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[CITE: 42USC1395l]

 
                 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. 1395l. Payment of benefits


(a) Amounts

    Except as provided in section 1395mm of this title, and subject to 
the succeeding provisions of this section, there shall be paid from the 
Federal Supplementary Medical Insurance Trust Fund, in the case of each 
individual who is covered under the insurance program established by 
this part and incurs expenses for services with respect to which 
benefits are payable under this part, amounts equal to--
        (1) in the case of services described in section 1395k(a)(1) of 
    this title--80 percent of the reasonable charges for the services; 
    except that (A) an organization which provides medical and other 
    health services (or arranges for their availability) on a prepayment 
    basis (and either is sponsored by a union or employer, or does not 
    provide, or arrange for the provision of, any inpatient hospital 
    services) may elect to be paid 80 percent of the reasonable cost of 
    services for which payment may be made under this part on behalf of 
    individuals enrolled in such organization in lieu of 80 percent of 
    the reasonable charges for such services if the organization 
    undertakes to charge such individuals no more than 20 percent of 
    such reasonable cost plus any amounts payable by them as a result of 
    subsection (b) of this section, (B) with respect to items and 
    services described in section 1395x(s)(10)(A) of this title, the 
    amounts paid shall be 100 percent of the reasonable charges for such 
    items and services, (C) with respect to expenses incurred for those 
    physicians' services for which payment may be made under this part 
    that are described in section 1395y(a)(4) of this title, the amounts 
    paid shall be subject to such limitations as may be prescribed by 
    regulations, (D) with respect to clinical diagnostic laboratory 
    tests for which payment is made under this part (i) on the basis of 
    a fee schedule under subsection (h)(1) of this section or section 
    1395m(d)(1) of this title, the amount paid shall be equal to 80 
    percent (or 100 percent, in the case of such tests for which payment 
    is made on an assignment-related basis or which are furnished on an 
    outpatient basis by a critical access hospital) of the lesser of the 
    amount determined under such fee schedule, the limitation amount for 
    that test determined under subsection (h)(4)(B) of this section, or 
    the amount of the charges billed for the tests, or (ii) on the basis 
    of a negotiated rate established under subsection (h)(6) of this 
    section, the amount paid shall be equal to 100 percent of such 
    negotiated rate, (E) with respect to services furnished to 
    individuals who have been determined to have end stage renal 
    disease, the amounts paid shall be determined subject to the 
    provisions of section 1395rr of this title, (F) with respect to 
    clinical social worker services under section 1395x(s)(2)(N) of this 
    title, the amounts paid shall be 80 percent of the lesser of (i) the 
    actual charge for the services or (ii) 75 percent of the amount 
    determined for payment of a psychologist under clause (L), [(G) 
    Repealed. Pub. L. 103-432, title I, Sec. 156(a)(2)(B)(ii), Oct. 31, 
    1994, 108 Stat. 4440,] (H) with respect to services of a certified 
    registered nurse anesthetist under section 1395x(s)(11) of this 
    title, the amounts paid shall be 80 percent of the least of the 
    actual charge, the prevailing charge that would be recognized (or, 
    for services furnished on or after January 1, 1992, the fee schedule 
    amount provided under section 1395w-4 of this title) if the services 
    had been performed by an anesthesiologist, or the fee schedule for 
    such services established by the Secretary in accordance with 
    subsection (l) of this section, (I) with respect to covered items 
    (described in section 1395m(a)(13) of this title), the amounts paid 
    shall be the amounts described in section 1395m(a)(1) of this title, 
    and \1\ (J) with respect to expenses incurred for radiologist 
    services (as defined in section 1395m(b)(6) of this title), subject 
    to section 1395w-4 of this title, the amounts paid shall be 80 
    percent of the lesser of the actual charge for the services or the 
    amount provided under the fee schedule established under section 
    1395m(b) of this title, (K) with respect to certified nurse-midwife 
    services under section 1395x(s)(2)(L) of this title, the amounts 
    paid shall be 80 percent of the lesser of the actual charge for the 
    services or the amount determined by a fee schedule established by 
    the Secretary for the purposes of this subparagraph (but in no event 
    shall such fee schedule exceed 65 percent of the prevailing charge 
    that would be allowed for the same service performed by a physician, 
    or, for services furnished on or after January 1, 1992, 65 percent 
    of the fee schedule amount provided under section 1395w-4 of this 
    title for the same service performed by a physician), (L) with 
    respect to qualified psychologist services under section 
    1395x(s)(2)(M) of this title, the amounts paid shall be 80 percent 
    of the lesser of the actual charge for the services or the amount 
    determined by a fee schedule established by the Secretary for the 
    purposes of this subparagraph, (M) with respect to prosthetic 
    devices and orthotics and prosthetics (as defined in section 
    1395m(h)(4) of this title), the amounts paid shall be the amounts 
    described in section 1395m(h)(1) of this title, (N) with respect to 
    expenses incurred for physicians' services (as defined in section 
    1395w-4(j)(3) of this title), the amounts paid shall be 80 percent 
    of the payment basis determined under section 1395w-4(a)(1) of this 
    title, (O) with respect to services described in section 
    1395x(s)(2)(K) of this title (relating to services furnished by 
    physician assistants, nurse practitioners, or clinic nurse 
    specialists), the amounts paid shall be equal to 80 percent of (i) 
    the lesser of the actual charge or 85 percent of the fee schedule 
    amount provided under section 1395w-4 of this title, or (ii) in the 
    case of services as an assistant at surgery, the lesser of the 
    actual charge or 85 percent of the amount that would otherwise be 
    recognized if performed by a physician who is serving as an 
    assistant at surgery, (P) with respect to surgical dressings, the 
    amounts paid shall be the amounts determined under section 1395m(i) 
    of this title, (Q) with respect to items or services for which fee 
    schedules are established pursuant to section 1395u(s) of this 
    title, the amounts paid shall be 80 percent of the lesser of the 
    actual charge or the fee schedule established in such section, (R) 
    with respect to ambulance service, the amounts paid shall be 80 
    percent of the lesser of the actual charge for the services or the 
    amount determined by a fee schedule established by the Secretary 
    under section 1395m(l) of this title, and (S) with respect to drugs 
    and biologicals not paid on a cost or prospective payment basis as 
    otherwise provided in this part (other than items and services 
    described in subparagraph (B)), the amounts paid shall be 80 percent 
    of the lesser of the actual charge or the payment amount established 
    in section 1395u(o) of this title;
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    \1\ So in original. The word ``and'' probably should not appear.
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        (2) in the case of services described in section 1395k(a)(2) of 
    this title (except those services described in subparagraphs (C), 
    (D), (E), (F), (G), (H), and (I) of such section and unless 
    otherwise specified in section 1395rr of this title)--
            (A) with respect to home health services (other than a 
        covered osteoporosis drug) (as defined in section 1395x(kk) of 
        this title), the amount determined under the prospective payment 
        system under section 1395fff of this title;
            (B) with respect to other items and services (except those 
        described in subparagraph (C), (D), or (E) of this paragraph and 
        except as may be provided in section 1395ww of this title or 
        section 1395yy(e)(9) of this title)--
                (i) furnished before January 1, 1999, the lesser of--
                    (I) the reasonable cost of such services, as 
                determined under section 1395x(v) of this title, or
                    (II) the customary charges with respect to such 
                services,

          less the amount a provider may charge as described in clause 
            (ii) of section 1395cc(a)(2)(A) of this title, but in no 
            case may the payment for such other services exceed 80 
            percent of such reasonable cost, or
                (ii) if such services are furnished before January 1, 
            1999, 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 
            clause), free of charge or at nominal charges to the public, 
            80 percent of the amount determined in accordance with 
            section 1395f(b)(2) of this title, or
                (iii) if such services are furnished on or after January 
            1, 1999, the amount determined under subsection (t) of this 
            section, or
                (iv) if (and for so long as) the conditions described in 
            section 1395f(b)(3) of this title are met, the amounts 
            determined under the reimbursement system described in such 
            section;

            (C) with respect to services described in the second 
        sentence of section 1395x(p) of this title, 80 percent of the 
        reasonable charges for such services;
            (D) with respect to clinical diagnostic laboratory tests for 
        which payment is made under this part (i) on the basis of a fee 
        schedule determined under subsection (h)(1) of this section or 
        section 1395m(d)(1) of this title, the amount paid shall be 
        equal to 80 percent (or 100 percent, in the case of such tests 
        for which payment is made on an assignment-related basis or 
        which are furnished on an outpatient basis by a critical access 
        hospital or to a provider having an agreement under section 
        1395cc of this title) of the lesser of the amount determined 
        under such fee schedule, the limitation amount for that test 
        determined under subsection (h)(4)(B) of this section, or the 
        amount of the charges billed for the tests, or (ii) on the basis 
        of a negotiated rate established under subsection (h)(6) of this 
        section, the amount paid shall be equal to 100 percent of such 
        negotiated rate for such tests;
            (E) with respect to--
                (i) outpatient hospital radiology services (including 
            diagnostic and therapeutic radiology, nuclear medicine and 
            CAT scan procedures, magnetic resonance imaging, and 
            ultrasound and other imaging services, but excluding 
            screening mammography), and
                (ii) effective for procedures performed on or after 
            October 1, 1989, diagnostic procedures (as defined by the 
            Secretary) described in section 1395x(s)(3) of this title 
            (other than diagnostic x-ray tests and diagnostic laboratory 
            tests),

        the amount determined under subsection (n) of this section or, 
        for services or procedures performed on or after January 1, 
        1999, subsection (t) of this section;
            (F) with respect to a covered osteoporosis drug (as defined 
        in section 1395x(kk) of this title) furnished by a home health 
        agency, 80 percent of the reasonable cost of such service, as 
        determined under section 1395x(v) of this title; and
            (G) with respect to items and services described in section 
        1395x(s)(10)(A) of this title, the lesser of--
                (i) the reasonable cost of such services, as determined 
            under section 1395x(v) of this title, or
                (ii) the customary charges with respect to such 
            services,

        or, 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 provision), free of charge or at nominal charges to the 
        public, the amount determined in accordance with section 
        1395f(b)(2) of this title;

        (3) in the case of services described in section 1395k(a)(2)(D) 
    of this title, the costs which are reasonable and related to the 
    cost of furnishing such services 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, less the amount a provider may charge as described in 
    clause (ii) of section 1395cc(a)(2)(A) of this title, but in no case 
    may the payment for such services (other than for items and services 
    described in section 1395x(s)(10)(A) of this title) exceed 80 
    percent of such costs;
        (4) in the case of facility services described in section 
    1395k(a)(2)(F) of this title, and outpatient hospital facility 
    services furnished in connection with surgical procedures specified 
    by the Secretary pursuant to subsection (i)(1)(A) of this section, 
    the applicable amount as determined under paragraph (2) or (3) of 
    subsection (i) of this section or subsection (t) of this section;
        (5) in the case of covered items (described in section 
    1395m(a)(13) of this title) the amounts described in section 
    1395m(a)(1) of this title;
        (6) in the case of outpatient critical access hospital services, 
    the amounts described in section 1395m(g) of this title;
        (7) in the case of prosthetic devices and orthotics and 
    prosthetics (as described in section 1395m(h)(4) of this title), the 
    amounts described in section 1395m(h) of this title;
        (8) in the case of--
            (A) outpatient physical therapy services (which includes 
        outpatient speech-language pathology services) and outpatient 
        occupational therapy services furnished--
                (i) by a rehabilitation agency, public health agency, 
            clinic, comprehensive outpatient rehabilitation facility, or 
            skilled nursing facility,
                (ii) by a home health agency to an individual who is not 
            homebound, or
                (iii) by another entity under an arrangement with an 
            entity described in clause (i) or (ii); and

            (B) outpatient physical therapy services (which includes 
        outpatient speech-language pathology services) and outpatient 
        occupational therapy services furnished--
                (i) by a hospital to an outpatient or to a hospital 
            inpatient who is entitled to benefits under part A of this 
            subchapter but has exhausted benefits for inpatient hospital 
            services during a spell of illness or is not so entitled to 
            benefits under part A of this subchapter, or
                (ii) by another entity under an arrangement with a 
            hospital described in clause (i),

    the amounts described in section 1395m(k) of this title; and
        (9) in the case of services described in section 1395k(a)(2)(E) 
    of this title that are not described in paragraph (8), the amounts 
    described in section 1395m(k) of this title.

