
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)]
[CITE: 42USC1395k]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
 Part B--Supplementary Medical Insurance Benefits for Aged and Disabled
 
Sec. 1395k. Scope of benefits; extension of coverage of 
        immunosuppressive drugs; definitions
        

(a) Scope of benefits

    The benefits provided to an individual by the insurance program 
established by this part shall consist of--
        (1) entitlement to have payment made to him or on his behalf 
    (subject to the provisions of this part) for medical and other 
    health services, except those described in subparagraphs (B) and (D) 
    of paragraph (2) and subparagraphs (E) and (F) of section 
    1395u(b)(6) of this title; and
        (2) entitlement to have payment made on his behalf (subject to 
    the provisions of this part) for--
            (A) home health services (other than items described in 
        subparagraph (G) or subparagraph (I));
            (B) medical and other health services (other than items 
        described in subparagraph (G) or subparagraph (I)) furnished by 
        a provider of services or by others under arrangement with them 
        made by a provider of services, excluding--
                (i) physician services except where furnished by--
                    (I) a resident or intern of a hospital, or
                    (II) a physician to a patient in a hospital which 
                has a teaching program approved as specified in 
                paragraph (6) of section 1395x(b) of this title 
                (including services in conjunction with the teaching 
                programs of such hospital whether or not such patient is 
                an inpatient of such hospital) where the conditions 
                specified in paragraph (7) of such section are met,

                (ii) services for which payment may be made pursuant to 
            section 1395n(b)(2) of this title,
                (iii) services described by section 1395x(s)(2)(K)(i) of 
            this title, certified nurse-midwife services, qualified 
            psychologist services, and services of a certified 
            registered nurse anesthetist; \1\
---------------------------------------------------------------------------
    \1\ So in original. The semicolon probably should be a comma.
---------------------------------------------------------------------------
                (iv) services of a nurse practitioner or clinical nurse 
            specialist but only if no facility or other provider charges 
            or is paid any amounts with respect to the furnishing of 
            such services; and \2\
---------------------------------------------------------------------------
    \2\ So in original. The word ``and'' probably should not appear.

            (C) outpatient physical therapy services (other than 
        services to which the second sentence of section 1395x(p) of 
        this title applies) and outpatient occupational therapy services 
        (other than services to which such sentence applies through the 
        operation of section 1395x(g) of this title);
            (D)(i) rural health clinic services and (ii) Federally 
        qualified health center services;
            (E) comprehensive outpatient rehabilitation facility 
        services;
            (F) facility services furnished in connection with surgical 
        procedures specified by the Secretary--
                (i) pursuant to section 1395l(i)(1)(A) of this title and 
            performed in an ambulatory surgical center (which meets 
            health, safety, and other standards specified by the 
            Secretary in regulations) if the center has an agreement in 
            effect with the Secretary by which the center agrees to 
            accept the standard overhead amount determined under section 
            1395l(i)(2)(A) of this title as full payment for such 
            services (including intraocular lens in cases described in 
            section 1395l(i)(2)(A)(iii) of this title) and to accept an 
            assignment described in section 1395u(b)(3)(B)(ii) of this 
            title with respect to payment for all such services 
            (including intraocular lens in cases described in section 
            1395l(i)(2)(A)(iii) of this title) furnished by the center 
            to individuals enrolled under this part, or
                (ii) pursuant to section 1395l(i)(1)(B) of this title 
            and performed by a physician, described in paragraph (1), 
            (2), or (3) of section 1395x(r) of this title, in his 
            office, if the Secretary has determined that--
                    (I) a quality control and peer review organization 
                (having a contract with the Secretary under part B of 
                subchapter XI of this chapter) is willing, able, and has 
                agreed to carry out a review (on a sample or other 
                reasonable basis) of the physician's performing such 
                procedures in the physician's office,
                    (II) the particular physician involved has agreed to 
                make available to such organization such records as the 
                Secretary determines to be necessary to carry out the 
                review, and
                    (III) the physician is authorized to perform the 
                procedure in a hospital located in the area in which the 
                office is located,

          and if the physician agrees to accept the standard overhead 
            amount determined under section 1395l(i)(2)(B) of this title 
            as full payment for such services and to accept payment on 
            an assignment-related basis with respect to payment for all 
            services (including all pre- and post-operative services) 
            described in paragraphs (1) and (2)(A) of section 1395x(s) 
            of this title and furnished in connection with such surgical 
            procedure to individuals enrolled under this part;

