111 Stat. 373, 422-
424, 470, 475.)

                       References in Text

    Section 402 of the Social Security Amendments of 1967, referred to 
in subsec. (b)(3), means section 402 of Pub. L. 90-248, which amended 
sections 1395b-1 and 1395ll of this title.
    Section 222 of the Social Security Amendments of 1972, referred to 
in subsec. (b)(3), means section 222 of Pub. L. 92-603, which amended 
sections 1395b-1 and 1395ll of this title and enacted a provision set 
out as a note under section 1395b-1 of this title.


                               Amendments

    1997--Subsec. (a)(2)(C). Pub. L. 105-33, Sec. 4615(a), inserted 
``(other than solely venipuncture for the purpose of obtaining a blood 
sample)'' after ``skilled nursing care''.
    Subsec. (a)(7)(A)(i). Pub. L. 105-33, Secs. 4443(b)(2)(A), 4448, in 
concluding provisions, substituted ``at the beginning of the period'' 
for `` not later than 2 days after hospice care is initiated (or, if 
each certify verbally not later than 2 days after hospice care is 
initiated, not later than 8 days after such care is initiated)'' and 
inserted ``and'' at end.
    Subsec. (a)(7)(A)(ii). Pub. L. 105-33, Sec. 4443(b)(2)(B), 
substituted ``60-day'' for ``30-day'' and substituted a period for ``, 
and'' at end.
    Subsec. (a)(7)(A)(iii). Pub. L. 105-33, Sec. 4443(b)(2)(C), struck 
out cl. (iii) which read as follows: ``in a subsequent extension period, 
the medical director or physician described in clause (i)(II) 
recertifies at the beginning of the period that the individual is 
terminally ill;''.
    Subsec. (a)(8). Pub. L. 105-33, Sec. 4201(c)(1), (3)(A), substituted 
``critical access'' for ``rural primary care'' in two places and ``96 
hours'' for ``72 hours''.
    Subsec. (b). Pub. L. 105-33, Sec. 4603(c)(1), substituted ``1395ww, 
and 1395fff of this title'' for ``and 1395ww of this title'' in 
introductory provisions.
    Pub. L. 105-33, Sec. 4201(c)(1), substituted ``critical access'' for 
``rural primary care'' in two places in introductory provisions.
    Subsec. (i)(1)(C)(ii)(V) to (VII). Pub. L. 105-33, Sec. 4441(a), 
struck out ``and'' at end of subcl. (V), added subcl. (VI), and 
redesignated former subcl. (VI) as (VII).
    Subsec. (i)(2)(D). Pub. L. 105-33, Sec. 4442(a), added subpar. (D).
    Subsec. (i)(3). Pub. L. 105-33, Sec. 4441(b), added par. (3).
    Subsec. (l). Pub. L. 105-33, Sec. 4201(c)(3)(B), amended heading and 
text of subsec. (l) generally. Prior to amendment, text read as follows:
    ``(1) The amount of payment under this part for inpatient rural 
primary care hospital services--
        ``(A) in the case of the first 12-month cost reporting period 
    for which the facility operates as such a hospital, is the 
    reasonable costs of the facility in providing inpatient rural 
    primary care hospital services during such period, as such costs are 
    determined on a per diem basis, and
        ``(B) in the case of a later reporting period, is the per diem 
    payment amount established under this paragraph for the preceding 
    12-month cost reporting period, increased by the applicable 
    percentage increase under section 1395ww(b)(3)(B)(i) of this title 
    for that particular cost reporting period applicable to hospitals 
    located in a rural area.
The payment amounts otherwise determined under this paragraph shall be 
reduced, to the extent necessary, to avoid duplication of any payment 
made under section 1395i-4(a)(2) of this title (or under section 4005(e) 
of the Omnibus Budget Reconciliation Act of 1987) to cover the provision 
of inpatient rural primary care hospital services.
    ``(2) The Secretary shall develop a prospective payment system for 
determining payment amounts for inpatient rural primary care hospital 
services under this part furnished on or after January 1, 1996.''
    1994--Subsec. (a)(5). Pub. L. 103-432, Sec. 106(b)(1)(A), struck out 
``and with respect to post-hospital extended care services furnished 
after such day of a continuous period of such services as may be 
prescribed in or pursuant to regulations'' after ``continuous period of 
such services'', ``or skilled nursing facility, as the case may be'' 
after ``such individual to the hospital'', and ``or facility'' after 
``made in such hospital''.
    Subsec. (a)(8). Pub. L. 103-432, Sec. 102(a)(3), substituted ``the 
individual may reasonably be expected to be discharged or transferred to 
a hospital within 72 hours after admission to the rural primary care 
hospital.'' for ``such services were required to be immediately 
furnished on a temporary, inpatient basis.''
    Subsec. (i)(1)(C)(i). Pub. L. 103-432, Sec. 110(d)(1), substituted 
``September 30, 1990,'' for ``September 30, 1990,,''.
    Subsec. (l)(2). Pub. L. 103-432, Sec. 102(d), substituted ``January 
1, 1996'' for ``January 1, 1993''.
    1993--Subsec. (i)(1)(C)(ii). Pub. L. 103-66 substituted ``increased 
by--'' and subcls. (I) to (VI) for ``increased by the market basket 
percentage increase (as defined in section 1395ww(b)(3)(B)(iii) of this 
title) otherwise applicable to discharges occurring in the fiscal 
year.''
    1991--Subsec. (h). Pub. L. 102-54 substituted ``Department of 
Veterans Affairs'' for ``Veterans' Administration'' in heading and par. 
(1) and ``Secretary of Veterans Affairs'' for ``Veterans' 
Administration'' in par. (2).
    1990--Subsec. (a)(7)(A)(iii). Pub. L. 101-508, Sec. 4006(b), added 
cl. (iii).
    Subsec. (b)(3). Pub. L. 101-508, Sec. 4008(i)(3), substituted 
``January 1, 1981'' for ``October 1, 1983'' in subpar. (B) substituted 
``37th month'' for ``seventh month'' in sentence following subpar. (B), 
and inserted at end provisions setting forth procedures to be followed 
by Secretary at end of 36-month period.
    Subsec. (i)(1)(C)(i). Pub. L. 101-508, Sec. 4008(m)(3)(A), 
substituted ``on or after January 1, 1990, and on or before September 
30, 1990,'' for ``during fiscal year 1990''.
    1989--Subsec. (a). Pub. L. 101-239, Sec. 6028(2), substituted ``a 
physician, nurse practitioner, or clinical nurse specialist (as the case 
may be) makes'' for ``a physician makes'' in first sentence of 
concluding provisions.
    Subsec. (a)(2). Pub. L. 101-239, Sec. 6028(1), substituted ``a 
physician, or, in the case of services described in subparagraph (B), a 