(b) Deductible provision

    Before applying subsection (a) of this section with respect to 
expenses incurred by an individual during any calendar year, the total 
amount of the expenses incurred by such individual during such year 
(which would, except for this subsection, constitute incurred expenses 
from which benefits payable under subsection (a) of this section are 
determinable) shall be reduced by a deductible of $75 for calendar years 
before 1991 and $100 for 1991 and subsequent years; except that (1) such 
total amount shall not include expenses incurred for items and services 
described in section 1395x(s)(10)(A) of this title, (2) such deductible 
shall not apply with respect to home health services (other than a 
covered osteoporosis drug (as defined in section 1395x(kk) of this 
title)), (3) such deductible shall not apply with respect to clinical 
diagnostic laboratory tests for which payment is made under this part 
(A) under subsection (a)(1)(D)(i) or (a)(2)(D)(i) of this section on an 
assignment-related basis, or to a provider having an agreement under 
section 1395cc of this title, or (B) on the basis of a negotiated rate 
determined under subsection (h)(6) of this section, (4) such deductible 
shall not apply to Federally qualified health center services, (5) such 
deductible shall not apply with respect to screening mammography (as 
described in section 1395x(jj) of this title), and (6) such deductible 
shall not apply with respect to screening pap smear and screening pelvic 
exam (as described in section 1395x(nn) of this title). The total amount 
of the expenses incurred by an individual as determined under the 
preceding sentence shall, after the reduction specified in such 
sentence, be further reduced by an amount equal to the expenses incurred 
for the first three pints of whole blood (or equivalent quantities of 
packed red blood cells, as defined under regulations) furnished to the 
individual during the calendar year, except that such deductible for 
such blood shall in accordance with regulations be appropriately reduced 
to the extent that there has been a replacement of such blood (or 
equivalent quantities of packed red blood cells, as so defined); and for 
such purposes blood (or equivalent quantities of packed red blood cells, 
as so defined) furnished such individual shall be deemed replaced when 
the institution or other person furnishing such blood (or such 
equivalent quantities of packed red blood cells, as so defined) is given 
one pint of blood for each pint of blood (or equivalent quantities of 
packed red blood cells, as so defined) furnished such individual with 
respect to which a deduction is made under this sentence. The deductible 
under the previous sentence for blood or blood cells furnished an 
individual in a year shall be reduced to the extent that a deductible 
has been imposed under section 1395e(a)(2) of this title to blood or 
blood cells furnished the individual in the year.

(c) Mental disorders

    Notwithstanding any other provision of this part, with respect to 
expenses incurred in any calendar year in connection with the treatment 
of mental, psychoneurotic, and personality disorders of an individual 
who is not an inpatient of a hospital at the time such expenses are 
incurred, there shall be considered as incurred expenses for purposes of 
subsections (a) and (b) of this section only 62\1/2\ percent of such 
expenses. For purposes of this subsection, the term ``treatment'' does 
not include brief office visits (as defined by the Secretary) for the 
sole purpose of monitoring or changing drug prescriptions used in the 
treatment of such disorders or partial hospitalization services that are 
not directly provided by a physician.

(d) Nonduplication of payments

    No payment may be made under this part with respect to any services 
furnished an individual to the extent that such individual is entitled 
(or would be entitled except for section 1395e of this title) to have 
payment made with respect to such services under part A of this 
subchapter.

(e) Information for determination of amounts due

    No payment shall be made to any provider of services or other person 
under this part unless there has been furnished such information as may 
be necessary in order to determine the amounts due such provider or 
other person under this part for the period with respect to which the 
amounts are being paid or for any prior period.

(f) Maximum rate of payment per visit for independent rural health 
        clinics

    In establishing limits under subsection (a) of this section on 
payment for rural health clinic services provided by rural health 
clinics (other than such clinics in rural hospitals with less than 50 
beds), the Secretary shall establish such limit, for services provided--
        (1) in 1988, after March 31, at $46 per visit, and
        (2) in a subsequent year, at the limit established under this 
    subsection for the previous year increased by the percentage 
    increase in the MEI (as defined in section 1395u(i)(3) of this 
    title) applicable to primary care services (as defined in section 
    1395u(i)(4) of this title) furnished as of the first day of that 
    year.

(g) Physical therapy services

    (1) Subject to paragraph (4), in the case of physical therapy 
services of the type described in section 1395x(p) of this title, but 
not described in subsection (a)(8)(B) of this section, and physical 
therapy services of such type which are furnished by a physician or as 
incident to physicians' services, with respect to expenses incurred in 
any calendar year, no more than the amount specified in paragraph (2) 
for the year shall be considered as incurred expenses for purposes of 
subsections (a) and (b) of this section.
    (2) The amount specified in this paragraph--
        (A) for 1999, 2000, and 2001, is $1,500, and
        (B) for a subsequent year is the amount specified in this 
    paragraph for the preceding year increased by the percentage 
    increase in the MEI (as defined in section 1395u(i)(3) of this 
    title) for such subsequent year;

except that if an increase under subparagraph (B) for a year is not a 
multiple of $10, it shall be rounded to the nearest multiple of $10.
    (3) Subject to paragraph (4), in the case of occupational therapy 
services (of the type that are described in section 1395x(p) of this 
title (but not described in subsection (a)(8)(B) of this section) 
through the operation of section 1395x(g) of this title and of such type 
which are furnished by a physician or as incident to physicians' 
services), with respect to expenses incurred in any calendar year, no 
more than the amount specified in paragraph (2) for the year shall be 
considered as incurred expenses for purposes of subsections (a) and (b) 
of this section.
    (4) This subsection shall not apply to expenses incurred with 
respect to services furnished during 2000 and 2001.

(h) Fee schedules for clinical diagnostic laboratory tests; percentage 
        of prevailing charge level; nominal fee for samples; 
        adjustments; recipients of payments; negotiated payment rate

    (1)(A) Subject to section 1395m(d)(1) of this title, the Secretary 
shall establish fee schedules for clinical diagnostic laboratory tests 
(including prostate cancer screening tests under section 1395x(oo) of 
this title consisting of prostate-specific antigen blood tests) for 
which payment is made under this part, other than such tests performed 
by a provider of services for an inpatient of such provider.
    (B) In the case of clinical diagnostic laboratory tests performed by 
a physician or by a laboratory (other than tests performed by a 
qualified hospital laboratory (as defined in subparagraph (D)) for 
outpatients of such hospital), the fee schedules established under 
subparagraph (A) shall be established on a regional, statewide, or 
carrier service area basis (as the Secretary may determine to be 
appropriate) for tests furnished on or after July 1, 1984.
    (C) In the case of clinical diagnostic laboratory tests performed by 
a qualified hospital laboratory (as defined in subparagraph (D)) for 
outpatients of such hospital, the fee schedules established under 
subparagraph (A) shall be established on a regional, statewide, or 
carrier service area basis (as the Secretary may determine to be 
appropriate) for tests furnished on or after July 1, 1984.
    (D) In this subsection, the term ``qualified hospital laboratory'' 
means a hospital laboratory, in a sole community hospital (as defined in 
section 1395ww(d)(5)(D)(iii) of this title), which provides some 
clinical diagnostic laboratory tests 24 hours a day in order to serve a 
hospital emergency room which is available to provide services 24 hours 
a day and 7 days a week.
    (2)(A)(i) Except as provided in paragraph (4), the Secretary shall 
set the fee schedules at 60 percent (or, in the case of a test performed 
by a qualified hospital laboratory (as defined in paragraph (1)(D)) for 
outpatients of such hospital, 62 percent) of the prevailing charge level 
determined pursuant to the third and fourth sentences of section 
1395u(b)(3) of this title for similar clinical diagnostic laboratory 
tests for the applicable region, State, or area for the 12-month period 
beginning July 1, 1984, adjusted annually (to become effective on 
January 1 of each year) by a percentage increase or decrease equal to 
the percentage increase or decrease in the Consumer Price Index for All 
Urban Consumers (United States city average), and subject to such other 
adjustments as the Secretary determines are justified by technological 
changes.
    (ii) Notwithstanding clause (i)--
        (I) any change in the fee schedules which would have become 
    effective under this subsection for tests furnished on or after 
    January 1, 1988, shall not be effective for tests furnished during 
    the 3-month period beginning on January 1, 1988,
        (II) the Secretary shall not adjust the fee schedules under 
    clause (i) to take into account any increase in the consumer price 
    index for 1988,
        (III) the annual adjustment in the fee schedules determined 
    under clause (i) for each of the years 1991, 1992, and 1993 shall be 
    2 percent, and
        (IV) the annual adjustment in the fee schedules determined under 
    clause (i) for each of the years 1994 and 1995 and 1998 through 2002 
    shall be 0 percent.

    (iii) In establishing fee schedules under clause (i) with respect to 
automated tests and tests (other than cytopathology tests) which before 
July 1, 1984, the Secretary made subject to a limit based on lowest 
charge levels under the sixth sentence of section 1395u(b)(3) of this 
title performed after March 31, 1988, the Secretary shall reduce by 8.3 
percent the fee schedules otherwise established for 1988, and such 
reduced fee schedules shall serve as the base for 1989 and subsequent 
years.
    (B) The Secretary may make further adjustments or exceptions to the 
fee schedules to assure adequate reimbursement of (i) emergency 
laboratory tests needed for the provision of bona fide emergency 
services, and (ii) certain low volume high-cost tests where highly 
sophisticated equipment or extremely skilled personnel are necessary to 
assure quality.
    (3) In addition to the amounts provided under the fee schedules, the 
Secretary shall provide for and establish (A) a nominal fee to cover the 
appropriate costs in collecting the sample on which a clinical 
diagnostic laboratory test was performed and for which payment is made 
under this part, except that not more than one such fee may be provided 
under this paragraph with respect to samples collected in the same 
encounter, and (B) a fee to cover the transportation and personnel 
expenses for trained personnel to travel to the location of an 
individual to collect the sample, except that such a fee may be provided 
only with respect to an individual who is homebound or an inpatient in 
an inpatient facility (other than a hospital). In establishing a fee to 
cover the transportation and personnel expenses for trained personnel to 
travel to the location of an individual to collect a sample, the 
Secretary shall provide a method for computing the fee based on the 
number of miles traveled and the personnel costs associated with the 
collection of each individual sample, but the Secretary shall only be 
required to apply such method in the case of tests furnished during the 
period beginning on April 1, 1989, and ending on December 31, 1990, by a 
laboratory that establishes to the satisfaction of the Secretary (based 
on data for the 12-month period ending June 30, 1988) that (i) the 
laboratory is dependent upon payments under this subchapter for at least 
80 percent of its collected revenues for clinical diagnostic laboratory 
tests, (ii) at least 85 percent of its gross revenues for such tests are 
attributable to tests performed with respect to individuals who are 
homebound or who are residents in a nursing facility, and (iii) the 
laboratory provided such tests for residents in nursing facilities 
representing at least 20 percent of the number of such facilities in the 
State in which the laboratory is located.
    (4)(A) In establishing any fee schedule under this subsection, the 
Secretary may provide for an adjustment to take into account, with 
respect to the portion of the expenses of clinical diagnostic laboratory 
tests attributable to wages, the relative difference between a region's 
or local area's wage rates and the wage rate presumed in the data on 
which the schedule is based.
    (B) For purposes of subsections (a)(1)(D)(i) and (a)(2)(D)(i) of 
this section, the limitation amount for a clinical diagnostic laboratory 
test performed--
        (i) on or after July 1, 1986, and before April 1, 1988, is equal 
    to 115 percent of the median of all the fee schedules established 
    for that test for that laboratory setting under paragraph (1),
        (ii) after March 31, 1988, and before January 1, 1990, is equal 
    to the median of all the fee schedules established for that test for 
    that laboratory setting under paragraph (1),
        (iii) after December 31, 1989, and before January 1, 1991, is 
    equal to 93 percent of the median of all the fee schedules 
    established for that test for that laboratory setting under 
    paragraph (1),
        (iv) after December 31, 1990, and before January 1, 1994, is 
    equal to 88 percent of such median,
        (v) after December 31, 1993, and before January 1, 1995, is 
    equal to 84 percent of such median,
        (vi) after December 31, 1994, and before January 1, 1996, is 
    equal to 80 percent of such median,
        (vii) after December 31, 1995, and before January 1, 1998, is 
    equal to 76 percent of such median, and
        (viii) after December 31, 1997, is equal to 74 percent of such 
    median.

    (5)(A) In the case of a bill or request for payment for a clinical 
diagnostic laboratory test for which payment may otherwise be made under 
this part on an assignment-related basis or under a provider agreement 
under section 1395cc of this title, payment may be made only to the 
person or entity which performed or supervised the performance of such 
test; except that--
        (i) if a physician performed or supervised the performance of 
    such test, payment may be made to another physician with whom he 
    shares his practice,
        (ii) in the case of a test performed at the request of a 
    laboratory by another laboratory, payment may be made to the 
    referring laboratory but only if--
            (I) the referring laboratory is located in, or is part of, a 
        rural hospital,
            (II) the referring laboratory is wholly owned by the entity 
        performing such test, the referring laboratory wholly owns the 
        entity performing such test, or both the referring laboratory 
        and the entity performing such test are wholly-owned by a third 
        entity, or
            (III) not more than 30 percent of the clinical diagnostic 
        laboratory tests for which such referring laboratory (but not 
        including a laboratory described in subclause (II)),\2\ receives 
        requests for testing during the year in which the test is 
        performed \2\ are performed by another laboratory, and
---------------------------------------------------------------------------
    \2\ So in original. The comma after ``subclause (II))'' probably 
should follow ``is performed''.

        (iii) in the case of a clinical diagnostic laboratory test 
    provided under an arrangement (as defined in section 1395x(w)(1) of 
    this title) made by a hospital, critical access hospital, or skilled 
    nursing facility, payment shall be made to the hospital or skilled 
---------------------------------------------------------------------------
    nursing facility.