            (G) covered items (described in section 1395m(a)(13) of this 
        title) furnished by a provider of services or by others under 
        arrangements with them made by a provider of services;
            (H) outpatient critical access hospital services (as defined 
        in section 1395x(mm)(3) of this title);
            (I) prosthetic devices and orthotics and prosthetics 
        (described in section 1395m(h)(4) of this title) furnished by a 
        provider of services or by others under arrangements with them 
        made by a provider of services; and
            (J) partial hospitalization services provided by a community 
        mental health center (as described in section 1395x(ff)(2)(B) of 
        this title).

(b) Extension of coverage of immunosuppressive drugs

                            (1) Extension

        (A) In general

            The Secretary shall specify consistent with this subsection 
        an additional number of months (which may be portions of months) 
        of coverage of immunosuppressive drugs for each cohort (as 
        defined in subparagraph (C)) in a year during the 5-year period 
        beginning with 2000. The number of such months for the cohort--
                (i) for 2000 shall be 8 months; and
                (ii) for 2001 shall, subject to paragraph (2)(A)(i), be 
            8 months.

        (B) Application of additional months in a year only to cohort in 
                that year

            (i) In general

                The additional months specified under this subsection 
            for a cohort in a year in such 5-year period shall apply 
            under section 1395x(s)(2)(J)(v) of this title only to 
            individuals within such cohort for such year.
            (ii) Construction

                Nothing in this subsection shall be construed as 
            preventing additional months of coverage provided for a 
            cohort for a year from extending coverage to drugs furnished 
            in months in the succeeding year.

        (C) Cohort defined

            In this subsection, the term ``cohort'' means, with respect 
        to a year, those individuals who would (but for this subsection) 
        exhaust benefits under section 1395x(s)(2)(J)(v) of this title 
        for prescription drugs used in immunosuppressive therapy 
        furnished at any time during such year.

                     (2) Timing of specification

        Consistent with paragraphs (3) and (4)--

        (A) May 1, 2001

            Not later than May 1, 2001, the Secretary--
                (i) may increase the number of months for the cohort for 
            2001 above the 8 months provided under paragraph (1)(A)(ii); 
            and
                (ii) shall compute and specify the number of additional 
            months of benefits that will be available for the cohort for 
            2002.

        (B) May 1, 2002 and 2003

            Not later than May 1 of 2002 and 2003, the Secretary shall 
        compute and specify the number of additional months of benefits 
        that will be available for the cohort for the following year 
        under this subsection. Such number may be more or less than 8 
        months.

                     (3) Basis for specification

        Using appropriate actuarial methods, the Secretary shall compute 
    the number of additional months for the cohort for a year under this 
    subsection in a manner so that the total expenditures under this 
    part attributable to this subsection, as computed based upon the 
    best available data at the time additional months are specified 
    under this subsection, do not exceed $150,000,000. Subject to 
    paragraph (4), the Secretary shall seek to compute such months in a 
    manner that provides for a level number of months for each cohort in 
    each year in the last 4 years of the 5-year period described in 
    paragraph (1)(A).

      (4) Annual adjustment to maintain aggregate expenditures 
                                within limits

        In computing and specifying the number of additional months 
    under paragraph (2), the Secretary shall adjust the number of 
    additional months under this subsection for a cohort for a year from 
    that provided in the previous year within such 5-year period to the 
    extent necessary to take into account, based upon the best available 
    data, differences between actual and estimated expenditures under 
    this part attributable to this subsection for previous years and to 
    comply with the limitation on total expenditures under paragraph 
    (3).