physician, or a nurse practitioner or clinical nurse specialist who does 
not have a direct or indirect employment relationship with the facility 
but is working in collaboration with a physician,'' for ``a physician'' 
after ``(2)''.
    Subsec. (a)(2)(B), (6). Pub. L. 101-234 repealed Pub. L. 100-360, 
Sec. 104(d)(2)(A), (B), and provided that the provisions of law amended 
or repealed by such section are restored or revived as if such section 
had not been enacted, see 1988 Amendment notes below.
    Subsec. (a)(7)(A)(i). Pub. L. 101-239, Sec. 6005(b), substituted 
``certify in writing, not later than 2 days after hospice care is 
initiated (or, if each certify verbally not later than 2 days after 
hospice care is initiated, not later than 8 days after such care is 
initiated),'' for ``certify, not later than two days after hospice care 
is initiated,'' in concluding provisions.
    Subsec. (a)(7)(A)(iii). Pub. L. 101-234 repealed Pub. L. 100-360, 
Sec. 104(d)(2)(C), and provided that the provisions of law amended or 
repealed by such section are restored or revived as if such section had 
not been enacted, see 1988 Amendment note below.
    Subsec. (a)(8). Pub. L. 101-239, Sec. 6003(g)(3)(B)(ii), added par. 
(8).
    Subsec. (b). Pub. L. 101-239, Sec. 6003(g)(3)(B)(iii)(I), inserted 
``, other than a rural primary care hospital providing inpatient rural 
primary care hospital services,'' after ``providing hospice care'' in 
introductory provisions.
    Subsec. (d)(3). Pub. L. 101-234 repealed Pub. L. 100-360, 
Sec. 104(d)(2)(D), and provided that the provisions of law amended or 
repealed by such section are restored or revived as if such section had 
not been enacted, see 1988 Amendment note below.
    Subsec. (i)(1)(A). Pub. L. 101-239, Sec. 6005(a)(1), inserted ``and 
except as otherwise provided in this paragraph'' after ``section 
1395e(a)(4) of this title''.
    Subsec. (i)(1)(C). Pub. L. 101-239, Sec. 6005(a)(2), added subpar. 
(C) and struck out former subpar. (C) which read as follows: ``With 
respect to care and services furnished on or after October 1, 1986, the 
Secretary shall, not less often than annually, review and make 
appropriate adjustments to the payment rate for routine home care and 
the payment rates for other services included in hospice care based on 
the costs that are reasonable and related to the costs of furnishing 
such care and services. The Secretary shall report to Congress on 
October 1 each year on such review and such adjustments and on the 
adequacy of the rates under this paragraph to ensure participation by an 
adequate number of hospice programs under this subchapter.''
    Subsec. (l). Pub. L. 101-239, Sec. 6003(g)(3)(B)(iii)(II), added 
subsec. (l).
    1988--Subsec. (a)(2)(B). Pub. L. 100-360, Sec. 104(d)(2)(A), (B), 
struck out ``post-hospital'' after ``in the case of'' and ``, for any of 
the conditions with respect to which he was receiving inpatient hospital 
services (or services which would constitute inpatient hospital services 
if the institution met the requirements of paragraphs (6) and (9) of 
section 1395x(e) of this title) prior to transfer to the skilled nursing 
facility or for a condition requiring such extended care services which 
arose after such transfer and while he was still in the facility for 
treatment of the condition or conditions for which he was receiving such 
inpatient hospital services'' before semicolon at end.
    Subsec. (a)(6). Pub. L. 100-360, Sec. 104(d)(2)(A), struck out 
``post-hospital'' before ``extended care services'' in two places.
    Subsec. (a)(7)(A)(iii). Pub. L. 100-360, Sec. 104(d)(2)(C), added 
cl. (iii) which read as follows: ``in a subsequent extension period, the 
medical director or physician described in clause (i)(II) recertifies at 
the beginning of the period that the individual is terminally ill;''.
    Subsec. (d)(3). Pub. L. 100-360, Sec. 104(d)(2)(D), substituted 
``equal to 100 percent'' for ``equal to 60 percent'' and ``plus 100 
percent'' for ``plus 80 percent'' and struck out ``two-thirds of'' after 
``based on''.
    1987--Subsec. (a). Pub. L. 100-203, Sec. 4024(a), inserted two 
sentences at end clarifying ``confined to his home'' for purposes of 
par. (2)(C).
    Subsec. (b)(3)(B). Pub. L. 100-203, Sec. 4008(b)(1), substituted 
``aggregate rate of increase from October 1, 1983, to the most recent 
date for which annual data are available'' for ``rate of increase for 
the previous three-year period''.
    Subsec. (j)(2)(B). Pub. L. 100-203, Sec. 4062(d)(1)(A), substituted 
``Section 1395m(a)(1)(B) of this title'' for ``Subsection (k)(1)(B) of 
this section''.
    Subsec. (k). Pub. L. 100-203, Sec. 4062(d)(1)(B), substituted ``the 
amount described in section 1395m(a)(1) of this title.'' for a dash and 
former pars. (1) and (2) which read as follows:
    ``(1) the lesser of--
        ``(A) the reasonable cost of such equipment, as determined under 
    section 1395x(v) of this title, or
        ``(B) the customary charges with respect to such equipment,
less the amount the home health agency may charge as described in 
section 1395cc(a)(2)(A)(ii) of this title, but in no case may the 
payment for such equipment exceed 80 percent of such reasonable cost, or
    ``(2) if such equipment is furnished by a public home health agency, 
or by another home health agency which demonstrates to the satisfaction 
of the Secretary that a significant portion of its patients are low-
income (and requests that payment be made under this paragraph), free of 
charge or at nominal charge to the public, 80 percent of the amount 
which the Secretary finds will provide fair compensation to the home 
health agency.''
    1986--Subsec. (i)(1)(B). Pub. L. 99-272, Sec. 9123(b)(1), amended 
subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: 
``Notwithstanding subparagraph (A), the rate of payment per day for 
routine home care furnished during fiscal year 1985 shall be $53.17.''
    Subsec. (i)(1)(C). Pub. L. 99-272, Sec. 9123(b)(2), substituted 
``1986'' for ``1985''.
    1984--Subsec. (a). Pub. L. 98-369, Sec. 2354(b)(1), as amended by 
Pub. L. 98-617, Sec. 3(a)(3), in concluding provisions, substituted 
``contractual'' for ``contractural''.
    Pub. L. 98-369, Sec. 2336(b), inserted before period at end of third 