    (B) In the case of such a bill or request for payment for a clinical 
diagnostic laboratory test for which payment may otherwise be made under 
this part, and which is not described in subparagraph (A), payment may 
be made to the beneficiary only on the basis of the itemized bill of the 
person or entity which performed or supervised the performance of the 
test.
    (C) Payment for a clinical diagnostic laboratory test, including a 
test performed in a physician's office but excluding a test performed by 
a rural health clinic may only be made on an assignment-related basis or 
to a provider of services with an agreement in effect under section 
1395cc of this title.
    (D) A person may not bill for a clinical diagnostic laboratory test, 
including a test performed in a physician's office but excluding a test 
performed by a rural health clinic,,\3\ other than on an assignment-
related basis. If a person knowingly and willfully and on a repeated 
basis bills for a clinical diagnostic laboratory test in violation of 
the previous sentence, the Secretary may apply sanctions against the 
person in the same manner as the Secretary may apply sanctions against a 
physician in accordance with paragraph (2) of section 1395u(j) of this 
title in the same manner such paragraphs apply \4\ with respect to a 
physician. Paragraph (4) of such section shall apply in this 
subparagraph in the same manner as such paragraph applies to such 
section.
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    \3\ So in original.
    \4\ So in original. Probably should be ``such paragraph applies''.
---------------------------------------------------------------------------
    (6) In the case of any diagnostic laboratory test payment for which 
is not made on the basis of a fee schedule under paragraph (1), the 
Secretary may establish a payment rate which is acceptable to the person 
or entity performing the test and which would be considered the full 
charge for such tests. Such negotiated rate shall be limited to an 
amount not in excess of the total payment that would have been made for 
the services in the absence of such rate.
    (7) Notwithstanding paragraphs (1) and (4), the Secretary shall 
establish a national minimum payment amount under this subsection for a 
diagnostic or screening pap smear laboratory test (including all 
cervical cancer screening technologies that have been approved by the 
Food and Drug Administration as a primary screening method for detection 
of cervical cancer) equal to $14.60 for tests furnished in 2000. For 
such tests furnished in subsequent years, such national minimum payment 
amount shall be adjusted annually as provided in paragraph (2).

(i) Outpatient surgery

    (1) The Secretary shall, in consultation with appropriate medical 
organizations--
        (A) specify those surgical procedures which are appropriately 
    (when considered in terms of the proper utilization of hospital 
    inpatient facilities) performed on an inpatient basis in a hospital 
    but which also can be performed safely on an ambulatory basis in an 
    ambulatory surgical center (meeting the standards specified under 
    section 1395k(a)(2)(F)(i) of this title), critical access hospital, 
    or hospital outpatient department, and
        (B) specify those surgical procedures which are appropriately 
    (when considered in terms of the proper utilization of hospital 
    inpatient facilities) performed on an inpatient basis in a hospital 
    but which also can be performed safely on an ambulatory basis in a 
    physician's office.

The lists of procedures established under subparagraphs (A) and (B) 
shall be reviewed and updated not less often than every 2 years, in 
consultation with appropriate trade and professional organizations.
    (2)(A) The amount of payment to be made for facility services 
furnished in connection with a surgical procedure specified pursuant to 
paragraph (1)(A) and furnished to an individual in an ambulatory 
surgical center described in such paragraph shall be equal to 80 percent 
of a standard overhead amount established by the Secretary (with respect 
to each such procedure) on the basis of the Secretary's estimate of a 
fair fee which--
        (i) takes into account the costs incurred by such centers, or 
    classes of centers, generally in providing services furnished in 
    connection with the performance of such procedure, as determined in 
    accordance with a survey (based upon a representative sample of 
    procedures and facilities) taken not later than January 1, 1995, and 
    every 5 years thereafter, of the actual audited costs incurred by 
    such centers in providing such services,
        (ii) takes such costs into account in such a manner as will 
    assure that the performance of the procedure in such a center will 
    result in substantially less amounts paid under this subchapter than 
    would have been paid if the procedure had been performed on an 
    inpatient basis in a hospital, and
        (iii) in the case of insertion of an intraocular lens during or 
    subsequent to cataract surgery includes payment which is reasonable 
    and related to the cost of acquiring the class of lens involved.

Each amount so established shall be reviewed and updated not later than 
July 1, 1987, and annually thereafter to take account of varying 
conditions in different areas.
    (B) The amount of payment to be made under this part for facility 
services furnished, in connection with a surgical procedure specified 
pursuant to paragraph (1)(B), in a physician's office shall be equal to 
80 percent of a standard overhead amount established by the Secretary 
(with respect to each such procedure) on the basis of the Secretary's 
estimate of a fair fee which--
        (i) takes into account additional costs, not usually included in 
    the professional fee, incurred by physicians in securing, 
    maintaining, and staffing the facilities and ancillary services 
    appropriate for the performance of such procedure in the physician's 
    office, and
        (ii) takes such items into account in such a manner which will 
    assure that the performance of such procedure in the physician's 
    office will result in substantially less amounts paid under this 
    subchapter than would have been paid if the services had been 
    furnished on an inpatient basis in a hospital.

Each amount so established shall be reviewed and updated not later than 
July 1, 1987, and annually thereafter to take account of varying 
conditions in different areas.
    (C) Notwithstanding the second sentence of subparagraph (A) or the 
second sentence of subparagraph (B), if the Secretary has not updated 
amounts established under such subparagraphs with respect to facility 
services furnished during a fiscal year (beginning with fiscal year 
1996), such amounts shall be increased by the percentage increase in the 
consumer price index for all urban consumers (U.S. city average) as 
estimated by the Secretary for the 12-month period ending with the 
midpoint of the year involved. In each of the fiscal years 1998 through 
2002, the increase under this subparagraph shall be reduced (but not 
below zero) by 2.0 percentage points.
    (3)(A) The aggregate amount of the payments to be made under this 
part for outpatient hospital facility services or critical access 
hospital services furnished before January 1, 1999, in connection with 
surgical procedures specified under paragraph (1)(A) shall be equal to 
the lesser of--
        (i) the amount determined with respect to such services under 
    subsection (a)(2)(B) of this section; or
        (ii) the blend amount (described in subparagraph (B)).

    (B)(i) The blend amount for a cost reporting period is the sum of--
        (I) the cost proportion (as defined in clause (ii)(I)) of the 
    amount described in subparagraph (A)(i), and
        (II) the ASC proportion (as defined in clause (ii)(II)) of the 
    standard overhead amount payable with respect to the same surgical 
    procedure as if it were provided in an ambulatory surgical center in 
    the same area, as determined under paragraph (2)(A), less the amount 
    a provider may charge as described in clause (ii) of section 
    1395cc(a)(2)(A) of this title.

    (ii) Subject to paragraph (4), in this paragraph:
        (I) The term ``cost proportion'' means 75 percent for cost 
    reporting periods beginning in fiscal year 1988, 50 percent for 
    portions of cost reporting periods beginning on or after October 1, 
    1988, and ending on or before December 31, 1990, and 42 percent for 
    portions of cost reporting periods beginning on or after January 1, 
    1991.
        (II) The term ``ASC proportion'' means 25 percent for cost 
    reporting periods beginning in fiscal year 1988, 50 percent for 
    portions of cost reporting periods beginning on or after October 1, 
    1988, and ending on or before December 31, 1990, and 58 percent for 
    portions of cost reporting periods beginning on or after January 1, 
    1991.

    (4)(A) In the case of a hospital that--
        (i) makes application to the Secretary and demonstrates that it 
    specializes in eye services or eye and ear services (as determined 
    by the Secretary),
        (ii) receives more than 30 percent of its total revenues from 
    outpatient services, and
        (iii) on October 1, 1987--
            (I) was an eye specialty hospital or an eye and ear 
        specialty hospital, or
            (II) was operated as an eye or eye and ear unit (as defined 
        in subparagraph (B)) of a general acute care hospital which, on 
        the date of the application described in clause (i), operates 
        less than 20 percent of the beds that the hospital operated on 
        October 1, 1987, and has sold or otherwise disposed of a 
        substantial portion of the hospital's other acute care 
        operations,

the cost proportion and ASC proportion in effect under subclauses (I) 
and (II) of paragraph (3)(B)(ii) for cost reporting periods beginning in 
fiscal year 1988 shall remain in effect for cost reporting periods 
beginning on or after October 1, 1988, and before January 1, 1995.
    (B) For purposes of this \5\ subparagraph (A)(iii)(II), the term 
``eye or eye and ear unit'' means a physically separate or distinct unit 
containing separate surgical suites devoted solely to eye or eye and ear 
services.
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    \5\ So in original. The word ``this'' probably should not appear.
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    (5)(A) The Secretary is authorized to provide by regulations that in 
the case of a surgical procedure, specified by the Secretary pursuant to 
paragraph (1)(A), performed in an ambulatory surgical center described 
in such paragraph, there shall be paid (in lieu of any amounts otherwise 
payable under this part) with respect to the facility services furnished 
by such center and with respect to all related services (including 
physicians' services, laboratory, X-ray, and diagnostic services) a 
single all-inclusive fee established pursuant to subparagraph (B), if 
all parties furnishing all such services agree to accept such fee (to be 
divided among the parties involved in such manner as they shall have 
previously agreed upon) as full payment for the services furnished.
    (B) In implementing this paragraph, the Secretary shall establish 
with respect to each surgical procedure specified pursuant to paragraph 
(1)(A) the amount of the all-inclusive fee for such procedure, taking 
into account such factors as may be appropriate. The amount so 
established with respect to any surgical procedure shall be reviewed 
periodically and may be adjusted by the Secretary, when appropriate, to 
take account of varying conditions in different areas.
    (6) Any person, including a facility having an agreement under 
section 1395k(a)(2)(F)(i) of this title, who knowingly and willfully 
presents, or causes to be presented, a bill or request for payment, for 
an intraocular lens inserted during or subsequent to cataract surgery 
for which payment may be made under paragraph (2)(A)(iii), is subject to 
a civil money penalty of not to exceed $2,000. The provisions of section 
1320a-7a of this title (other than subsections (a) and (b)) shall apply 
to a civil money penalty under the previous sentence in the same manner 
as such provisions apply to a penalty or proceeding under section 1320a-
7a(a) of this title.

(j) Accrual of interest on balance of excess or deficit not paid

    Whenever a final determination is made that the amount of payment 
made under this part either to a provider of services or to another 
person pursuant to an assignment under section 1395u(b)(3)(B)(ii) of 
this title was in excess of or less than the amount of payment that is 
due, and payment of such excess or deficit is not made (or effected by 
offset) within 30 days of the date of the determination, interest shall 
accrue on the balance of such excess or deficit not paid or offset (to 
the extent that the balance is owed by or owing to the provider) at a 
rate determined in accordance with the regulations of the Secretary of 
the Treasury applicable to charges for late payments.

(k) Hepatitis B vaccine

    With respect to services described in section 1395x(s)(10)(B) of 
this title, the Secretary may provide, instead of the amount of payment 
otherwise provided under this part, for payment of such an amount or 
amounts as reasonably reflects the general cost of efficiently providing 
such services.

(l) Fee schedule for services of certified registered nurse anesthetists

    (1)(A) The Secretary shall establish a fee schedule for services of 
certified registered nurse anesthetists under section 1395x(s)(11) of 
this title.
    (B) In establishing the fee schedule under this paragraph the 
Secretary may utilize a system of time units, a system of base and time 
units, or any appropriate methodology.
    (C) The provisions of this subsection shall not apply to certain 
services furnished in certain hospitals in rural areas under the 
provisions of section 9320(k) of the Omnibus Budget Reconciliation Act 
of 1986, as amended by section 6132 of the Omnibus Budget Reconciliation 
Act of 1989.
    (2) Except as provided in paragraph (3), the fee schedule 
established under paragraph (1) shall be initially based on audited data 
from cost reporting periods ending in fiscal year 1985 and such other 
data as the Secretary determines necessary.
    (3)(A) In establishing the initial fee schedule for those services, 
the Secretary shall adjust the fee schedule to the extent necessary to 
ensure that the estimated total amount which will be paid under this 
subchapter for those services plus applicable coinsurance in 1989 will 
equal the estimated total amount which would be paid under this 
subchapter for those services in 1989 if the services were included as 
inpatient hospital services and payment for such services was made under 
part A of this subchapter in the same manner as payment was made in 
fiscal year 1987, adjusted to take into account changes in prices and 
technology relating to the administration of anesthesia.
    (B) The Secretary shall also reduce the prevailing charge of 
physicians for medical direction of a certified registered nurse 
anesthetist, or the fee schedule for services of certified registered 
nurse anesthetists, or both, to the extent necessary to ensure that the 
estimated total amount which will be paid under this subchapter plus 
applicable coinsurance for such medical direction and such services in 
1989 and 1990 will not exceed the estimated total amount which would 
have been paid plus applicable coinsurance but for the enactment of the 
amendments made by section 9320 of the Omnibus Budget Reconciliation Act 
of 1986. A reduced prevailing charge under this subparagraph shall 
become the prevailing charge but for subsequent years for purposes of 
applying the economic index under the fourth sentence of section 
1395u(b)(3) of this title.
    (4)(A) Except as provided in subparagraphs (C) and (D), in 
determining the amount paid under the fee schedule under this subsection 
for services furnished on or after January 1, 1991, by a certified 
registered nurse anesthetist who is not medically directed--
        (i) the conversion factor shall be--
            (I) for services furnished in 1991, $15.50,
            (II) for services furnished in 1992, $15.75,
            (III) for services furnished in 1993, $16.00,
            (IV) for services furnished in 1994, $16.25,
            (V) for services furnished in 1995, $16.50,
            (VI) for services furnished in 1996, $16.75, and
            (VII) for services furnished in calendar years after 1996, 
        the previous year's conversion factor increased by the update 
        determined under section 1395w-4(d) of this title for physician 
        anesthesia services for that year;