(c) Definitions

    For definitions of ``spell of illness'', ``medical and other health 
services'', and other terms used in this part, see section 1395x of this 
title.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1832, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 302; amended Pub. L. 90-
248, title I, Secs. 129(c)(6)(B), 133(d), Jan. 2, 1968, 81 Stat. 848, 
851; Pub. L. 92-603, title II, Secs. 227(e)(1), 251(a)(4), Oct. 30, 
1972, 86 Stat. 1406, 1445; Pub. L. 95-210, Sec. 1(a), Dec. 13, 1977, 91 
Stat. 1485; Pub. L. 96-499, title IX, Secs. 930(g), 933(a), 934(a), 
948(a)(2), Dec. 5, 1980, 94 Stat. 2631, 2635, 2637, 2643; Pub. L. 97-
248, title I, Sec. 148(c), Sept. 3, 1982, 96 Stat. 394; Pub. L. 98-369, 
div. B, title III, Secs. 2341(b), 2354(b)(6), July 18, 1984, 98 Stat. 
1094, 1100; Pub. L. 99-509, title IX, Secs. 9320(d), 9337(a), 
9343(e)(1), Oct. 21, 1986, 100 Stat. 2013, 2033, 2041; Pub. L. 100-203, 
title IV, Secs. 4062(d)(2), 4063(e)(2), 4073(b)(1), 4077(b)(2), 
4085(i)(22)(A), Dec. 22, 1987, 101 Stat. 1330-108, 1330-118, 1330-120, 
as amended Pub. L. 100-360, title IV, Sec. 411(g)(2)(E), (h)(4)(A), 
(7)(B), (i)(4)(C)(vi), July 1, 1988, 102 Stat. 783, 786, 787, 789; Pub. 
L. 100-360, title I, Sec. 104(d)(3), title II, Secs. 203(a), 205(a), 
July 1, 1988, 102 Stat. 689, 721, 729, 783; Pub. L. 101-234, title I, 
Sec. 101(a), title II, Sec. 201(a), Dec. 13, 1989, 103 Stat. 1979, 1981; 
Pub. L. 101-239, title VI, Sec. 6116(a)(2), Dec. 19, 1989, 103 Stat. 
2219; Pub. L. 101-508, title IV, Secs. 4153(a)(2)(A), 4155(b)(1), 
4157(b), 4161(a)(3)(A), 4162(b)(1), Nov. 5, 1990, 104 Stat. 1388-83, 
1388-86, 1388-89, 1388-93, 1388-96; Pub. L. 105-33, title IV, 
Secs. 4201(c)(1), 4432(b)(5)(B), 4511(c), 4603(c)(2)(B)(ii), Aug. 5, 
1997, 111 Stat. 373, 421, 443, 471; Pub. L. 106-113, div. B, 
Sec. 1000(a)(6) [title II, Sec. 227(b)], Nov. 29, 1999, 113 Stat. 1536, 
1501A-354.)

                       References in Text

    Part B of subchapter XI of this chapter, referred to in subsec. 
(a)(2)(F)(ii)(I), is classified to section 1320c et seq. of this title.