sentence ``, except that such prohibition shall not apply with respect 
to a home health agency which is a sole community home health agency (as 
determined by the Secretary)''.
    Pub. L. 98-369, Sec. 2336(a), inserted sentence at end that for 
purposes of the preceding sentence, service by a physician as an 
uncompensated officer or director of a home health agency shall not 
constitute having a significant ownership interest in, or a significant 
financial or contractual relationship with, such agency.
    Pub. L. 98-369, Sec. 2335(a)(4), in concluding provisions, 
substituted ``or (D)'' for ``(D), or (E)''.
    Subsec. (a)(2)(B) to (E). Pub. L. 98-369, Sec. 2335(a)(1), 
redesignated subpars. (C) to (E) as (B) to (D), respectively, and struck 
out former subpar. (B) which provided that payment could be made only if 
a physician certified, in the case of inpatient tuberculosis hospital 
services, that such services were required to be given on an inpatient 
basis, by or under the supervision of a physician, for the treatment of 
an individual for tuberculosis; and that such treatment could reasonably 
be expected to improve the condition for which such treatment was 
necessary or render the condition noncommunicable.
    Subsec. (a)(3). Pub. L. 98-369, Sec. 2335(a)(2), struck out ``and 
inpatient tuberculosis hospital services'' after ``psychiatric hospital 
services''.
    Subsec. (a)(5) to (8). Pub. L. 98-369, Sec. 2335(a)(3), redesignated 
pars. (6) to (8) as (5) to (7), respectively, and struck out former par. 
(5) which had provided that payment would be made only if, in the case 
of inpatient tuberculosis hospital services, the services were those 
which the records of the hospital indicate were furnished to the 
individual during periods when he was receiving treatment which could 
reasonably be expected to improve his condition or render it 
noncommunicable.
    Subsec. (b). Pub. L. 98-369, Sec. 2321(a)(1), inserted in provisions 
preceding par. (1) ``and other than a home health agency with respect to 
durable medical equipment'' after ``hospice care''.
    Subsec. (b)(2). Pub. L. 98-369, Sec. 2308(b)(2)(A), inserted ``, or 
by another provider which demonstrates to the satisfaction of the 
Secretary that a significant portion of its patients are low-income (and 
requests that payment be made under this paragraph),''.
    Subsec. (b)(3). Pub. L. 98-369, Sec. 2354(c)(1)(A), amended 
directory language of Pub. L. 96-449, Sec. 903(a)(4), resulting in no 
change in text. See 1980 Amendment note below.
    Subsec. (i)(1). Pub. L. 98-617, Sec. 1(a), designated existing 
provisions as subpar. (A) and added subpars. (B) and (C).
    Subsec. (j)(2)(B) to (D). Pub. L. 98-369, Sec. 2321(f), added 
subpar. (B) and redesignated former subpars. (B) and (C) as (C) and (D), 
respectively.
    Subsec. (k). Pub. L. 98-369, Sec. 2321(a)(2), added subsec. (k).
    Subsec. (k)(2). Pub. L. 98-617, Sec. 3(b)(1), inserted ``, or by 
another home health agency which demonstrates to the satisfaction of the 
Secretary that a significant portion of its patients are low-income (and 
requests that payment be made under this paragraph),'' after ``public 
home health agency'' and ``80 percent of'' before ``the amount''.
    1983--Subsec. (g). Pub. L. 98-21, Sec. 602(b), inserted ``(or would 
be if section 1395ww of this title did not apply)'' after ``section 
1395x(v)(1)(D) of this title''.
    Subsec. (h)(2). Pub. L. 98-21, Sec. 602(c), substituted ``the amount 
that would be payable for such services under subsection (b) of this 
section and section 1395ww of this title'' for ``the reasonable costs 
for such services''.
    Subsec. (i)(1). Pub. L. 97-448 inserted ``made'' before ``for 
bereavement counseling''.
    Subsec. (i)(2)(A). Pub. L. 98-90, Sec. 1(1), struck out ``located in 
a region (as defined by the Secretary)'' after ``a hospice program'' and 
``for the region'' after `` `the cap amount' ''.
    Subsec. (i)(2)(B). Pub. L. 98-90, Sec. 1(2), amended subpar. (B) 
generally, substituting provisions establishing a hospice reimbursement 
cap amount of $6,500, indexed by the medical care component of the 
Consumer Price Index, for provisions which had established a cap of 40% 
of the estimated regional average medicare expenditure per beneficiary 
in the regular medicare program during the six months of life for 
persons dying of cancer.
    Subsec. (j). Pub. L. 98-21, Sec. 601(d)(2), added subsec. (j) by 
transferring and redesignating provisions formerly classified to subsec. 
(d) of section 1395ww of this title.
    Subsec. (j)(2)(A). Pub. L. 98-21, Sec. 601(d)(1), substituted 
``subsection (b) of this section'' for ``section 1395f(b) of this 
title''.
    1982--Subsec. (a)(8). Pub. L. 97-248, Sec. 122(c)(1), added par. 
(8).
    Subsec. (b). Pub. L. 97-248, Sec. 101(c)(1), substituted ``sections 
1395e and 1395ww'' for ``section 1395e'' in provisions preceding par. 
(1), and substituted ``until the first day of the seventh month 
beginning after the date the Secretary determines and notifies the 
Governor of the State'' for ``until the Secretary determines'' in 
provisions following par. (3).
    Pub. L. 97-248, Sec. 122(c)(2)(A), inserted ``(other than a hospice 
program providing hospice care)'' after ``The amount paid to any 
provider of services''.
    Subsec. (i). Pub. L. 97-248, Sec. 122(c)(2)(B), added subsec. (i).
    1981--Subsec. (a)(2)(D). Pub. L. 97-35, Sec. 2122(a)(1), substituted 
``needs or needed skilled nursing care on an intermittent basis or 
physical or speech therapy or, in the case of an individual who has been 
furnished home health services based on such a need and who no longer 
has such a need for such care or therapy, continues or continued to need 
occupational therapy'' for ``needed skilled nursing care on an 
intermittent basis, or physical, occupational, or speech therapy''.
    Subsec. (a)(2)(F). Pub. L. 97-35, Sec. 2121(b), struck out subpar. 
(F) which provided that in the case of alcohol detoxification facility 
services, such services were required on an inpatient basis (based upon 
an examination by such certifying physician made prior to initiation of 
alcohol detoxification).
    1980--Subsec. (a). Pub. L. 96-499, Sec. 930(e), inserted provision 
at end of subsec. (a) authorizing the Secretary to prescribe regulations 