        (ii) the payment areas to be used shall be the fee schedule 
    areas used under section 1395w-4 of this title (or, in the case of 
    services furnished during 1991, the localities used under section 
    1395u(b) of this title) for purposes of computing payments for 
    physicians' services that are anesthesia services;
        (iii) the geographic adjustment factors to be applied to the 
    conversion factor under clause (i) for services in a fee schedule 
    area or locality is-- \6\
---------------------------------------------------------------------------
    \6\ So in original. Probably should be ``are--''.
---------------------------------------------------------------------------
            (I) in the case of services furnished in 1991, the 
        geographic work index value and the geographic practice cost 
        index value specified in section 1395u(q)(1)(B) of this title 
        for physicians' services that are anesthesia services furnished 
        in the area or locality, and
            (II) in the case of services furnished after 1991, the 
        geographic work index value, the geographic practice cost index 
        value, and the geographic malpractice index value used for 
        determining payments for physicians' services that are 
        anesthesia services under section 1395w-4 of this title,

    with 70 percent of the conversion factor treated as attributable to 
    work and 30 percent as attributable to overhead for services 
    furnished in 1991 (and the portions attributable to work, practice 
    expenses, and malpractice expenses in 1992 and thereafter being the 
    same as is applied under section 1395w-4 of this title).

    (B)(i) Except as provided in clause (ii) and subparagraph (D), in 
determining the amount paid under the fee schedule under this subsection 
for services furnished on or after January 1, 1991, and before January 
1, 1994, by a certified registered nurse anesthetist who is medically 
directed, the Secretary shall apply the same methodology specified in 
subparagraph (A).
    (ii) The conversion factor used under clause (i) shall be--
        (I) for services furnished in 1991, $10.50,
        (II) for services furnished in 1992, $10.75, and
        (III) for services furnished in 1993, $11.00.

    (iii) In the case of services of a certified registered nurse 
anesthetist who is medically directed or medically supervised by a 
physician which are furnished on or after January 1, 1994, the fee 
schedule amount shall be one-half of the amount described in section 
1395w-4(a)(5)(B) of this title with respect to the physician.
    (C) Notwithstanding subclauses (I) through (V) of subparagraph 
(A)(i)--
        (i) in the case of a 1990 conversion factor that is greater than 
    $16.50, the conversion factor for a calendar year after 1990 and 
    before 1996 shall be the 1990 conversion factor reduced by the 
    product of the last digit of the calendar year and one-fifth of the 
    amount by which the 1990 conversion factor exceeds $16.50; and
        (ii) in the case of a 1990 conversion factor that is greater 
    than $15.49 but less than $16.51, the conversion factor for a 
    calendar year after 1990 and before 1996 shall be the greater of--
            (I) the 1990 conversion factor, or
            (II) the conversion factor specified in subparagraph (A)(i) 
        for the year involved.

    (D) Notwithstanding subparagraph (C), in no case may the conversion 
factor used to determine payment for services in a fee schedule area or 
locality under this subsection, as adjusted by the adjustment factors 
specified in subparagraphs \7\ (A)(iii), exceed the conversion factor 
used to determine the amount paid for physicians' services that are 
anesthesia services in the area or locality.
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    \7\ So in original. Probably should be ``subparagraph''.
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    (5)(A) Payment for the services of a certified registered nurse 
anesthetist (for which payment may otherwise be made under this part) 
may be made on the basis of a claim or request for payment presented by 
the certified registered nurse anesthetist furnishing such services, or 
by a hospital, critical access hospital, physician, group practice, or 
ambulatory surgical center with which the certified registered nurse 
anesthetist furnishing such services has an employment or contractual 
relationship that provides for payment to be made under this part for 
such services to such hospital, critical access hospital, physician, 
group practice, or ambulatory surgical center.
    (B) No hospital or critical access hospital that presents a claim or 
request for payment for services of a certified nurse anesthetist under 
this part may treat any uncollected coinsurance amount imposed under 
this part with respect to such services as a bad debt of such hospital 
or critical access hospital for purposes of this subchapter.
    (6) If an adjustment under paragraph (3)(B) results in a reduction 
in the reasonable charge for a physicians' service and a 
nonparticipating physician furnishes the service to an individual 
entitled to benefits under this part after the effective date of the 
reduction, the physician's actual charge is subject to a limit under 
section 1395u(j)(1)(D) of this title.

(m) Incentive payments for physicians' services furnished in underserved 
        areas

    In the case of physicians' services furnished to an individual, who 
is covered under the insurance program established by this part and who 
incurs expenses for such services, in an area that is designated (under 
section 254e(a)(1)(A) of this title) as a health professional shortage 
area, in addition to the amount otherwise paid under this part, there 
also shall be paid to the physician (or to an employer or facility in 
the cases described in clause (A) of section 1395u(b)(6) of this title) 
(on a monthly or quarterly basis) from the Federal Supplementary Medical 
Insurance Trust Fund an amount equal to 10 percent of the payment amount 
for the service under this part.

(n) Payments to hospital outpatient departments for radiology; amount; 
        definitions

    (1)(A) \8\ The aggregate amount of the payments to be made for all 
or part of a cost reporting period for services described in subsection 
(a)(2)(E)(i) of this section furnished under this part on or after 
October 1, 1988, and before January 1, 1999, and for services described 
in subsection (a)(2)(E)(ii) of this section furnished under this part on 
or after October 1, 1989, and before January 1, 1999, shall be equal to 
the lesser of--
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    \8\ So in original. No par. (2) has been enacted.
---------------------------------------------------------------------------
        (i) the amount determined with respect to such services under 
    subsection (a)(2)(B) of this section, or
        (ii) the blend amount for radiology services and diagnostic 
    procedures determined in accordance with subparagraph (B).

    (B)(i) The blend amount for radiology services and diagnostic 
procedures for a cost reporting period is the sum of--
        (I) the cost proportion (as defined in clause (ii)) of the 
    amount described in subparagraph (A)(i); and
        (II) the charge proportion (as defined in clause (ii)(II)) of 62 
    percent (for services described in subsection (a)(2)(E)(i) of this 
    section), or (for procedures described in subsection (a)(2)(E)(ii) 
    of this section), 42 percent or such other percent established by 
    the Secretary (or carriers acting pursuant to guidelines issued by 
    the Secretary) based on prevailing charges established with actual 
    charge data, of the prevailing charge or (for services described in 
    subsection (a)(2)(E)(i) of this section furnished on or after April 
    1, 1989 and for services described in subsection (a)(2)(E)(ii) of 
    this section furnished on or after January 1, 1992) the fee schedule 
    amount established for participating physicians for the same 
    services as if they were furnished in a physician's office in the 
    same locality as determined under section 1395u(b) of this title 
    (or, in the case of services furnished on or after January 1, 1992, 
    under section 1395w-4 of this title), less the amount a provider may 
    charge as described in clause (ii) of section 1395cc(a)(2)(A) of 
    this title.

    (ii) In this subparagraph:
        (I) The term ``cost proportion'' means 50 percent, except that 
    such term means 65 percent in the case of outpatient radiology 
    services for portions of cost reporting periods which occur in 
    fiscal year 1989 and in the case of diagnostic procedures described 
    in subsection (a)(2)(E)(ii) of this section for portions of cost 
    reporting periods which occur in fiscal year 1990, and such term 
    means 42 percent in the case of outpatient radiology services for 
    portions of cost reporting periods beginning on or after January 1, 
    1991.
        (II) The term ``charge proportion'' means 100 percent minus the 
    cost proportion.

(o) Limitation on benefit for payment for therapeutic shoes for 
        individuals with severe diabetic foot disease

    (1) In the case of shoes described in section 1395x(s)(12) of this 
title--
        (A) no payment may be made under this part, with respect to any 
    individual for any year, for the furnishing of--
            (i) more than one pair of custom molded shoes (including 
        inserts provided with such shoes) and 2 additional pairs of 
        inserts for such shoes, or
            (ii) more than one pair of extra-depth shoes (not including 
        inserts provided with such shoes) and 3 pairs of inserts for 
        such shoes, and

        (B) with respect to expenses incurred in any calendar year, no 
    more than the limits established under paragraph (2) shall be 
    considered as incurred expenses for purposes of subsections (a) and 
    (b) of this section.

Payment for shoes (or inserts) under this part shall be considered to 
include payment for any expenses for the fitting of such shoes (or 
inserts).
    (2)(A) Except as provided by the Secretary under subparagraphs (B) 
and (C), the limits established under this paragraph--
        (i) for the furnishing of--
            (I) one pair of custom molded shoes (including any inserts 
        that are provided initially with the shoes) is $300, and
            (II) any additional pair of inserts with respect to such 
        shoes is $50; and

        (ii) for the furnishing of extra-depth shoes and inserts is--
            (I) $100 for the pair of shoes itself, and
            (II) $50 for any pairs of inserts for a pair of shoes.

    (B) The Secretary or a carrier may establish limits for shoes that 
are lower than the limits established under subparagraph (A) if the 
Secretary finds that shoes and inserts of an appropriate quality are 
readily available at or below such lower limits.
    (C) For each year after 1988, each dollar amount under subparagraph 
(A) or (B) (as previously adjusted under this subparagraph) shall be 
increased by the same percentage increase as the Secretary provides with 
respect to durable medical equipment for that year, except that if such 
increase is not a multiple of $1, it shall be rounded to the nearest 
multiple of $1.
    (D) In accordance with procedures established by the Secretary, an 
individual entitled to benefits with respect to shoes described in 
section 1395x(s)(12) of this title may substitute modification of such 
shoes instead of obtaining one (or more, as specified by the Secretary) 
pairs \9\ of inserts (other than the original pair of inserts with 
respect to such shoes). In such case, the Secretary shall substitute, 
for the limits established under subparagraph (A), such limits as the 
Secretary estimates will assure that there is no net increase in 
expenditures under this subsection as a result of this subparagraph.
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    \9\ So in original. Probably should be ``pair''.
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    (3) In this subchapter, the term ``shoes'' includes, except for 
purposes of subparagraphs (A)(ii) and (B) of paragraph (2), inserts for 
extra-depth shoes.

(p) Repealed. Pub. L. 103-432, title I, Sec. 123(b)(2)(A)(ii), Oct. 31, 
        1994, 108 Stat. 4411

(q) Requests for payment to include information on referring physician

    (1) Each request for payment, or bill submitted, for an item or 
service furnished by an entity for which payment may be made under this 
part and for which the entity knows or has reason to believe there has 
been a referral by a referring physician (within the meaning of section 
1395nn of this title) shall include the name and unique physician 
identification number for the referring physician.
    (2)(A) In the case of a request for payment for an item or service 
furnished by an entity under this part on an assignment-related basis 
and for which information is required to be provided under paragraph (1) 
but not included, payment may be denied under this part.
    (B) In the case of a request for payment for an item or service 
furnished by an entity under this part not submitted on an assignment-
related basis and for which information is required to be provided under 
paragraph (1) but not included--
        (i) if the entity knowingly and willfully fails to provide such 
    information promptly upon request of the Secretary or a carrier, the 
    entity may be subject to a civil money penalty in an amount not to 
    exceed $2,000, and
        (ii) if the entity knowingly, willfully, and in repeated cases 
    fails, after being notified by the Secretary of the obligations and 
    requirements of this subsection to provide the information required 
    under paragraph (1), the entity may be subject to exclusion from 
    participation in the programs under this chapter for a period not to 
    exceed 5 years, in accordance with the procedures of subsections 
    (c), (f), and (g) of section 1320a-7 of this title.

The provisions of section 1320a-7a of this title (other than subsections 
(a) and (b)) shall apply to civil money penalties under clause (i) in 
the same manner as they apply to a penalty or proceeding under section 
1320a-7a(a) of this title.

(r) Cap on prevailing charge; billing on assignment-related basis

    (1) With respect to services described in section 1395x(s)(2)(K)(ii) 
of this title (relating to nurse practitioner or clinical nurse 
specialist services), payment may be made on the basis of a claim or 
request for payment presented by the nurse practitioner or clinical 
nurse specialist furnishing such services, or by a hospital, critical 
access hospital, skilled nursing facility or nursing facility (as 
defined in section 1396r(a) of this title), physician, group practice, 
or ambulatory surgical center with which the nurse practitioner or 
clinical nurse specialist has an employment or contractual relationship 
that provides for payment to be made under this part for such services 
to such hospital, physician, group practice, or ambulatory surgical 
center.
    (2) No hospital or critical access hospital that presents a claim or 
request for payment under this part for services described in section 
1395x(s)(2)(K)(ii) of this title may treat any uncollected coinsurance 
amount imposed under this part with respect to such services as a bad 
debt of such hospital for purposes of this subchapter.