                               Amendments

    1999--Subsecs. (b), (c). Pub. L. 106-113 added subsec. (b) and 
redesignated former subsec. (b) as (c).
    1997--Subsec. (a)(1). Pub. L. 105-33, Sec. 4603(c)(2)(B)(ii), 
substituted ``subparagraphs (E) and (F) of section 1395u(b)(6) of this 
title;'' for ``section 1395u(b)(6)(E) of this title;''.
    Pub. L. 105-33, Sec. 4432(b)(5)(B), substituted ``(2) and section 
1395u(b)(6)(E) of this title;'' for ``(2);''.
    Subsec. (a)(2)(B)(iv). Pub. L. 105-33, Sec. 4511(c), substituted 
``but only if no facility or other provider charges or is paid any 
amounts with respect to the furnishing of such services'' for ``provided 
in a rural area (as defined in section 1395ww(d)(2)(D) of this title)''.
    Subsec. (a)(2)(H). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care''.
    1990--Subsec. (a)(2)(A), (B). Pub. L. 101-508, 
Sec. 4153(a)(2)(A)(i), substituted ``subparagraph (G) or subparagraph 
(I)'' for ``subparagraph (G)''.
    Subsec. (a)(2)(B)(iii). Pub. L. 101-508, Sec. 4157(b), amended cl. 
(iii) generally. Prior to amendment, cl. (iii) related to services of a 
certified registered nurse anesthetist.
    Subsec. (a)(2)(B)(iv). Pub. L. 101-508, Sec. 4155(b)(1), added cl. 
(iv).
    Subsec. (a)(2)(D). Pub. L. 101-508, Sec. 4161(a)(3)(A), designated 
existing provisions as cl. (i) and added cl. (ii).
    Subsec. (a)(2)(I). Pub. L. 101-508, Sec. 4153(a)(2)(A)(ii)-(iv), 
added subpar. (I).
    Subsec. (a)(2)(J). Pub. L. 101-508, Sec. 4162(b)(1), added subpar. 
(J).
    1989--Subsec. (a). Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 
100-360, Secs. 203(a), 205(a), and provided that the provisions of law 
amended or repealed by such sections are restored or revived as if such 
sections had not been enacted, see 1988 Amendment notes below.
    Subsec. (a)(2)(H). Pub. L. 101-239 added subpar. (H).
    Subsec. (b). Pub. L. 101-234, Sec. 101(a), repealed Pub. L. 100-360, 
Sec. 104(d)(3), 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.
    1988--Subsec. (a). Pub. L. 100-360, Sec. 205(a)(2), inserted 
sentence at end relating to in-home care provided to a chronically 
dependent individual on any day.
    Subsec. (a)(2)(A). Pub. L. 100-360, Sec. 205(a)(1), designated 
existing provisions as cl. (i) and added cl. (ii) relating to in-home 
care for a chronically dependent individual.
    Pub. L. 100-360, Sec. 203(a), inserted ``and home intravenous drug 
therapy services'' before semicolon at end.
    Subsec. (a)(2)(B)(iv). Pub. L. 100-360, Sec. 411(h)(7)(B), struck 
out Pub. L. 100-203, Sec. 4077(b)(2), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(h)(4)(A), struck out Pub. L. 100-203, 
Sec. 4073(b)(1), see 1987 Amendment note below.
    Subsec. (a)(2)(F)(i). Pub. L. 100-360, Sec. 411(g)(2)(E), added Pub. 
L. 100-203, Sec. 4063(e)(2), see 1987 Amendment note below.
    Subsec. (a)(2)(F)(ii). Pub. L. 100-360, Sec. 411(i)(4) (C)(vi), 
added Pub. L. 100-203, Sec. 4085(i)(22)(A), see 1987 Amendment note 
below.
    Subsec. (b). Pub. L. 100-360, Sec. 104(d)(3), substituted 
``definitions of `medical and other health services' and'' for 
``definitions of `spell of illness', `medical and other health 
services', and''.
    1987--Subsec. (a)(2)(A). Pub. L. 100-203, Sec. 4062(d)(2)(A), 
inserted ``(other than items described in subparagraph (G))'' after 
``services''.
    Subsec. (a)(2)(B). Pub. L. 100-203, Sec. 4062(d)(2)(B), inserted 
``(other than items described in subparagraph (G))'' after ``health 
services''.
    Subsec. (a)(2)(B)(iv). Pub. L. 100-203, Sec. 4077(b)(2), which 
directed the addition of cl. (iv) relating to qualified psychologist 
services, was repealed by Pub. L. 100-360, Sec. 411(h)(7)(B).
    Pub. L. 100-203, Sec. 4073(b)(1), which directed the addition of cl. 
(iv) relating to certified nurse-midwife services, was repealed by Pub. 
L. 100-360, Sec. 411(h)(4)(A).
    Subsec. (a)(2)(F)(i). Pub. L. 100-203, Sec. 4063(e)(2), as added by 
Pub. L. 100-360, Sec. 411(g)(2)(E), inserted ``(including intraocular 
lens in cases described in section 1395l(i)(2)(A)(iii) of this title)'' 
after ``services'' in two places.
    Subsec. (a)(2)(F)(ii). Pub. L. 100-203, Sec. 4085(i)(22)(A), as 
added by Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), substituted ``payment 
on an assignment-related basis'' for ``an assignment described in 
section 1395u(b)(3)(B)(ii) of this title'' in concluding provisions.
    Subsec. (a)(2)(G). Pub. L. 100-203, Sec. 4062(d)(2)(C), added 
subpar. (G).
    1986--Subsec. (a)(2)(B)(iii). Pub. L. 99-509, Sec. 9320(d), added 
cl. (iii).
    Subsec. (a)(2)(C). Pub. L. 99-509, Sec. 9337(a), amended subpar. (C) 
generally. Prior to amendment, subpar. (C) read as follows: ``outpatient 
physical therapy services, other than services to which the next to last 
sentence of section 1395x(p) of this title applies;''.
    Subsec. (a)(2)(F). Pub. L. 99-509, Sec. 9343(e)(1), inserted 
``standard overhead'' in cl. (i) and concluding provisions of cl. (ii).
    1984--Subsec. (a)(2)(F)(ii). Pub. L. 98-369, Sec. 2341(b), 
substituted ``paragraph (1), (2), or (3) of section 1395x(r) of this 
title'' for ``section 1395x(r)(1) of this title''.
    Subsec. (a)(2)(F)(ii)(II). Pub. L. 98-369, Sec. 2354(b)(6), 
substituted ``organization'' for ``Organization''.
    1982--Subsec. (a)(2)(F)(ii)(I). Pub. L. 97-248 substituted ``quality 
control and peer review organization (having a contract with the 
Secretary'' for ``Professional Standards Review Organization 
(designated, conditionally or otherwise,''.
    1980--Subsec. (a)(2)(A). Pub. L. 96-499, Sec. 930(g), struck out 
restriction on home health services of 100 visits during a calendar 
year.
    Subsec. (a)(2)(B)(i)(II). Pub. L. 96-499, Sec. 948(a)(2), 
substituted ``where the conditions specified in paragraph (7) of such 
section are met'' for ``, unless either clause (A) or (B) of paragraph 
(7) of such section is met''.
    Subsec. (a)(2)(E). Pub. L. 96-499, Sec. 933(a), added subpar. (E).
    Subsec. (a)(2)(F). Pub. L. 96-499, Sec. 934(a), added subpar. (F).
    1977--Subsec. (a)(1). Pub. L. 95-210, Sec. 1(a)(1), substituted 
``subparagraphs (B) and (D) of paragraph (2)'' for ``paragraph (2)(B)''.
    Subsec. (a)(2)(D). Pub. L. 95-210, Sec. 1(a)(2), added subpar. (D).
    1972--Subsec. (a)(2)(B). Pub. L. 92-603, Sec. 227(e)(1), inserted 
provisions relating to medical and other health services performed by a 
physician to a patient in a hospital which has an approved teaching 
program.
    Subsec. (a)(2)(C). Pub. L. 92-603, Sec. 251(a)(4), inserted ``, 
other than services to which the next to last sentence of section 
1395x(p) of this title applies''.
    1968--Subsec. (a)(2)(B). Pub. L. 90-248, Sec. 129(c)(6)(B), inserted 
``and the services for which payment may be made pursuant to section 
1395n(b)(2) of this title'' after ``hospital''.
    Subsec. (a)(2)(C). Pub. L. 90-248, Sec. 133(d), added subpar. (C).