to prohibit significantly interested physicians from performing the 
physician certification required by par. (2) for home health services.
    Subsec. (a)(2)(D). Pub. L. 96-499, Sec. 930(f), substituted ``home 
health services'' for ``post-hospital home health services'' and 
``physical, occupational, or speech'' for ``physical or speech'' and 
deleted ``, for any of the conditions with respect to which he was 
receiving inpatient hospital services (or services which would 
constitute inpatient hospital services if the institution met the 
requirements of paragraphs (6) and (9) of section 1395x(e) of this 
title) or post-hospital extended care services'' after ``therapy''.
    Subsec. (a)(2)(E). Pub. L. 96-499, Sec. 936(b), inserted ``or 
because of the severity of the dental procedure'' and substituted ``such 
services'' for ``such dental services''.
    Subsec. (a)(2)(F). Pub. L. 96-499, Sec. 931(b), added subpar. (F).
    Subsec. (b)(1). Pub. L. 96-499, Sec. 903(a)(1), inserted ``except as 
provided in paragraph (3),''.
    Subsec. (b)(3). Pub. L. 96-499, Sec. 903(a)(4), as amended by Pub. 
L. 98-369, Sec. 2354(c)(1)(A), added par. (3).
    Subsec. (c). Pub. L. 96-499, Sec. 941(b), substituted ``subsection 
(h)'' for ``subsection (j)''.
    Subsecs. (h) to (j). Pub. L. 96-499, Sec. 941(a), struck out 
subsecs. (h) and (i) and redesignated subsec. (j) as (h).
    1978--Subsec. (b)(1). Pub. L. 95-292 inserted ``and as further 
limited by section 1395rr(b)(2)(B) of this title'' after ``section 
1395x(v) of this title''.
    1977--Subsec. (c). Pub. L. 95-142, Sec. 23(a), inserted reference to 
subsec. (j) of this section.
    Subsec. (j). Pub. L. 95-142, Sec. 23(b), added subsec. (j).
    1976--Subsec. (c). Pub. L. 94-437 substituted ``Subject to section 
1395qq of this title, no payment'' for ``No payment''.
    1973--Subsec. (a)(2)(E). Pub. L. 93-233, Sec. 18(k)(1), substituted 
``the care, treatment, filling, removal, or replacement of teeth or 
structures directly supporting teeth, the individual, because of his 
underlying medical condition and clinical status, requires 
hospitalization in connection with the provision of such dental 
services'' for ``a dental procedure, the individual suffers from 
impairments of such severity as to require hospitalization''.
    Subsec. (a), last sentence. Pub. L. 93-233, Sec. 18(k)(2), inserted 
reference to subpar. (E) of par. (2).
    1972--Subsec. (a). Pub. L. 92-603, Secs. 226(c)(1), 227(b)(1), 
inserted reference to subsec. (g) of this section and section 1395mm of 
this title in provisions preceding par. (1).
    Subsec. (a)(1). Pub. L. 92-603, Sec. 281(e), placed a 3-year time 
limitation on the time within which a written request for payment is 
filed, with provision for reduction of the limit to 1 year.
    Subsec. (a)(2)(C). Pub. L. 92-603, Secs. 234(g)(1), 247(a), 
278(a)(1), substituted ``because the individual needs or needed on a 
daily basis skilled nursing care (provided directly by or requiring the 
supervision of skilled nursing personnel) or other skilled 
rehabilitation services, which as a practical matter can only be 
provided in a skilled nursing facility on an inpatient basis,'' for ``on 
an inpatient basis because the individual needs or needed skilled 
nursing care on a continuing basis'', ``skilled nursing facility'' for 
``extended care facility'', and ``paragraphs (6) and (9) of section 
1395x(e) of this title'' for ``paragraphs (6) and (8) of section 
1395x(e) of this title''.
    Subsec. (a)(2)(D). Pub. L. 92-603, Sec. 234(g)(1), substituted 
reference to par. (9) of section 1395x(e) of this title for reference to 
par. (8) of section 1395x(e) of this title.
    Subsec. (a)(2)(E). Pub. L. 92-603, Sec. 256(a), added subpar. (E).
    Subsec. (a)(6). Pub. L. 92-603, Sec. 278(a)(2), substituted 
``skilled nursing facility'' for ``extended care facility''.
    Subsec. (a)(7). Pub. L. 92-603, Secs. 238(a), 278(a)(3), inserted 
``, including any finding made in the course of a sample or other review 
of admissions to the institution'' after ``as described in section 
1395x(k)(4) of this title'' in the parenthetical provisions covering the 
finding not made by the committee or group, and substituted ``skilled 
nursing facility'' for ``extended care facility''.
    Subsec. (b). Pub. L. 92-603, Sec. 233(a), substituted pars. (1) and 
(2) for provisions describing the amount payable as the reasonable cost 
determined under section 1395x(v) of this title.
    Subsec. (f). Pub. L. 92-603, Sec. 211(a), designated existing 
provisions as par. (2), added pars. (1) and (3), and in par. (2) as so 
redesignated inserted provisions covering individuals physically present 
at a place within Canada while traveling without unreasonable delay by 
the most direct route between Alaska and another State.
    Subsec. (g). Pub. L. 92-603, Sec. 227(b)(2), added subsec. (g).
    Subsec. (h). Pub. L. 92-603, Secs. 228(a), 278(b)(4), (17), added 
subsec. (h) and substituted ``skilled nursing facility'' for ``extended 
care facility''.
    Subsec. (i). Pub. L. 92-603, Sec. 228(a), added subsec. (i).
    1968--Subsec. (a). Pub. L. 90-248, Secs. 126(a)(5), 129(c)(5)(B), 
struck out references to former subpars. (E) and (F) in last sentence.
    Subsec. (a)(2)(A) to (E). Pub. L. 90-248, Sec. 126(a)(1), (2), 
struck out subpar. (A) which provided that there be a physician's 
certification of medical necessity for admissions to hospitals other 
than psychiatric or tuberculosis institutions, and redesignated subpars. 
(B) to (E) as (A) to (D), respectively.
    Subsec. (a)(2)(F). Pub. L. 90-248, Sec. 129(c)(5)(A), struck out 
subpar. (F) which provided that there be a physician's certification for 
services furnished to outpatients.
    Subsec. (a)(3) to (7). Pub. L. 90-248, Sec. 126(a)(3), (4), added 
par. (3) and redesignated former pars. (3) to (6) as (4) to (7), 
respectively.
    Subsec. (d). Pub. L. 90-248, Sec. 129(c)(6)(A), struck out reference 
to outpatient hospital diagnostic services from provisions requiring 
payment for emergency hospital services.
    Subsec. (d)(1) to (3). Pub. L. 90-248, Sec. 143(c), designated 
existing provisions as par. (1), inserted ``in a calendar year'' after 
``furnished'' in first sentence of par. (1), added subpar. (C) to par. 
(1), and added pars. (2) and (3).