(s) Other prepaid organizations

    The Secretary may not provide for payment under subsection (a)(1)(A) 
of this section with respect to an organization unless the organization 
provides assurances satisfactory to the Secretary that the organization 
meets the requirement of section 1395cc(f) of this title (relating to 
maintaining written policies and procedures respecting advance 
directives).

(t) Prospective payment system for hospital outpatient department 
        services

                        (1) Amount of payment

        (A) In general

            With respect to covered OPD services (as defined in 
        subparagraph (B)) furnished during a year beginning with 1999, 
        the amount of payment under this part shall be determined under 
        a prospective payment system established by the Secretary in 
        accordance with this subsection.

        (B) Definition of covered OPD services

            For purposes of this subsection, the term ``covered OPD 
        services''--
                (i) means hospital outpatient services designated by the 
            Secretary;
                (ii) subject to clause (iv), includes inpatient hospital 
            services designated by the Secretary that are covered under 
            this part and furnished to a hospital inpatient who (I) is 
            entitled to benefits under part A of this subchapter but has 
            exhausted benefits for inpatient hospital services during a 
            spell of illness, or (II) is not so entitled;
                (iii) includes implantable items described in paragraph 
            (3), (6), or (8) of section 1395x(s) of this title; but
                (iv) does not include any therapy services described in 
            subsection (a)(8) of this section or ambulance services, for 
            which payment is made under a fee schedule described in 
            section 1395m(k) of this title or section 1395m(l) of this 
            title.

                       (2) System requirements

        Under the payment system--
            (A) the Secretary shall develop a classification system for 
        covered OPD services;
            (B) the Secretary may establish groups of covered OPD 
        services, within the classification system described in 
        subparagraph (A), so that services classified within each group 
        are comparable clinically and with respect to the use of 
        resources and so that an implantable item is classified to the 
        group that includes the service to which the item relates;
            (C) the Secretary shall, using data on claims from 1996 and 
        using data from the most recent available cost reports, 
        establish relative payment weights for covered OPD services (and 
        any groups of such services described in subparagraph (B)) based 
        on median (or, at the election of the Secretary, mean) hospital 
        costs and shall determine projections of the frequency of 
        utilization of each such service (or group of services) in 1999;
            (D) the Secretary shall determine a wage adjustment factor 
        to adjust the portion of payment and coinsurance attributable to 
        labor-related costs for relative differences in labor and labor-
        related costs across geographic regions in a budget neutral 
        manner;
            (E) the Secretary shall establish, in a budget neutral 
        manner, outlier adjustments under paragraph (5) and transitional 
        pass-through payments under paragraph (6) and other adjustments 
        as determined to be necessary to ensure equitable payments, such 
        as adjustments for certain classes of hospitals; and
            (F) the Secretary shall develop a method for controlling 
        unnecessary increases in the volume of covered OPD services.

    For purposes of subparagraph (B), items and services within a group 
    shall not be treated as ``comparable with respect to the use of 
    resources'' if the highest median cost (or mean cost, if elected by 
    the Secretary under subparagraph (C)) for an item or service within 
    the group is more than 2 times greater than the lowest median cost 
    (or mean cost, if so elected) for an item or service within the 
    group; except that the Secretary may make exceptions in unusual 
    cases, such as low volume items and services, but may not make such 
    an exception in the case of a drug or biological that has been 
    designated as an orphan drug under section 360bb of title 21.

                   (3) Calculation of base amounts

        (A) Aggregate amounts that would be payable if deductibles were 
                disregarded

            The Secretary shall estimate the sum of--
                (i) the total amounts that would be payable from the 
            Trust Fund under this part for covered OPD services in 1999, 
            determined without regard to this subsection, as though the 
            deductible under subsection (b) of this section did not 
            apply, and
                (ii) the total amounts of copayments estimated to be 
            paid under this subsection by beneficiaries to hospitals for 
            covered OPD services in 1999, as though the deductible under 
            subsection (b) of this section did not apply.

        (B) Unadjusted copayment amount

            (i) In general

                For purposes of this subsection, subject to clause (ii), 
            the ``unadjusted copayment amount'' applicable to a covered 
            OPD service (or group of such services) is 20 percent of the 
            national median of the charges for the service (or services 
            within the group) furnished during 1996, updated to 1999 
            using the Secretary's estimate of charge growth during the 
            period.
            (ii) Adjusted to be 20 percent when fully phased in

                If the pre-deductible payment percentage for a covered 
            OPD service (or group of such services) furnished in a year 
            would be equal to or exceed 80 percent, then the unadjusted 
            copayment amount shall be 20 percent of amount determined 
            under subparagraph (D).
            (iii) Rules for new services

                The Secretary shall establish rules for establishment of 
            an unadjusted copayment amount for a covered OPD service not 
            furnished during 1996, based upon its classification within 
            a group of such services.

        (C) Calculation of conversion factors

            (i) For 1999

                (I) In general

                    The Secretary shall establish a 1999 conversion 
                factor for determining the medicare OPD fee schedule 
                amounts for each covered OPD service (or group of such 
                services) furnished in 1999. Such conversion factor 
                shall be established on the basis of the weights and 
                frequencies described in paragraph (2)(C) and in such a 
                manner that the sum for all services and groups of the 
                products (described in subclause (II) for each such 
                service or group) equals the total projected amount 
                described in subparagraph (A).
                (II) Product described

                    The Secretary shall determine for each service or 
                group the product of the medicare OPD fee schedule 
                amounts (taking into account appropriate adjustments 
                described in paragraphs (2)(D) and (2)(E)) and the 
                estimated frequencies for such service or group.
            (ii) Subsequent years

                Subject to paragraph (8)(B), the Secretary shall 
            establish a conversion factor for covered OPD services 
            furnished in subsequent years in an amount equal to the 
            conversion factor established under this subparagraph and 
            applicable to such services furnished in the previous year 
            increased by the OPD fee schedule increase factor specified 
            under clause (iii) for the year involved.
            (iii) OPD fee schedule increase factor

                For purposes of this subparagraph, the ``OPD fee 
            schedule increase factor'' for services furnished in a year 
            is equal to the market basket percentage increase applicable 
            under section 1395ww(b)(3)(B)(iii) of this title to hospital 
            discharges occurring during the fiscal year ending in such 
            year, reduced by 1 percentage point for such factor for 
            services furnished in each of 2000, 2001, and 2002. In 
            applying the previous sentence for years beginning with 
            2000, the Secretary may substitute for the market basket 
            percentage increase an annual percentage increase that is 
            computed and applied with respect to covered OPD services 
            furnished in a year in the same manner as the market basket 
            percentage increase is determined and applied to inpatient 
            hospital services for discharges occurring in a fiscal year.

        (D) Calculation of medicare OPD fee schedule amounts

            The Secretary shall compute a medicare OPD fee schedule 
        amount for each covered OPD service (or group of such services) 
        furnished in a year, in an amount equal to the product of--
                (i) the conversion factor computed under subparagraph 
            (C) for the year, and
                (ii) the relative payment weight (determined under 
            paragraph (2)(C)) for the service or group.

        (E) Pre-deductible payment percentage

            The pre-deductible payment percentage for a covered OPD 
        service (or group of such services) furnished in a year is equal 
        to the ratio of--
                (i) the medicare OPD fee schedule amount established 
            under subparagraph (D) for the year, minus the unadjusted 
            copayment amount determined under subparagraph (B) for the 
            service or group, to
                (ii) the medicare OPD fee schedule amount determined 
            under subparagraph (D) for the year for such service or 
            group.

                     (4) Medicare payment amount

        The amount of payment made from the Trust Fund under this part 
    for a covered OPD service (and such services classified within a 
    group) furnished in a year is determined, subject to paragraph (7), 
    as follows:

        (A) Fee schedule adjustments

            The medicare OPD fee schedule amount (computed under 
        paragraph (3)(D)) for the service or group and year is adjusted 
        for relative differences in the cost of labor and other factors 
        determined by the Secretary, as computed under paragraphs (2)(D) 
        and (2)(E).

        (B) Subtract applicable deductible

            Reduce the adjusted amount determined under subparagraph (A) 
        by the amount of the deductible under subsection (b) of this 
        section, to the extent applicable.

        (C) Apply payment proportion to remainder

            The amount of payment is the amount so determined under 
        subparagraph (B) multiplied by the pre-deductible payment 
        percentage (as determined under paragraph (3)(E)) for the 
        service or group and year involved, plus the amount of any 
        reduction in the copayment amount attributable to paragraph 
        (8)(C).

                       (5) Outlier adjustment

        (A) In general

            Subject to subparagraph (D), the Secretary shall provide for 
        an additional payment for each covered OPD service (or group of 
        services) for which a hospital's charges, adjusted to cost, 
        exceed--
                (i) a fixed multiple of the sum of--
                    (I) the applicable medicare OPD fee schedule amount 
                determined under paragraph (3)(D), as adjusted under 
                paragraph (4)(A) (other than for adjustments under this 
                paragraph or paragraph (6)); and
                    (II) any transitional pass-through payment under 
                paragraph (6); and

                (ii) at the option of the Secretary, such fixed dollar 
            amount as the Secretary may establish.

        (B) Amount of adjustment

            The amount of the additional payment under subparagraph (A) 
        shall be determined by the Secretary and shall approximate the 
        marginal cost of care beyond the applicable cutoff point under 
        such subparagraph.

        (C) Limit on aggregate outlier adjustments

            (i) In general

                The total of the additional payments made under this 
            paragraph for covered OPD services furnished in a year (as 
            estimated by the Secretary before the beginning of the year) 
            may not exceed the applicable percentage (specified in 
            clause (ii)) of the total program payments estimated to be 
            made under this subsection for all covered OPD services 
            furnished in that year. If this paragraph is first applied 
            to less than a full year, the previous sentence shall apply 
            only to the portion of such year.
            (ii) Applicable percentage

                For purposes of clause (i), the term ``applicable 
            percentage'' means a percentage specified by the Secretary 
            up to (but not to exceed)--
                    (I) for a year (or portion of a year) before 2004, 
                2.5 percent; and
                    (II) for 2004 and thereafter, 3.0 percent.

        (D) Transitional authority

            In applying subparagraph (A) for covered OPD services 
        furnished before January 1, 2002, the Secretary may--
                (i) apply such subparagraph to a bill for such services 
            related to an outpatient encounter (rather than for a 
            specific service or group of services) using OPD fee 
            schedule amounts and transitional pass-through payments 
            covered under the bill; and
                (ii) use an appropriate cost-to-charge ratio for the 
            hospital involved (as determined by the Secretary), rather 
            than for specific departments within the hospital.

       (6) Transitional pass-through for additional costs of 
             innovative medical devices, drugs, and biologicals

        (A) In general

            The Secretary shall provide for an additional payment under 
        this paragraph for any of the following that are provided as 
        part of a covered OPD service (or group of services):
            (i) Current orphan drugs

                A drug or biological that is used for a rare disease or 
            condition with respect to which the drug or biological has 
            been designated as an orphan drug under section 360bb of 
            title 21 if payment for the drug or biological as an 
            outpatient hospital service under this part was being made 
            on the first date that the system under this subsection is 
            implemented.
            (ii) Current cancer therapy drugs and biologicals 
                    and brachytherapy

                A drug or biological that is used in cancer therapy, 
            including (but not limited to) a chemotherapeutic agent, an 
            antiemetic, a hematopoietic growth factor, a colony 
            stimulating factor, a biological response modifier, a 
            bisphosphonate, and a device of brachytherapy, if payment 
            for such drug, biological, or device as an outpatient 
            hospital service under this part was being made on such 
            first date.
            (iii) Current radiopharmaceutical drugs and 
                    biological products

                A radiopharmaceutical drug or biological product used in 
            diagnostic, monitoring, and therapeutic nuclear medicine 
            procedures if payment for the drug or biological as an 
            outpatient hospital service under this part was being made 
            on such first date.
            (iv) New medical devices, drugs, and biologicals

                A medical device, drug, or biological not described in 
            clause (i), (ii), or (iii) if--
                    (I) payment for the device, drug, or biological as 
                an outpatient hospital service under this part was not 
                being made as of December 31, 1996; and
                    (II) the cost of the device, drug, or biological is 
                not insignificant in relation to the OPD fee schedule 
                amount (as calculated under paragraph (3)(D)) payable 
                for the service (or group of services) involved.

        (B) Limited period of payment

            The payment under this paragraph with respect to a medical 
        device, drug, or biological shall only apply during a period of 
        at least 2 years, but not more than 3 years, that begins--
                (i) on the first date this subsection is implemented in 
            the case of a drug, biological, or device described in 
            clause (i), (ii), or (iii) of subparagraph (A) and in the 
            case of a device, drug, or biological described in 
            subparagraph (A)(iv) and for which payment under this part 
            is made as an outpatient hospital service before such first 
            date; or
                (ii) in the case of a device, drug, or biological 
            described in subparagraph (A)(iv) not described in clause 
            (i), on the first date on which payment is made under this 
            part for the device, drug, or biological as an outpatient 
            hospital service.