                    Effective Date of 1997 Amendment

    Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to 
services furnished on or after Oct. 1, 1997, see section 4201(d) of Pub. 
L. 105-33, set out as a note under section 1395f of this title.
    Amendment by section 4432(b)(5)(B) of Pub. L. 105-33 applicable to 
items and services furnished on or after July 1, 1998, see section 
4432(d) of Pub. L. 105-33, set out as a note under section 1395i-3 of 
this title.
    Section 4511(e) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1395l, 1395x, 
1395y, 1395cc, and 1395yy of this title] shall apply with respect to 
services furnished and supplies provided on and after January 1, 1998.''
    Amendment by section 4603(c)(2)(B)(ii) 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.


                    Effective Date of 1990 Amendment

    Section 4153(a)(3) of Pub. L. 101-508 provided that: ``The 
amendments made by paragraphs (1) and (2) [amending this section and 
sections 1395l and 1395m of this title] shall apply to items furnished 
on or after January 1, 1991.''
    Section 4155(e) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and sections 1395l, 1395u, 
and 1395x of this title] shall apply to services furnished on or after 
January 1, 1991.''
    Section 4157(d) of Pub. L. 101-508 provided that: ``The amendments 
made by the preceding subsections [amending this section and sections 
1395x, 1395y, and 1395cc of this title] apply to services furnished on 
or after January 1, 1991.''
    Section 4161(a)(8) of Pub. L. 101-508 provided that:
    ``(A) Subject to subparagraphs (B) and (C), the amendments made by 
this section [probably means this subsection, which amended this section 
and sections 1320a-7b, 1395l, 1395x, 1395y, and 1395oo of this title] 
shall apply to services furnished on or after October 1, 1991.
    ``(B) In the case of a Federally qualified health care center that 
has elected, as of January 1, 1990, under part B of title XVIII of the 
Social Security Act [this part], to have the amount of payments for 
services under such part determined on a reasonable-charge basis, the 
amendment made by paragraph (3)(A) [amending this section] shall only 
apply on and after such date (not earlier than October 1, 1991) as the 
center may elect.
    ``(C) The amendment made by paragraph (6) [amending section 1395oo 
of this title] shall apply to cost reports for periods beginning on or 
after October 1, 1991.''
    Section 4162(c) of Pub. L. 101-508 provided that: ``The amendments 
made by subsections (a) and (b) [amending this section and sections 
1395x and 1395cc of this title] shall apply with respect to partial 
hospitalization services provided on or after October 1, 1991.''