                    Effective Date of 1997 Amendment

    Section 4201(d) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1320a-7a, 
1320a-7b, 1320b-4, 1320b-8, 1395d, 1395e, 1395h, 1395i-4, 1395k to 
1395n, 1395u, 1395x, 1395y, 1395aa, 1395cc, 1395dd, and 1395ww of this 
title] shall apply to services furnished on or after October 1, 1997.''
    Pub. L. 105-33, title IV, Sec. 4442(b), Aug. 5, 1997, 111 Stat. 423, 
as amended by Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title III, 
Sec. 321(i)], Nov. 29, 1999, 113 Stat. 1536, 1501A-366, provided that: 
``The amendment made by subsection (a) [amending this section] applies 
to items and services furnished on or after October 1, 1997.''
    Amendment by sections 4441, 4443(b)(2), and 4448 of Pub. L. 105-33 
applicable to benefits provided on or after Aug. 5, 1997, except as 
otherwise provided, see section 4449 of Pub. L. 105-33, set out as a 
note under section 1395d of this title.
    Amendment by section 4603(c)(1) of Pub. L. 105-33 applicable to cost 
reporting periods beginning on or after Oct. 1, 1999, except as 
otherwise provided, see section 4603(d) of Pub. L. 105-33, set out as an 
Effective Date note under section 1395fff of this title.
    Section 4615(b) of Pub. L. 105-33 provided that: ``The amendments 
made by subsection (a) [amending this section and section 1395n of this 
title] apply to home health services furnished after the 6-month period 
beginning after the date of enactment of this Act [Aug. 5, 1997].''


                    Effective Date of 1994 Amendment

    Amendment by section 106(b)(1)(A) of Pub. L. 103-432 effective as if 
included in the enactment of Pub. L. 100-203, see section 106(b)(2) of 
Pub. L. 103-432, set out as a note under section 1395cc of this title.


                    Effective Date of 1990 Amendment

    Amendment by section 4006(b) of Pub. L. 101-508 applicable with 
respect to care and services furnished on or after Jan. 1, 1990, see 
section 4006(c) of Pub. L. 101-508, set out as a note under section 
1395d of this title.


                    Effective Date of 1989 Amendments

    Section 6005(c) of Pub. L. 101-239, as amended by Pub. L. 101-508, 
title IV, Sec. 4008(m)(3)(B), Nov. 5, 1990, 104 Stat. 1388-54, provided 
that: ``The amendments made by subsections (a) and (b) [amending this 
section] shall become effective with respect to care and services 
furnished on or after January 1, 1990.''
    Amendment by Pub. L. 101-234 effective Jan. 1, 1990, see section 
101(d) of Pub. L. 101-234, set out as a note under section 1395c of this 
title.


                    Effective Date of 1988 Amendment

    Amendment by Pub. L. 100-360 effective Jan. 1, 1989, except as 
otherwise provided, and applicable to inpatient hospital deductible for 
1989 and succeeding years, to care and services furnished on or after 
Jan. 1, 1989, to premiums for January 1989 and succeeding months, and to 
blood or blood cells furnished on or after Jan. 1, 1989, see section 
104(a) of Pub. L. 100-360, set out as a note under section 1395d of this 
title.


                    Effective Date of 1987 Amendment

    Section 4008(b)(2) of Pub. L. 100-203 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall take effect on the 
date of the enactment of this Act [Dec. 22, 1987].''
    Section 4024(c) of Pub. L. 100-203 provided that: ``The amendments 
made by subsections (a) and (b) [amending this section and section 1395n 
of this title] shall apply to items and services provided on or after 
January 1, 1988.''
    Section 4062(e) of Pub. L. 100-203, as amended by Pub. L. 101-508, 
title IV, Sec. 4152(h), Nov. 5, 1990, 104 Stat. 1388-80, provided that: 
``The amendments made by this section [enacting section 1395m of this 
title, amending this section and sections 1395k, 1395l, and 1395cc of 
this title, and repealing section 1395zz of this title] shall apply to 
covered items (other than oxygen and oxygen equipment) furnished on or 
after January 1, 1989 and to oxygen and oxygen equipment furnished on or 
after June 1, 1989.''
    [Section 4152(h) of Pub. L. 101-508 provided that amendment by that 
section to section 4062(e) of Pub. L. 100-203, set out above, is 
effective as if included in enactment of Omnibus Budget Reconciliation 
Act of 1987, Pub. L. 100-203.]


                    Effective Date of 1984 Amendments

    Section 1(b) of Pub. L. 98-617 provided that: ``The amendments made 
by this Act [probably means section 1 of Pub. L. 98-617, amending this 
section] shall apply to routine home care and other services included in 
hospice care furnished on or after October 1, 1984.''
    Section 3(c) of Pub. L. 98-617 provided that: ``The amendments made 
by this section [amending this section and sections 1395l, 1395n, 1395r, 
1395u, 1395x, 1395rr, 1395ww, 1396a, and 1396b of this title and 
amending provisions set out as notes under sections 1395h and 1395mm of 
this title] shall be effective as if they had been originally included 
in the Deficit Reduction Act of 1984 [Pub. L. 98-369].''
    Section 2321(g) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [enacting section 1395zz of this title and amending 
this section and sections 1395l, 1395x, and 1395cc of this title] shall 
apply to items and services furnished on or after the date of the 
enactment of this Act [July 18, 1984].''
    Section 2335(g) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section and sections 1395x, 1395z, 
1395cc, 1396a, and 1396d of this title] shall become effective on the 
date of the enactment of this Act [July 18, 1984].''
    Section 2336(c)(1) of Pub. L. 98-369 provided that: ``The amendments 
made by subsection (a) [amending this section and section 1395n of this 
title] shall apply to certifications and plans of care made or 
established on or after the date of the enactment of this Act [July 18, 
1984].''
    Amendment by section 2354(b)(1) of Pub. L. 98-369 effective July 18, 
1984, but not to be construed as changing or affecting any right, 
liability, status, or interpretation which existed (under the provisions 
of law involved) before that date, see section 2354(e)(1) of Pub. L. 98-
369, set out as a note under section 1320a-1 of this title.
    Amendment by section 2354(c)(1)(A) of Pub. L. 98-369 effective as if 
originally included in Pub. L. 96-499, see section 2354(e)(2) of Pub. L. 
98-369, set out as a note under section 1320a-1 of this title.