        (C) Amount of additional payment

            Subject to subparagraph (D)(iii), the amount of the payment 
        under this paragraph with respect to a device, drug, or 
        biological provided as part of a covered OPD service is--
                (i) in the case of a drug or biological, the amount by 
            which the amount determined under section 1395u(o) of this 
            title for the drug or biological exceeds the portion of the 
            otherwise applicable medicare OPD fee schedule that the 
            Secretary determines is associated with the drug or 
            biological; or
                (ii) in the case of a medical device, the amount by 
            which the hospital's charges for the device, adjusted to 
            cost, exceeds the portion of the otherwise applicable 
            medicare OPD fee schedule that the Secretary determines is 
            associated with the device.

        (D) Limit on aggregate annual adjustment

            (i) In general

                The total of the additional payments made under this 
            paragraph for covered OPD services furnished in a year (as 
            estimated by the Secretary before the beginning of the year) 
            may not exceed the applicable percentage (specified in 
            clause (ii)) of the total program payments estimated to be 
            made under this subsection for all covered OPD services 
            furnished in that year. If this paragraph is first applied 
            to less than a full year, the previous sentence shall apply 
            only to the portion of such year.
            (ii) Applicable percentage

                For purposes of clause (i), the term ``applicable 
            percentage'' means--
                    (I) for a year (or portion of a year) before 2004, 
                2.5 percent; and
                    (II) for 2004 and thereafter, a percentage specified 
                by the Secretary up to (but not to exceed) 2.0 percent.
            (iii) Uniform prospective reduction if aggregate 
                    limit projected to be exceeded

                If the Secretary estimates before the beginning of a 
            year that the amount of the additional payments under this 
            paragraph for the year (or portion thereof) as determined 
            under clause (i) without regard to this clause will exceed 
            the limit established under such clause, the Secretary shall 
            reduce pro rata the amount of each of the additional 
            payments under this paragraph for that year (or portion 
            thereof) in order to ensure that the aggregate additional 
            payments under this paragraph (as so estimated) do not 
            exceed such limit.

       (7) Transitional adjustment to limit decline in payment

        (A) Before 2002

            Subject to subparagraph (D), for covered OPD services 
        furnished before January 1, 2002, for which the PPS amount (as 
        defined in subparagraph (E)) is--
                (i) at least 90 percent, but less than 100 percent, of 
            the pre-BBA amount (as defined in subparagraph (F)), the 
            amount of payment under this subsection shall be increased 
            by 80 percent of the amount of such difference;
                (ii) at least 80 percent, but less than 90 percent, of 
            the pre-BBA amount, the amount of payment under this 
            subsection shall be increased by the amount by which (I) the 
            product of 0.71 and the pre-BBA amount, exceeds (II) the 
            product of 0.70 and the PPS amount;
                (iii) at least 70 percent, but less than 80 percent, of 
            the pre-BBA amount, the amount of payment under this 
            subsection shall be increased by the amount by which (I) the 
            product of 0.63 and the pre-BBA amount, exceeds (II) the 
            product of 0.60 and the PPS amount; or
                (iv) less than 70 percent of the pre-BBA amount, the 
            amount of payment under this subsection shall be increased 
            by 21 percent of the pre-BBA amount.

        (B) 2002

            Subject to subparagraph (D), for covered OPD services 
        furnished during 2002, for which the PPS amount is--
                (i) at least 90 percent, but less than 100 percent, of 
            the pre-BBA amount, the amount of payment under this 
            subsection shall be increased by 70 percent of the amount of 
            such difference;
                (ii) at least 80 percent, but less than 90 percent, of 
            the pre-BBA amount, the amount of payment under this 
            subsection shall be increased by the amount by which (I) the 
            product of 0.61 and the pre-BBA amount, exceeds (II) the 
            product of 0.60 and the PPS amount; or
                (iii) less than 80 percent of the pre-BBA amount, the 
            amount of payment under this subsection shall be increased 
            by 13 percent of the pre-BBA amount.

        (C) 2003

            Subject to subparagraph (D), for covered OPD services 
        furnished during 2003, for which the PPS amount is--
                (i) at least 90 percent, but less than 100 percent, of 
            the pre-BBA amount, the amount of payment under this 
            subsection shall be increased by 60 percent of the amount of 
            such difference; or
                (ii) less than 90 percent of the pre-BBA amount, the 
            amount of payment under this subsection shall be increased 
            by 6 percent of the pre-BBA amount.

        (D) Hold harmless provisions

            (i) Temporary treatment for small rural hospitals

                In the case of a hospital located in a rural area and 
            that has not more than 100 beds, for covered OPD services 
            furnished before January 1, 2004, for which the PPS amount 
            is less than the pre-BBA amount, the amount of payment under 
            this subsection shall be increased by the amount of such 
            difference.
            (ii) Permanent treatment for cancer hospitals

                In the case of a hospital described in section 
            1395ww(d)(1)(B)(v) of this title, for covered OPD services 
            for which the PPS amount is less than the pre-BBA amount, 
            the amount of payment under this subsection shall be 
            increased by the amount of such difference.

        (E) PPS amount defined

            In this paragraph, the term ``PPS amount'' means, with 
        respect to covered OPD services, the amount payable under this 
        subchapter for such services (determined without regard to this 
        paragraph), including amounts payable as copayment under 
        paragraph (8), coinsurance under section 1395cc(a)(2)(A)(ii) of 
        this title, and the deductible under subsection (b) of this 
        section.

        (F) Pre-BBA amount defined

            (i) In general

                In this paragraph, the ``pre-BBA amount'' means, with 
            respect to covered OPD services furnished by a hospital in a 
            year, an amount equal to the product of the reasonable cost 
            of the hospital for such services for the portions of the 
            hospital's cost reporting period (or periods) occurring in 
            the year and the base OPD payment-to-cost ratio for the 
            hospital (as defined in clause (ii)).
            (ii) Base payment-to-cost ratio defined

                For purposes of this subparagraph, the ``base payment-
            to-cost ratio'' for a hospital means the ratio of--
                    (I) the hospital's reimbursement under this part for 
                covered OPD services furnished during the cost reporting 
                period ending in 1996, including any reimbursement for 
                such services through cost-sharing described in 
                subparagraph (E), to
                    (II) the reasonable cost of such services for such 
                period.

          The Secretary shall determine such ratios as if the amendments 
            made by section 4521 of the Balanced Budget Act of 1997 were 
            in effect in 1996.

        (G) Interim payments

            The Secretary shall make payments under this paragraph to 
        hospitals on an interim basis, subject to retrospective 
        adjustments based on settled cost reports.

        (H) No effect on copayments

            Nothing in this paragraph shall be construed to affect the 
        unadjusted copayment amount described in paragraph (3)(B) or the 
        copayment amount under paragraph (8).

        (I) Application without regard to budget neutrality

            The additional payments made under this paragraph--
                (i) shall not be considered an adjustment under 
            paragraph (2)(E); and
                (ii) shall not be implemented in a budget neutral 
            manner.

                        (8) Copayment amount

        (A) In general

            Except as provided in subparagraphs (B) and (C), the 
        copayment amount under this subsection is the amount by which 
        the amount described in paragraph (4)(B) exceeds the amount of 
        payment determined under paragraph (4)(C).

        (B) Election to offer reduced copayment amount

            The Secretary shall establish a procedure under which a 
        hospital, before the beginning of a year (beginning with 1999), 
        may elect to reduce the copayment amount otherwise established 
        under subparagraph (A) for some or all covered OPD services to 
        an amount that is not less than 20 percent of the medicare OPD 
        fee schedule amount (computed under paragraph (3)(D)) for the 
        service involved. Under such procedures, such reduced copayment 
        amount may not be further reduced or increased during the year 
        involved and the hospital may disseminate information on the 
        reduction of copayment amount effected under this subparagraph.

        (C) Limiting copayment amount to inpatient hospital deductible 
                amount

            In no case shall the copayment amount for a procedure 
        performed in a year exceed the amount of the inpatient hospital 
        deductible established under section 1395e(b) of this title for 
        that year.

        (D) No impact on deductibles

            Nothing in this paragraph shall be construed as affecting a 
        hospital's authority to waive the charging of a deductible under 
        subsection (b) of this section.

        (E) Computation ignoring outlier and pass-through adjustments

            The copayment amount shall be computed under subparagraph 
        (A) as if the adjustments under paragraphs (5) and (6) (and any 
        adjustment made under paragraph (2)(E) in relation to such 
        adjustments) had not occurred.

         (9) Periodic review and adjustments components of 
                         prospective payment system

        (A) Periodic review

            The Secretary shall review not less often than annually and 
        revise the groups, the relative payment weights, and the wage 
        and other adjustments described in paragraph (2) to take into 
        account changes in medical practice, changes in technology, the 
        addition of new services, new cost data, and other relevant 
        information and factors. The Secretary shall consult with an 
        expert outside advisory panel composed of an appropriate 
        selection of representatives of providers to review (and advise 
        the Secretary concerning) the clinical integrity of the groups 
        and weights. Such panel may use data collected or developed by 
        entities and organizations (other than the Department of Health 
        and Human Services) in conducting such review.

        (B) Budget neutrality adjustment

            If the Secretary makes adjustments under subparagraph (A), 
        then the adjustments for a year may not cause the estimated 
        amount of expenditures under this part for the year to increase 
        or decrease from the estimated amount of expenditures under this 
        part that would have been made if the adjustments had not been 
        made.

        (C) Update factor

            If the Secretary determines under methodologies described in 
        paragraph (2)(F) that the volume of services paid for under this 
        subsection increased beyond amounts established through those 
        methodologies, the Secretary may appropriately adjust the update 
        to the conversion factor otherwise applicable in a subsequent 
        year.

              (10) Special rule for ambulance services

        The Secretary shall pay for hospital outpatient services that 
    are ambulance services on the basis described in section 
    1395x(v)(1)(U) of this title, or, if applicable, the fee schedule 
    established under section 1395m(l) of this title.

              (11) Special rules for certain hospitals

        In the case of hospitals described in section 1395ww(d)(1)(B)(v) 
    of this title--
            (A) the system under this subsection shall not apply to 
        covered OPD services furnished before January 1, 2000; and
            (B) the Secretary may establish a separate conversion factor 
        for such services in a manner that specifically takes into 
        account the unique costs incurred by such hospitals by virtue of 
        their patient population and service intensity.

                      (12) Limitation on review

        There shall be no administrative or judicial review under 
    section 1395ff of this title, 1395oo of this title, or otherwise 
    of--
            (A) the development of the classification system under 
        paragraph (2), including the establishment of groups and 
        relative payment weights for covered OPD services, of wage 
        adjustment factors, other adjustments, and methods described in 
        paragraph (2)(F);
            (B) the calculation of base amounts under paragraph (3);
            (C) periodic adjustments made under paragraph (6);
            (D) the establishment of a separate conversion factor under 
        paragraph (8)(B); and
            (E) the determination of the fixed multiple, or a fixed 
        dollar cutoff amount, the marginal cost of care, or applicable 
        percentage under paragraph (5) or the determination of 
        insignificance of cost, the duration of the additional payments 
        (consistent with paragraph (6)(B)), the portion of the medicare 
        OPD fee schedule amount associated with particular devices, 
        drugs, or biologicals, and the application of any pro rata 
        reduction under paragraph (6).