                    Effective Date of 1989 Amendment

    Amendment by section 101(a) of 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.
    Amendment by section 201(a) of Pub. L. 101-234 effective Jan. 1, 
1990, see section 201(c) of Pub. L. 101-234, set out as a note under 
section 1320a-7a of this title.


                    Effective Date of 1988 Amendment

    Amendment by section 104(d)(3) of 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.
    Amendment by section 203(a) of Pub. L. 100-360 applicable to items 
and services furnished on or after Jan. 1, 1990, see section 203(g) of 
Pub. L. 100-360, set out as a note under section 1320c-3 of this title.
    Section 205(f) of Pub. L. 100-360, which provided that the 
amendments made by section 205 of Pub. L. 100-360 [amending this section 
and sections 1395l, 1395n, 1395x, and 1395y of this title] were 
applicable to items and services furnished on or after January 1, 1990, 
was repealed by Pub. L. 101-234, title II, Sec. 201(a), Dec. 13, 1989, 
103 Stat. 1981.
    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by section 411(g)(2)(E), (h)(4)(A), (7)(B), (i)(4)(C)(vi) of 
Pub. L. 100-360, as it relates to a provision in the Omnibus Budget 
Reconciliation Act of 1987, Pub. L. 100-203, effective as if included in 
the enactment of that provision in Pub. L. 100-203, see section 411(a) 
of Pub. L. 100-360, set out as a Reference to OBRA; Effective Date note 
under section 106 of Title 1, General Provisions.


                    Effective Date of 1987 Amendment

    Amendment by section 4062(d)(2) of Pub. L. 100-203 applicable to 
covered items (other than oxygen and oxygen equipment) furnished on or 
after Jan. 1, 1989, and to oxygen and oxygen equipment furnished on or 
after June 1, 1989, see section 4062(e) of Pub. L. 100-203, as amended, 
set out as a note under section 1395f of this title.
    Section 4073(e) of Pub. L. 100-203 provided that: ``The amendments 
made by this section [amending this section and sections 1395l, 1395x, 
and 1396d of this title] shall be effective with respect to services 
performed on or after July 1, 1988.''
    Section 4077(b)(5), formerly Sec. 4077(b)(6), of Pub. L. 100-203, as 
renumbered by Pub. L. 100-360, title IV, Sec. 411(h)(7)(F), July 1, 
1988, 102 Stat. 787, provided that: ``The amendments made by this 
subsection [amending this section and sections 1395l and 1395x of this 
title] shall be effective with respect to services performed on or after 
July 1, 1988.''


                    Effective Date of 1986 Amendment

    Section 9320(i) of Pub. L. 99-509, as amended by Pub. L. 100-485, 
title VI, Sec. 608(c)(1), Oct. 13, 1988, 102 Stat. 2412, provided that: 
``Except as provided in subsection (k) [set out below], the amendments 
made by this section (other than subsection (a)) [amending this section 
and sections 1395l, 1395u, 1395x, 1395y, 1395aa, 1395bb, 1395cc, 1395ww, 
1396a, and 1396n of this title] shall apply to services furnished on or 
after January 1, 1989.''
    Section 9337(e) of Pub. L. 99-509 provided that: ``The amendments 
made by this section [amending this section and sections 1395l, 1395n, 
1395x, and 1395cc of this title] shall apply to expenses incurred for 
outpatient occupational therapy services furnished on or after July 1, 
1987.''


                    Effective Date of 1984 Amendment

    Section 2341(d) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section and section 1395x of this 
title] apply to services furnished on or after the date of the enactment 
of this Act [July 18, 1984].''
    Amendment by section 2354(b)(6) 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.