                    Effective Date of 1983 Amendments

    Amendment by Pub. L. 98-21 applicable to items and services 
furnished by or under arrangement with a hospital beginning with its 
first cost reporting period that begins on or after Oct. 1, 1983, any 
change in a hospital's cost reporting period made after November 1982 to 
be recognized for such purposes only if the Secretary finds good cause 
therefor, see section 604(a)(1) of Pub. L. 98-21, set out as a note 
under section 1395ww of this title.
    Amendment by Pub. L. 97-448 effective as if originally included as a 
part of this section as this section was amended by the Tax Equity and 
Fiscal Responsibility Act of 1982, Pub. L. 97-248, see section 309(c)(2) 
of Pub. L. 97-448, set out as a note under section 426-1 of this title.


                    Effective Date of 1982 Amendment

    Amendment by section 122(c)(1), (2) of Pub. L. 97-248 applicable to 
hospice care provided on or after Nov. 1, 1983, see section 122(h)(1) of 
Pub. L. 97-248, as amended, set out as a note under section 1395c of 
this title.


                    Effective Date of 1981 Amendment

    Amendment by section 2121(b) of Pub. L. 97-35 applicable to services 
furnished in detoxification facilities for inpatient stays beginning on 
or after the tenth day after Aug. 13, 1981, see section 2121(i) of Pub. 
L. 97-35, set out as a note under section 1395d of this title.
    Section 2122(b) of Pub. L. 97-35 provided that: ``The amendments 
made by this section [amending this section and section 1395n of this 
title] shall apply to services furnished pursuant to plans of treatment 
implemented after the third month beginning after the date of the 
enactment of this Act [Aug. 13, 1981].''


                    Effective Date of 1980 Amendment

    Amendment by section 930(e), (f) of Pub. L. 96-499 effective with 
respect to services furnished on or after July 1, 1981, see section 
930(s)(1) of Pub. L. 96-499, set out as a note under section 1395x of 
this title.
    Amendment by section 931(b) of Pub. L. 96-499 effective Apr. 1, 
1981, see section 931(e) of Pub. L. 96-499, set out as a note under 
section 1395d of this title.
    Section 936(d) of Pub. L. 96-499 provided that: ``The amendments 
made by this section [amending this section and sections 1395x and 1395y 
of this title] shall apply with respect to services provided on or after 
July 1, 1981.''
    Section 941(c) of Pub. L. 96-499 provided that: ``The amendments 
made by this section [amending this section] shall take effect on 
January 1, 1981.''


                    Effective Date of 1978 Amendment

    Amendment by Pub. L. 95-292 effective with respect to services, 
supplies, and equipment furnished after the third calendar month 
beginning after June 13, 1978, except that provisions for the 
implementation of an incentive reimbursement system for dialysis 
services furnished in facilities and providers to become effective with 
respect to a facility's or provider's first accounting period beginning 
after the last day of the twelfth month following the month of June 
1978, and except that provisions for reimbursement rates for home 
dialysis to become effective on Apr. 1, 1979, see section 6 of Pub. L. 
95-292, set out as a note under section 426 of this title.


                    Effective Date of 1977 Amendment

    Section 23(c) of Pub. L. 95-142 provided that: ``The amendments made 
by this section [amending this section] shall apply to inpatient 
hospital services furnished on and after July 1, 1974.''


                    Effective Date of 1973 Amendment

    Section 18(z-3)(2) of Pub. L. 93-233 provided that: ``The amendments 
made by subsection (k) [amending this section and section 1395y of this 
title] shall be effective with respect to admissions subject to the 
provisions of section 1814(a)(2) of the Social Security Act [subsec. 
(a)(2) of this section] which occur after December 31, 1972.''


                    Effective Date of 1972 Amendment

    Section 211(d) of Pub. L. 92-603 provided that: ``The amendments 
made by this section [amending this section and sections 1395l, 1395u, 
1395x, and 1395y of this title] shall apply to services furnished with 
respect to admissions occurring after December 31, 1972.''
    Amendment by section 226(c)(1) of Pub. L. 92-603 effective with 
respect to services provided on or after July 1, 1973, see section 
226(f) of Pub. L. 92-603, set out as an Effective Date note under 
section 1395mm of this title.
    Amendment by section 227(b) of Pub. L. 92-603 applicable with 
respect to accounting periods beginning after June 30, 1973, see section 
227(g) of Pub. L. 92-603, set out as a note under section 1395x of this 
title.
    Section 228(b) of Pub. L. 92-603 provided that: ``The amendment made 
by subsection (a) [amending this section] and any regulations adopted 
pursuant to such amendment shall apply with respect to plans of care 
initiated on or after January 1, 1973, and with respect to admission to 
skilled nursing facilities and home health plans initiated on or after 
such date.''
    Section 233(f) of Pub. L. 92-603 provided that: ``The amendments 
made by subsections (a) and (b) [amending this section and section 1395l 
of this title] shall apply to services furnished by hospitals, extended 
care facilities, and home health agencies in accounting periods 
beginning after December 31, 1972. The amendments made by subsections 
(c), (d), and (e) [amending sections 706, 709, and 1396b of this title] 
shall apply with respect to services furnished by hospitals in 
accounting periods beginning after December 31, 1972.'' See, also, 
section 16 of Pub. L. 93-233, set out below.
    Amendment by section 234(g)(1) of Pub. L. 92-603 applicable with 
respect to providers of services for fiscal years beginning after fifth 
month following October 1972, see section 234(i) of Pub. L. 92-603, set 
out as a note under section 1395x of this title.
    Section 238(b) of Pub. L. 92-603 provided that: ``The amendment made 
by subsection (a) [amending this section] shall apply with respect to 
services furnished after the second month following the month in which 
this Act is enacted [October 1972].''
    Section 247(c) of Pub. L. 92-603 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title] shall be effective with respect to services furnished after 
December 31, 1972.''
    Section 256(d) of Pub. L. 92-603 provided that: ``The amendments 
made by this section [amending this section and sections 1395x and 1395y 
of this title] shall apply with respect to admissions occurring after 
the second month following the month in which this Act is enacted 
[October 1972].''
    Amendment by section 281(e) of Pub. L. 92-603 applicable in the case 
of services furnished (or deemed to have been furnished) after 1970, see 
section 281(g) of Pub. L. 92-603, set out as a note under section 1395gg 
of this title.