                    (13) Miscellaneous provisions

        (A) \10\ Application of reclassification of certain hospitals
---------------------------------------------------------------------------

    \10\ So in original. No subpar. (B) has been enacted.
---------------------------------------------------------------------------
            If a hospital is being treated as being located in a rural 
        area under section 1395ww(d)(8)(E) of this title, that hospital 
        shall be treated under this subsection as being located in that 
        rural area.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1833, 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)(7), (8), 131(a), (b), 132(b), 135(c), Jan. 2, 
1968, 81 Stat. 848-850, 853; Pub. L. 92-603, title II, Secs. 204(a), 
211(c)(4), 226(c)(2), 233(b), 245(d), 251(a)(2), (3), 279, 299K(a), Oct. 
30, 1972, 86 Stat. 1377, 1384, 1404, 1411, 1424, 1445, 1454, 1464; Pub. 
L. 95-142, Sec. 16(a), Oct. 25, 1977, 91 Stat. 1200; Pub. L. 95-210, 
Sec. 1(b), Dec. 13, 1977, 91 Stat. 1485; Pub. L. 95-292, Sec. 4(b), (c), 
June 13, 1978, 92 Stat. 315; Pub. L. 96-473, Sec. 6(j), Oct. 19, 1980, 
94 Stat. 2266; Pub. L. 96-499, title IX, Secs. 918(a)(4), 930(h), 
932(a)(1), 934(b), (d)(1), (3), 935(a), 942, 943(a), Dec. 5, 1980, 94 
Stat. 2626, 2631, 2634, 2637, 2639, 2641; Pub. L. 96-611, Sec. 1(b)(1), 
(2), Dec. 28, 1980, 94 Stat. 3566; Pub. L. 97-35, title XXI, 
Secs. 2106(a), 2133(a), 2134(a), Aug. 13, 1981, 95 Stat. 792, 797; Pub. 
L. 97-248, title I, Secs. 101(c)(2), 112(a), (b), 117(a)(2), 148(d), 
Sept. 3, 1982, 96 Stat. 336, 340, 355, 394; Pub. L. 98-369, div. B, 
title III, Secs. 2303(a)-(d), 2305(a)-(d), 2308(b)(2)(B), 2321(b), 
(d)(4)(A), 2323(b)(1), (2), (4), 2354(b)(5), (7), July 18, 1984, 98 
Stat. 1064, 1069, 1070, 1074, 1084-1086, 1100; Pub. L. 98-617, 
Sec. 3(b)(2), (3), Nov. 8, 1984, 98 Stat. 3295; Pub. L. 99-272, title 
IX, Secs. 9303(a)(1), (b)(1)-(3), 9401(b)-(2)(E), Apr. 7, 1986, 100 
Stat. 188, 189, 198, 199; Pub. L. 99-509, title IX, Secs. 9320(e)(1), 
(2), 9337(b), 9339(a)(1), (b)(1), (2), (c)(1), 9343(a), (b), (e)(2), 
Oct. 21, 1986, 100 Stat. 2014, 2033, 2036, 2039-2041; Pub. L. 100-203, 
title IV, Secs. 4042(b)(2)(B), 4043(a), 4045(c)(2)(A), 4049(a)(1), 
4055(a), formerly 4054(a), 4062(d)(3), 4063(b), (e)(1), 4064(a), (b)(1), 
(2), (c)(1), formerly (c), 4066(a), (b), 4067(a), 4068(a), 4070(a), 
(b)(4), 4072(b), 4073(b), formerly (b)(2), (3), 4077(b)(2), (3), 
formerly (b)(3), (4), 4084(a), (c)(2), 4085(b)(1), (i)(1)-(3), 
(21)(D)(i), (22)(B), (23), Dec. 22, 1987, 101 Stat. 1330-85, 1330-88, 
1330-90, 1330-108 to 1330-115, 1330-117, 1330-118, 1330-120, 1330-121, 
1330-129 to 1330-133, as amended Pub. L. 100-360, title IV, 
Sec. 411(f)(2)(D), (8)(B)(i), (12)(A), (14), (g)(2)(E), (3)(A)-(C), (E), 
(F), (h)(3)(B), (4)(B), (C), (7)(C), (D), (F), (i)(3), (4)(C)(i), (ii), 
(iv), (vi), July 1, 1988, 102 Stat. 777, 779, 781, 783, 784, 786-789; 
Pub. L. 100-360, title I, Sec. 104(d)(7), title II, Secs. 201(a), 
202(b)(1)-(3), 203(c)(1)(A)-(E), 204(d)(1), 205(c), 212(c)(2), title IV, 
Sec. 411(f)(8)(C), (g)(1)(E), (2)(D), (3)(D), (4)(C), (5), (h)(1)(A), 
(i)(4)(B), July 1, 1988, 102 Stat. 699, 704, 722, 729, 730, 741, 779, 
782-785, 789, as amended Pub. L. 100-485, title VI, Sec. 608(d)(3)(G), 
Oct. 13, 1988, 102 Stat. 2414; Pub. L. 100-485, title VI, 
Sec. 608(d)(4), (22)(B), (D), (23)(A), Oct. 13, 1988, 102 Stat. 2414, 
2420, 2421; Pub. L. 100-647, title VIII, Secs. 8421(a), 8422(a), Nov. 
10, 1988, 102 Stat. 3802; Pub. L. 101-234, title II, Secs. 201(a), 
202(a), Dec. 13, 1989, 103 Stat. 1981; Pub. L. 101-239, title VI, 
Secs. 6003(e)(2)(A), (g)(3)(D)(vii), 6102(c)(1), (e)(1), (5), (6)(A), 
(7), (f)(2), 6111(a), (b)(1), 6113(b)(3), (d), 6116(b)(1), 6131(a)(1), 
(b), 6133(a), 6204(b), Dec. 19, 1989, 103 Stat. 2143, 2153, 2184, 2187-
2189, 2213, 2214, 2217, 2219, 2221, 2222, 2241; Pub. L. 101-508, title 
IV, Secs. 4008(m)(2)(C), 4104(b)(1), 4118(f)(2)(D), 4151(c)(1), (2), 
4153(a)(2)(B), (C), 4154(a), (b)(1), (c)(1), (e)(1), 4155(b)(2), (3), 
4160, 4161(a)(3)(B), 4163(d)(1), 4206(b)(2), 4302, Nov. 5, 1990, 104 
Stat. 1388-53, 1388-59, 1388-70, 1388-73, 1388-83 to 1388-87, 1388-91, 
1388-93, 1388-100, 1388-116, 1388-125; Pub. L. 101-597, title IV, 
Sec. 401(c)(2), Nov. 16, 1990, 104 Stat. 3035; Pub. L. 103-66, title 
XIII, Secs. 13516(b), 13532(a), 13544(b)(2), 13551, 13555(a), Aug. 10, 
1993, 107 Stat. 584, 586, 590, 592; Pub. L. 103-432, title I, 
Secs. 123(b)(2)(A), (e), 141(a), (c)(1), 147(a), (d), (e)(2), (3), 
(f)(6)(C), (D), 156(a)(2)(B), 160(d)(1), Oct. 31, 1994, 108 Stat. 4411, 
4412, 4424, 4425, 4429, 4430, 4432, 4440, 4443; Pub. L. 105-33, title 
IV, Secs. 4002(j)(1)(A), 4101(b), 4102(b), 4103(b), 4104(c)(1), (2), 
4201(c)(1), 4205(a)(1)(A), (2), 4315(b), 4432(b)(5)(C), 4511(b), 
4512(b)(1), 4521(a), (b), 4523(a), (d)(1)(A)(i), (B)-(3), 4531(b)(1), 
4541(a)(1), (c), (d)(1), 4553(a), (b), 4555, 4556(b), 4603(c)(2)(A), 
Aug. 5, 1997, 111 Stat. 330, 360-362, 365, 373, 376, 390, 421, 442-445, 
449, 450, 454, 456, 460, 462, 463, 470; Pub. L. 106-113, div. B, 
Sec. 1000(a)(6) [title II, Secs. 201(a)-(e)(1), (f)-(h)(1), (i), (j), 
202(a), 204(a),(b), 211(a)(3)(B), 221(a)(1), 224(a), title III, 
Sec. 321(g)(2), (k)(2), title IV, Secs. 401(b)(1), 403(e)(1)], Nov. 29, 
1999, 113 Stat. 1536, 1501A-336 to 1501A-342, 1501A-345, 1501A-348, 
1501A-351, 1501A-353, 1501A-366, 1501A-369, 1501A-371.)

                       References in Text

    Part A of this subchapter, referred to in subsecs. (a)(8)(B)(i), 
(d), (l)(3)(A), and (t)(1)(B)(ii)(I), is classified to section 1395c et 
seq. of this title.
    Section 9320(k) of the Omnibus Budget Reconciliation Act of 1986, as 
amended by section 6132 of the Omnibus Budget Reconciliation Act of 
1989, referred to in subsec. (l)(1)(C), is section 9320(k) of Pub. L. 
99-509, as amended, which is set out as a note under section 1395k of 
this title.
    The amendments made by section 9320 of the Omnibus Budget 
Reconciliation Act of 1986, referred to in subsec. (l)(3)(B), are 
amendments made by section 9320 of Pub. L. 99-509, which amended 
sections 1395k, 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.
    Section 4521 of The Balanced Budget Act of 1997, referred to in 
subsec. (t)(7)(F), is section 4521 of Pub. L. 105-33, Aug. 5, 1997, 111 
Stat. 444, which amended this section and enacted provisions set out as 
a note under this section.