                    Effective Date of 1982 Amendment

    Amendment by Pub. L. 97-248 effective with respect to contracts 
entered into or renewed on or after Sept. 3, 1982, see section 149 of 
Pub. L. 97-248, set out as an Effective Date note under section 1320c of 
this title.


                    Effective Date of 1980 Amendment

    Amendment by section 930(g) 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.
    Section 933(h) of Pub. L. 96-499 provided that: ``The amendments 
made by this section [amending this section and sections 1395n, 1395x, 
1395z, and 1395aa of this title] shall become effective with respect to 
a comprehensive outpatient rehabilitation facility's first accounting 
period which begins on or after July 1, 1981.''
    Amendment by section 948(a)(2) of Pub. L. 96-499 applicable with 
respect to cost accounting periods beginning on or after Oct. 1, 1978, 
see section 948(c)(1) of Pub. L. 96-499, set out as a note under section 
1395x of this title.


                    Effective Date of 1977 Amendment

    Section 1(j) of Pub. L. 95-210 provided that: ``The amendments made 
by this section [amending this section and sections 1395l, 1395x, 1395y, 
and 1395aa of this title and enacting provisions set out as notes under 
sections 1395l and 1395x of this title] shall apply to services rendered 
on or after the first day of the third calendar month which begins after 
the date of enactment of this Act [Dec. 13, 1977].''


                    Effective Date of 1972 Amendment

    Amendment by section 227(e)(1) 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.
    Amendment by section 251(a)(4) of Pub. L. 92-603 applicable with 
respect to services furnished on or after July 1, 1973, see section 
251(d)(1) of Pub. L. 92-603, set out as a note under section 1395x of 
this title.


                    Effective Date of 1968 Amendment

    Amendment by section 129(c)(6)(B) of Pub. L. 90-248 applicable with 
respect to services furnished after Mar. 31, 1968, see section 129(d) of 
Pub. L. 90-248, set out as a note under section 1395d of this title.
    Section 133(g) of Pub. L. 90-248 provided that: ``The amendments 
made by the preceding subsections of this section [amending this section 
and sections 1395n, 1395x, 1395aa, and 1395cc of this title] shall apply 
to services furnished after June 30, 1968.''


                Report on Immunosuppressive Drug Benefit

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 227(d)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-356, provided that:
    ``(1) In general.--Not later than March 1, 2003, the Secretary of 
Health and Human Services shall submit to Congress a report on the 
operation of this section and the amendments made by this section 
[amending this section and section 1395x of this title]. The report 
shall include--
        ``(A) an analysis of the impact of this section; and
        ``(B) recommendations regarding an appropriate cost-effective 
    method for providing coverage of immunosuppressive drugs under the 
    medicare program on a permanent basis.
    ``(2) Considerations.--In making recommendations under paragraph 
(1)(B), the Secretary shall identify potential modifications to the 
immunosuppressive drug benefit that would best promote the objectives 
of--
        ``(A) improving health outcomes (by decreasing transplant 
    rejection rates that are attributable to failure to comply with 
    immunosuppressive drug regimens);
        ``(B) achieving cost savings to the medicare program (by 
    decreasing the need for secondary transplants and other care 
    relating to post-transplant complications); and
        ``(C) meeting the needs of those medicare beneficiaries who, 
    because of income or other factors, would be less likely to maintain 
    an immunosuppressive drug regimen in the absence of such 
    modifications.''


             Construction of Section 9320 of Pub. L. 99-509

    Section 9320(j) of Pub. L. 99-509 provided that: ``Nothing in this 
section or the amendments made by this section [amending this section 
and sections 1395l, 1395u, 1395x, 1395y, 1395aa, 1395bb, 1395cc, 1395ww, 
1396a, and 1396n of this title, enacting provisions set out as notes 
under this section, and amending provisions set out as a note under 
section 1395ww of this title] shall contravene provisions of State law 
relating to the practice of medicine or nursing or State law 
requirements or institutional requirements regarding the administration 
of anesthesia and its medical direction or supervision.''