                    Effective Date of 1968 Amendment

    Section 126(c) of Pub. L. 90-248 provided that: ``The amendments 
made by this section [amending this section and section 1395n of this 
title] shall apply with respect to services furnished after the date of 
the enactment of this Act [Jan. 2, 1968].''
    Amendment by section 129(c)(5), (6)(A) of Pub. L. 90-248 applicable 
with respect to services furnished after Jan. 2, 1968, see section 
129(d) of Pub. L. 90-248, set out as a note under section 1395d of this 
title.
    Amendment by section 143(c) of Pub. L. 90-248 applicable with 
respect to services furnished with respect to admissions occurring after 
Dec. 31, 1967, and to outpatient hospital diagnostic services furnished 
after Dec. 31, 1967, and before Apr. 1, 1968, see section 143(d) of Pub. 
L. 90-248, set out as a note under section 1395d of this title.


             Temporary Increase in Payment for Hospice Care

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title I, Sec. 131], Nov. 
29, 1999, 113 Stat. 1536, 1501A-333, provided that:
    ``(a) Increase for Fiscal Years 2001 and 2002.--For purposes of 
payments under section 1814(i)(1)(C) of the Social Security Act (42 
U.S.C. 1395f(i)(1)(C)) for hospice care furnished during fiscal years 
2001 and 2002, the Secretary of Health and Human Services shall increase 
the payment rate in effect (but for this section) for--
        ``(1) fiscal year 2001, by 0.5 percent, and
        ``(2) fiscal year 2002, by 0.75 percent.
    ``(b) Additional Payment Not Built Into the Base.--The Secretary of 
Health and Human Services shall not include any additional payment made 
under this subsection (a) in updating the payment rate, as increased by 
the applicable market basket percentage increase for the fiscal year 
involved under section 1814(i)(1)(C)(ii) of that Act (42 U.S.C. 
1395f(i)(1)(C)(ii)).''


Study and Report to Congress Regarding Modification of Payment Rates for 
                              Hospice Care

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title I, Sec. 132], Nov. 
29, 1999, 113 Stat. 1536, 1501A-333, provided that:
    ``(a) Study.--The Comptroller General of the United States shall 
conduct a study to determine the feasibility and advisability of 
updating the payment rates and the cap amount determined with respect to 
a fiscal year under section 1814(i) of the Social Security Act (42 
U.S.C. 1395f(i)) for routine home care and other services included in 
hospice care. Such study shall examine the cost factors used to 
determine such rates and such amount and shall evaluate whether such 
factors should be modified, eliminated, or supplemented with additional 
cost factors.
    ``(b) Report.--Not later than one year after the date of enactment 
of this Act [Nov. 29, 1999], the Comptroller General of the United 
States shall submit to Congress a report on the study conducted under 
subsection (a), together with any recommendations for legislation that 
the Comptroller General determines to be appropriate as a result of such 
study.''


       Study of Methods To Compensate Hospices for High-Cost Care

    Section 6016 of Pub. L. 101-239 directed Secretary of Health and 
Human Services to conduct a study of high-cost hospice care provided to 
medicare beneficiaries under the medicare program, evaluate the ability 
of hospice programs participating in the medicare program to provide 
such high-cost care to such patients, develop methods to compensate such 
programs for providing such high-cost care, and submit, not later than 
Apr. 1, 1991, a report to the Committee on Ways and Means of the House 
of Representatives and the Committee on Finance of the Senate on the 
study, including in the report any recommendations developed by the 
Secretary to compensate hospice programs for providing high-cost hospice 
care to medicare beneficiaries.


       Continuation of Bad Debt Recognition for Hospital Services

    Section 4008(c) of Pub. L. 100-203, as amended by Pub. L. 100-647, 
title VIII, Sec. 8402, Nov. 10, 1987, 102 Stat. 3798; Pub. L. 101-239, 
title VI, Sec. 6023(a), Dec. 19, 1989, 103 Stat. 2167, provided that: 
``In making payments to hospitals under title XVIII of the Social 
Security Act [this subchapter], the Secretary of Health and Human 
Services shall not make any change in the policy in effect on August 1, 
1987, with respect to payment under title XVIII of the Social Security 
Act to providers of service for reasonable costs relating to unrecovered 
costs associated with unpaid deductible and coinsurance amounts incurred 
under such title (including criteria for what constitutes a reasonable 
collection effort, including criteria for indigency determination 
procedures, for record keeping, and for determining whether to refer a 
claim to an external collection agency). The Secretary may not require a 
hospital to change its bad debt collection policy if a fiscal 
intermediary, in accordance with the rules in effect as of August 1, 
1987, with respect to criteria for indigency determination procedures, 
record keeping, and determining whether to refer a claim to an external 
collection agency, has accepted such policy before that date, and the 
Secretary may not collect from the hospital on the basis of an 
expectation of a change in the hospital's collection policy.''
    [Section 6023(b) of Pub. L. 101-239 provided that: ``The amendment 
made by subsection (a) [amending section 4008(c) of Pub. L. 100-203, set 
out above] shall take effect as if included in the enactment of the 
Omnibus Budget Reconciliation Act of 1987 [Pub. L. 100-203].'']
    [Pub. L. 100-647, title VIII, Sec. 8402, Nov. 10, 1988, 102 Stat. 
3798, provided that amendment of section 4008(c) of Pub. L. 100-203, set 
out above, by section 8402 of Pub. L. 100-647 is effective as of date of 
enactment of Omnibus Budget Reconciliation Act of 1987, Pub. L. 100-203, 
which was approved Dec. 22, 1987.]