   Quality and Utilization of In-Home Care for Chronically Dependent 
                               Individuals

    Section 205(e)(2) of Pub. L. 100-360 directed Secretary of Health 
and Human Services to take appropriate efforts to assure quality and 
provide for appropriate utilization of in-home care for chronically 
dependent individuals under the amendments made by section 205 of Pub. 
L. 100-360 [amending this section and sections 1395l, 1395n, 1395x, and 
1395y of this title], prior to repeal by Pub. L. 101-234, title II, 
Sec. 201(a), Dec. 13, 1989, 103 Stat. 1981.


                Study of Alternative Out-of-Home Services

    Section 205(g) of Pub. L. 100-360, which required Secretary of 
Health and Human Services to study, and report to Congress, not later 
than 18 months after July 1, 1988, on advisability of providing, to 
chronically dependent individuals eligible for in-home care under 
amendments made by section 205 of Pub. L. 100-360 [amending this section 
and sections 1395l, 1395n, 1395x, and 1395y of this title], out-of-home 
services as alternative services to in-home care, was repealed by Pub. 
L. 101-234, title II, Sec. 201(a), Dec. 13, 1989, 103 Stat. 1981.


    Continuation of Cost Pass-Through for Certified Registered Nurse 
                              Anesthetists

    Section 9320(k) of Pub. L. 99-509, as added by Pub. L. 100-485, 
title VI, Sec. 608(c)(2), Oct. 13, 1988, 102 Stat. 2412, and amended by 
Pub. L. 101-239, title VI, Sec. 6132(a), Dec. 19, 1989, 103 Stat. 2222, 
provided that:
    ``(1) Subject to paragraph (2), the amendments made by this section 
[amending this section and sections 1395l, 1395u, 1395x, 1395y, 1395aa, 
1395bb, 1395cc, 1395ww, 1396a, and 1396n of this title and provisions 
set out as a note under section 1395ww of this title] shall not apply 
during a year (beginning with 1989) to a hospital located in a rural 
area (as defined for purposes of section 1886(d) of the Social Security 
Act [section 1395ww(d) of this title]) if the hospital establishes, at 
any time before the year[,] to the satisfaction of the Secretary of 
Health and Human Services that--
        ``(A) as of January 1, 1988, the hospital employed or contracted 
    with a certified registered nurse anesthetist (but not more than one 
    full-time equivalent certified registered nurse anesthetist),
        ``(B) in 1987 the hospital had a volume of surgical procedures 
    (including inpatient and outpatient procedures) requiring anesthesia 
    services that did not exceed 500 (or such higher number as the 
    Secretary determines to be appropriate), and
        ``(C) each certified registered nurse anesthetist employed by, 
    or under contract with, the hospital has agreed not to bill under 
    part B of title XVIII of such Act [this part] for professional 
    services furnished by the anesthetist at the hospital.
    ``(2) Paragraph (1) shall not apply in a year (after 1989) to a 
hospital unless the hospital establishes, before the beginning of the 
year, that the hospital has had a volume of surgical procedures 
(including inpatient and outpatient procedures) requiring anesthesia 
services in the previous year that did not exceed 500 (or such higher 
number as the Secretary determines to be appropriate).''
    [Section 6132(b) of Pub. L. 101-239 provided that: ``The amendments 
made by this section [amending section 9320(k) of Pub. L. 99-509, set 
out above] shall apply to services furnished on or after January 1, 
1990.'']


 Payment for Services of Physicians Rendered in a Teaching Hospital for 
 Accounting Periods Beginning After June 30, 1975, and Prior to October 
            1, 1978; Studies, Reports, etc.; Effective Dates

    Pub. L. 93-233, Sec. 15(a)(2), Dec. 31, 1973, 87 Stat. 966, provided 
that for the cost accounting periods beginning after June 30, 1975, and 
prior to Oct. 1, 1978, subsec. (a)(2)(B)(i) of this section will be 
administered as if subclause II of subsec. (a)(2)(B)(i) read as follows: 
``(II) a physician to a patient in a hospital which has a teaching 
program approved as specified in paragraph (6) of section 1861(b) 
[section 1395x(b)(6) of this title] (including services in conjunction 
with the teaching programs of such hospital whether or not such patient 
is an inpatient of such hospital), where the conditions specified in 
paragraph (7) of such section [section 1395x(b)(7) of this title] are 
met and''.

                  Section Referred to in Other Sections

    This section is referred to in sections 1395l, 1395n, 1395x, 1395z, 
1395aa, 1395gg of this title.