Providers of Services To Calculate and Report Lesser-of-Cost-or-Charges 
 Determinations Separately With Respect to Payments Under Parts A and B 
               of This Subchapter; Issuance of Regulations

    Section 2308(a) of Pub. L. 98-369 provided that: ``The Secretary of 
Health and Human Services shall issue regulations which require, for 
purposes of title XVIII of the Social Security Act [this subchapter], 
that providers of services calculate and report the lesser-of-cost-or-
charges determinations separately with respect to payments for services 
under part A and services under part B of such title (other than 
clinical diagnostic laboratory tests paid under section 1833(h) [section 
1395l(h) of this title]), and that payment under such title be based 
upon such separate determinations. Such regulations shall apply to cost 
reporting periods beginning on or after October 1, 1984.''


      Determination of Nominal Charges for Applying Nominality Test

    Section 2308(b)(1) of Pub. L. 98-369 provided that: ``For purposes 
of applying the nominality test under sections 1814(b)(2) [subsec. 
(b)(2) of this section] and 1833(a)(2)(B)(ii) [section 
1395l(a)(2)(B)(ii) of this title] of the Social Security Act, the 
Secretary shall, in addition to those rules for establishing nominality 
which the Secretary determines to be appropriate, provide that charges 
representing 60 percent or less of costs shall be considered nominal. 
The charges used in making such determinations shall be the charges 
actually billed to charge-paying patients who are not entitled to 
benefits under either part of such title [sections 1395c et seq., 1395j 
et seq. of this title]. Such determination shall be made separately with 
respect to payments for services under part A and services under part B 
of such title (other than clinical diagnostic laboratory tests paid 
under section 1833(h)), or on the basis of inpatient and outpatient 
services, except that the determination need not be made separately for 
home health services if the Secretary finds that such separation is not 
appropriate.''


    Revision of Regulations Regarding Access to Home Health Services

    Section 2336(c)(2) of Pub. L. 98-369 provided that: ``The Secretary 
shall provide, not later than 90 days after the date of the enactment of 
this Act [July 18, 1984], for such revision of regulations as may be 
required to reflect the amendments made by subsection (b) [amending this 
section and section 1395n of this title].''


                       Promulgation of Regulations

    Section 122(h)(2) of Pub. L. 97-248 provided that: ``In order to 
provide for the timely implementation of the amendments made by this Act 
[probably means section 122 of Pub. L. 97-248, which amended this 
section and sections 1395c to 1395e, 1395h, and 1395x to 1395cc of this 
title and section 231f of Title 45, Railroads, and enacted provisions 
set out as notes under this section and sections 1395b-1 and 1395c of 
this title], the Secretary of Health and Human Services shall, not later 
than September 1, 1983, promulgate such final regulations as may be 
necessary to set forth--
        ``(A) a description of the care included in `hospice care' and 
    the standards for qualification of a `hospice program', under 
    section 1861(dd) of the Social Security Act [section 1395x(dd) of 
    this title], and
        ``(B) the standards for payment for hospice care under part A of 
    title XVIII of such Act [this part], pursuant to section 1814(i) of 
    such Act [subsec. (i) of this section].''


   Study and Report Relating to the Reimbursement Method and Benefit 
Structure for Hospice Care; Supervision of Report by Comptroller General

    Section 122(j), formerly Sec. 122(i), of Pub. L. 97-248, 
redesignated Sec. 122(i), by Pub. L. 97-448, title III, Sec. 309(a)(6), 
Jan. 12, 1983, 96 Stat. 2408, provided that:
    ``(1) The Secretary of Health and Human Services shall conduct a 
study and, prior to January 1, 1986, report to the Congress on whether 
or not the reimbursement method and benefit structure (including 
copayments) for hospice care under title XVIII of the Social Security 
Act [this subchapter] are fair and equitable and promote the most 
efficient provision of hospice care. Such report shall include the 
feasibility and advisability of providing for prospective reimbursement 
for hospice care, an evaluation of the inclusion of payment for 
outpatient drugs, an evaluation of the need to alter the method of 
reimbursement for nutritional, dietary, and bereavement counseling as 
hospice care, and any recommendations for legislative changes in the 
hospice care reimbursement or benefit structure.
    ``(2) The Comptroller General shall monitor and evaluate the study 
and the preparation of the report under paragraph (1).''


Waiver of Limitations To Allow Pre-Existing Hospices To Participate as a 
                             Hospice Program

    Section 122(k), formerly Sec. 122(j), of Pub. L. 97-248, as 
redesignated and amended by Pub. L. 97-448, title III, Sec. 309(a)(6), 
(7), Jan. 12, 1983, 96 Stat. 2408, provided that: ``The Secretary of 
Health and Human Services shall grant waivers of the limitations imposed 
by section 1814(i)(2) of the Social Security Act [subsec. (i)(2) of this 
section] (relating to the cap amount), section 1861(dd)(1)(G) of such 
Act [section 1395x(dd)(1)(G) of this title] (relating to the limitations 
on the frequency and number of respite care days), and section 
1861(dd)(2)(A)(iii) of such Act [section 1395x(dd)(2)(A)(iii) of this 
title] (relating to the aggregate limit on the number of days of 
inpatient care), as may be necessary to allow any institution which 
commenced operations as a hospice prior to January 1, 1975, to 
participate until October 1, 1986, in a viable manner as a hospice 
program under title XVIII of the Social Security Act [this 
subchapter].''


Medicare Payment Basis for Services Provided by Agencies and Providers; 
                             Effective Date

    Section 16 of Pub. L. 93-233 provided that: ``In the administration 
of titles V, XVIII, and XIX of the Social Security Act [subchapters V, 
XVIII, and XIX of this chapter], the amount payable under such title to 
any provider of services on account of services provided by such 
hospital, skilled nursing facility, or home health agency shall be 
determined (for any period with respect to which the amendments made by 
section 233 of Public Law 92-603 [this section and sections 706, 709, 
1395l, and 1396b of this title] would, except for the provisions of this 
section, be applicable) in like manner as if the date contained in the 
first and second sentences of subsection (f) of such section 233 [set 
out as an Effective Date of 1972 Amendment note above] were December 31, 
1973, rather than December 31, 1972.''

                  Section Referred to in Other Sections

    This section is referred to in sections 426, 1320a-7a, 1395d, 1395e, 
1395g, 1395l, 1395n, 1395w-23, 1395x, 1395y, 1395cc, 1395gg, 1395mm, 
1395pp, 1395qq, 1395uu, 1395ww, 1395yy, 1395eee, 1395fff, 1395ggg of 
this title; title 5 section 8904.