                               Amendments

    1999--Subsec. (a)(1)(D)(i). Pub. L. 106-113, Sec. 1000(a)(6) [title 
IV, Sec. 403(e)(1)], inserted ``or which are furnished on an outpatient 
basis by a critical access hospital'' after ``on an assignment-related 
basis''.
    Subsec. (a)(1)(O). Pub. L. 106-113, Sec. 1000(a)(6) [title III, 
Sec. 321(k)(2)], substituted a comma for the semicolon at end.
    Subsec. (a)(2)(D)(i). Pub. L. 106-113, Sec. 1000(a)(6) [title IV, 
Sec. 403(e)(1)], inserted ``or which are furnished on an outpatient 
basis by a critical access hospital'' after ``on an assignment-related 
basis''.
    Subsec. (g)(1), (3). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 221(a)(1)(A)], substituted ``Subject to paragraph (4), in the 
case'' for ``In the case''.
    Subsec. (g)(4). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 221(a)(1)(B)], added par. (4).
    Subsec. (h)(5)(A)(iii). Pub. L. 106-113, Sec. 1000(a)(6) [title III, 
Sec. 321(g)(2)], substituted ``, critical access hospital, or skilled 
nursing facility,'' for ``or critical access hospital,'' and inserted 
``or skilled nursing facility'' before period at end.
    Subsec. (h)(7). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 224(a)], added par. (7).
    Subsec. (l)(4)(A)(i)(VII). Pub. L. 106-113, Sec. 1000(a)(6) [title 
II, Sec. 211(a)(3)(B)], substituted ``1395w-4(d) of this title'' for 
``1395w-4(d)(3) of this title''.
    Subsec. (t)(1)(B)(ii). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(e)(1)(A)], substituted ``clause (iv)'' for ``clause (iii)'' and 
directed the striking out of ``but'' which was executed by striking out 
``but'' after semicolon at end to reflect the probable intent of 
Congress.
    Subsec. (t)(1)(B)(iii), (iv). Pub. L. 106-113, Sec. 1000(a)(6) 
[title II, Sec. 201(e)(1)(B)], added cl. (iii) and redesignated former 
cl. (iii) as (iv).
    Subsec. (t)(2). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(g)], inserted concluding provisions.
    Subsec. (t)(2)(B). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(e)(1)(C)], inserted ``and so that an implantable item is 
classified to the group that includes the service to which the item 
relates'' before semicolon at end.
    Subsec. (t)(2)(C). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(f)], inserted ``(or, at the election of the Secretary, mean)'' 
after ``median''.
    Subsec. (t)(2)(E). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(c)], substituted ``, in a budget neutral manner, outlier 
adjustments under paragraph (5) and transitional pass-through payments 
under paragraph (6) and other adjustments as determined to be necessary 
to ensure equitable payments, such as'' for ``other adjustments, in a 
budget neutral manner, as determined to be necessary to ensure equitable 
payments, such as outlier adjustments or''.
    Subsec. (t)(4). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 202(a)(1)], inserted ``, subject to paragraph (7),'' after ``is 
determined'' in introductory provisions.
    Subsec. (t)(4)(C). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 204(b)], inserted ``, plus the amount of any reduction in the 
copayment amount attributable to paragraph (8)(C)'' before period at 
end.
    Subsec. (t)(5). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(a)(2)], added par. (5). Former par. (5) redesignated (7).
    Subsec. (t)(6). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(b)], added par. (6). Former par. (6) redesignated (8).
    Subsec. (t)(7). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 202(a)(3)], added par. (7). Former par. (7) redesignated (8).
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(a)(1)], 
redesignated par. (5) as (7). Former par. (7) redesignated (9).
    Subsec. (t)(7)(D). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(i)], added subpar. (D).
    Subsec. (t)(8). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 202(a)(2)], redesignated par. (7) as (8). Former par. (8) 
redesignated (9).
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(a)(1)], 
redesignated par. (6) as (8). Former par. (8) redesignated (10).
    Subsec. (t)(8)(A). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 204(a)(1)], substituted ``subparagraphs (B) and (C)'' for 
``subparagraph (B)''.
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(h)(1)(B)], 
inserted at end ``The Secretary shall consult with an expert outside 
advisory panel composed of an appropriate selection of representatives 
of providers to review (and advise the Secretary concerning) the 
clinical integrity of the groups and weights. Such panel may use data 
collected or developed by entities and organizations (other than the 
Department of Health and Human Services) in conducting such review.''
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(h)(1)(A)], 
substituted ``shall review not less often than annually'' for ``may 
periodically review''.
    Subsec. (t)(8)(C) to (E). Pub. L. 106-113, Sec. 1000(a)(6) [title 
II, Sec. 204(a)(2), (3)], added subpar. (C) and redesignated former 
subpars. (C) and (D) as (D) and (E), respectively.
    Subsec. (t)(9). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 202(a)(2)], redesignated par. (8) as (9). Former par. (9) 
redesignated (10).
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(j)], 
substituted ``section 1395x(v)(1)(U) of this title'' for ``the matter in 
subsection (a)(1) of this section preceding subparagraph (A)''.
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(a)(1)], 
redesignated par. (7) as (9). Former par. (9) redesignated (11).
    Subsec. (t)(10). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 202(a)(2)], redesignated par. (9) as (10). Former par. (10) 
redesignated (11).
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(a)(1)], 
redesignated par. (8) as (10).
    Subsec. (t)(11). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 202(a)(2)], redesignated par. (10) as (11). Former par. (11) 
redesignated (12).
    Pub. L. 106-113, Sec. 1000(a)(6) [title II, Sec. 201(a)(1)], 
redesignated par. (9) as (11).
    Subsec. (t)(11)(E). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 201(d)], added subpar. (E).
    Subsec. (t)(12). Pub. L. 106-113, Sec. 1000(a)(6) [title II, 
Sec. 202(a)(2)], redesignated par. (11) as (12).
    Subsec. (t)(13). Pub. L. 106-113, Sec. 1000(a)(6) [title IV, 
Sec. 401(b)(1)], added par. (13).
    1997--Subsec. (a)(1)(A). Pub. L. 105-33, Sec. 4002(j)(1)(A), 
inserted ``(and either is sponsored by a union or employer, or does not 
provide, or arrange for the provision of, any inpatient hospital 
services)'' after ``prepayment basis''.
    Subsec. (a)(1)(D). Pub. L. 105-33, Sec. 4104(c), inserted ``or 
section 1395m(d)(1) of this title'' after ``subsection (h)(1) of this 
section''.
    Subsec. (a)(1)(O). Pub. L. 105-33, Sec. 4512(b)(1), substituted 
``section 1395x(s)(2)(K) of this title'' for ``section 
1395x(s)(2)(K)(ii) of this title'' and ``services furnished by physician 
assistants, nurse practitioners, or clinic nurse specialists'' for 
``nurse practitioner or clinical nurse specialist services''.
    Pub. L. 105-33, Sec. 4511(b)(1), amended cl. (O) generally. Prior to 
amendment, cl. (O) read as follows: ``with respect to services described 
in section 1395x(s)(2)(K)(iii) of this title (relating to nurse 
practitioner or clinical nurse specialist services provided in a rural 
area), the amounts paid shall be 80 percent of the lesser of the actual 
charge or the prevailing charge that would be recognized (or, for 
services furnished on or after January 1, 1992, the fee schedule amount 
provided under section 1395w-4 of this title) if the services had been 
performed by a physician (subject to the limitation described in 
subsection (r)(2) of this section),''.
    Subsec. (a)(1)(Q). Pub. L. 105-33, Sec. 4315(b), added cl. (Q).
    Subsec. (a)(1)(R). Pub. L. 105-33, Sec. 4531(b)(1), added cl. (R).
    Subsec. (a)(1)(S). Pub. L. 105-33, Sec. 4556(b), added cl. (S).
    Subsec. (a)(2). Pub. L. 105-33, Sec. 4541(a)(1)(A), inserted 
``(C),'' before ``(D)'' in introductory provisions.
    Subsec. (a)(2)(A). Pub. L. 105-33, Sec. 4603(c)(2)(A)(i), amended 
subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: 
``with respect to home health services (other than a covered 
osteoporosis drug (as defined in section 1395x(kk) of this title)) and 
to items and services described in section 1395x(s)(10)(A) of this 
title, the lesser of--
        ``(i) the reasonable cost of such services, as determined under 
    section 1395x(v) of this title, or
        ``(ii) the customary charges with respect to such services,
or, 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 provision), free of charge or 
at nominal charges to the public, the amount determined in accordance 
with section 1395f(b)(2) of this title;''.
    Subsec. (a)(2)(B). Pub. L. 105-33, Sec. 4432(b)(5)(C), inserted ``or 
section 1395yy(e)(9) of this title'' after ``1395ww of this title'' in 
introductory provisions.
    Pub. L. 105-33, Sec. 4523(d)(3), inserted ``furnished before January 
1, 1999,'' after ``(i)'' in cl. (i), inserted ``before January 1, 
1999,'' after ``furnished'' in cl. (ii), added cl. (iii), and 
redesignated former cl. (iii) as (iv).
    Subsec. (a)(2)(D). Pub. L. 105-33, Sec. 4104(c)(1), inserted ``or 
section 1395m(d)(1) of this title'' after ``subsection (h)(1) of this 
section''.
    Subsec. (a)(2)(E). Pub. L. 105-33, Sec. 4523(d)(2)(B), inserted 
``or, for services or procedures performed on or after January 1, 1999, 
subsection (t) of this section'' before semicolon at end.
    Subsec. (a)(2)(G). Pub. L. 105-33, Sec. 4603(c)(2)(A)(ii)-(iv), 
added subpar. (G).
    Subsec. (a)(3). Pub. L. 105-33, Sec. 4541(a)(1)(B), substituted 
``section 1395k(a)(2)(D) of this title'' for ``subparagraphs (D) and (E) 
of section 1395k(a)(2) of this title''.
    Subsec. (a)(4). Pub. L. 105-33, Sec. 4523(d)(1)(B), inserted ``or 
subsection (t) of this section'' before semicolon at end.
    Subsec. (a)(6). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care''.
    Subsec. (a)(8), (9). Pub. L. 105-33, Sec. 4541(a)(1)(C)-(E), added 
pars. (8) and (9).
    Subsec. (b)(5). Pub. L. 105-33, Sec. 4101(b), added cl. (5) at end 
of first sentence.
    Subsec. (b)(6). Pub. L. 105-33, Sec. 4102(b), added cl. (6) at end 
of first sentence.
    Subsec. (f). Pub. L. 105-33, Sec. 4205(a)(1)(A), substituted ``rural 
health clinics (other than such clinics in rural hospitals with less 
than 50 beds)'' for ``independent rural health clinics'' in introductory 
provisions.
    Subsec. (f)(1). Pub. L. 105-33, Sec. 4205(a)(2), inserted ``per 
visit'' after ``$46''.
    Subsec. (g). Pub. L. 105-33, Sec. 4541(d)(1), substituted ``the 
amount specified in paragraph (2) for the year'' for ``$900'' in two 
places, redesignated first sentence as par. (1) and last sentence as 
par. (3), and added par. (2).
    Pub. L. 105-33, Sec. 4541(c), (d)(1)(A), substituted, in first 
sentence, ``physical therapy services of the type described in section 
1395x(p) of this title, but not described in subsection (a)(8)(B) of 
this section, and physical therapy services of such type which are 
furnished by a physician or as incident to physicians' services'' for 
``services described in the second sentence of section 1395x(p) of this 
title'', and substituted, in last sentence, ``occupational therapy 
services (of the type that are described in section 1395x(p) of this 
title (but not described in subsection (a)(8)(B) of this section) 
through the operation of section 1395x(g) of this title and of such type 
which are furnished by a physician or as incident to physicians' 
services)'' for ``outpatient occupational therapy services which are 
described in the second sentence of section 1395x(p) of this title 
through the operation of section 1395x(g) of this title''.
    Subsec. (h)(1)(A). Pub. L. 105-33, Sec. 4104(c)(2), substituted 
``Subject to section 1395m(d)(1) of this title, the Secretary'' for 
``The Secretary''.
    Pub. L. 105-33, Sec. 4103(b), inserted ``(including prostate cancer 
screening tests under section 1395x(oo) of this title consisting of 
prostate-specific antigen blood tests)'' after ``laboratory tests''.
    Subsec. (h)(2)(A)(ii)(IV). Pub. L. 105-33, Sec. 4553(a), inserted 
``and 1998 through 2002'' after ``1995''.
    Subsec. (h)(4)(B)(vii). Pub. L. 105-33, Sec. 4553(b)(2)(A), inserted 
``and before January 1, 1998,'' after ``December 31, 1995,''.
    Subsec. (h)(4)(B)(viii). Pub. L. 105-33, Sec. 4553(b)(1), (2)(B), 
(3), added cl. (viii).
    Subsec. (h)(5)(A)(iii). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care''.
    Subsec. (i)(1)(A). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care''.
    Subsec. (i)(2)(C). Pub. L. 105-33, Sec. 4555, inserted at end ``In 
each of the fiscal years 1998 through 2002, the increase under this 
subparagraph shall be reduced (but not below zero) by 2.0 percentage 
points.''
    Subsec. (i)(3)(A). Pub. L. 105-33, Sec. 4523(d)(1)(A)(i), inserted 
``before January 1, 1999,'' after ``furnished'' and struck out ``in a 
cost reporting period'' after ``paragraph (1)(A)''.
    Pub. L. 105-33, Sec. 4201(c)(1), substituted ``critical access'' for 
``rural primary care''.
    Subsec. (i)(3)(B)(i)(II). Pub. L. 105-33, Sec. 4521(a), struck out 
``of 80 percent'' before ``of the standard overhead amount'' and 
inserted before period at end ``, less the amount a provider may charge 
as described in clause (ii) of section 1395cc(a)(2)(A) of this title''.
    Subsec. (l)(5). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care'' wherever appearing.
    Subsec. (n)(1)(A). Pub. L. 105-33, Sec. 4523(d)(2)(A), inserted 
``and before January 1, 1999,'' after ``October 1, 1988,'' and after 
``October 1, 1989,''.
    Subsec. (n)(1)(B)(i)(II). Pub. L. 105-33, Sec. 4521(b), struck out 
``of 80 percent'' before ``of the prevailing charge'' and inserted 
before period at end ``, less the amount a provider may charge as 
described in clause (ii) of section 1395cc(a)(2)(A) of this title''.
    Subsec. (r)(1). Pub. L. 105-33, Sec. 4511(b)(2)(A), substituted 
``section 1395x(s)(2)(K)(ii) of this title (relating to nurse 
practitioner or clinical nurse specialist services)'' for ``section 
1395x(s)(2)(K)(iii) of this title (relating to nurse practitioner or 
clinical nurse specialist services provided in a rural area)''.
    Pub. L. 105-33, Sec. 4201(c)(1), substituted ``critical access'' for 
``rural primary care''.
    Subsec. (r)(2). Pub. L. 105-33, Sec. 4511(b)(2)(B), (D), 
redesignated par. (3) as (2) and struck out former par. (2) which read 
as follows:
    ``(2)(A) For purposes of subsection (a)(1)(O) of this section, the 
prevailing charge for services described in section 1395x(s)(2)(K)(iii) 
of this title may not exceed the applicable percentage (as defined in 
subparagraph (B)) of the prevailing charge (or, for services furnished 
on or after January 1, 1992, the fee schedule amount provided under 
section 1395w-4 of this title) determined for such services performed by 
physicians who are not specialists.
    ``(B) In subparagraph (A), the term `applicable percentage' means--
        ``(i) 75 percent in the case of services performed in a 
    hospital, and
        ``(ii) 85 percent in the case of other services.''
    Subsec. (r)(3). Pub. L. 105-33, Sec. 4511(b)(2)(C), (D), 
redesignated par. (3) as (2) and substituted ``section 
1395x(s)(2)(K)(ii) of this title'' for ``section 1395x(s)(2)(K)(iii) of 
this title''.
    Pub. L. 105-33, Sec. 4201(c)(1), substituted ``critical access'' for 
``rural primary care''.
    Subsec. (t). Pub. L. 105-33, Sec. 4523(a), added subsec. (t).
    1994--Subsec. (a)(1)(D)(i). Pub. L. 103-432, Sec. 156(a)(2)(B)(i), 
struck out ``, or for tests furnished in connection with obtaining a 
second opinion required under section 1320c-13(c)(2) of this title (or a 
third opinion, if the second opinion was in disagreement with the first 
opinion)'' after ``assignment-related basis''.
    Subsec. (a)(1)(G). Pub. L. 103-432, Sec. 156(a)(2)(B)(ii), struck 
out cl. (G) which read as follows: ``with respect to items and services 
(other than clinical diagnostic laboratory tests) furnished in 
connection with obtaining a second opinion required under section 1320c-
13(c)(2) of this title (or a third opinion, if the second opinion was in 
disagreement with the first opinion), the amounts paid shall be 100 
percent of the reasonable charges for such items and services,''.
    Subsec. (a)(2)(A). Pub. L. 103-432, Sec. 156(a)(2)(B)(iii), struck 
out ``, to items and services (other than clinical diagnostic laboratory 
tests) furnished in connection with obtaining a second opinion required 
under section 1320c-13(c)(2) of this title (or a third opinion, if the 
second opinion was in disagreement with the first opinion),'' before 
``and to items and services'' in introductory provisions.
    Pub. L. 103-432, Sec. 147(f)(6)(C)(i), substituted ``health services 
(other than a covered osteoporosis drug (as defined in section 1395x(kk) 
of this title))'' for ``health services'' in introductory provisions.
    Subsec. (a)(2)(D)(i). Pub. L. 103-432, Sec. 156(a)(2)(B)(iv), 
substituted ``assignment-related basis or'' for ``assignment-related 
basis,'' and struck out ``, or for tests furnished in connection with 
obtaining a second opinion required under section 1320c-13(c)(2) of this 
title (or a third opinion, if the second opinion was in disagreement 
with the first opinion)'' after ``section 1395cc of this title''.
    Subsec. (a)(2)(F). Pub. L. 103-432, Sec. 147(f)(6)(C)(ii)-(iv), 
added subpar. (F).
    Subsec. (a)(3). Pub. L. 103-432, Sec. 156(a)(2)(B)(v), struck out 
``and for items and services furnished in connection with obtaining a 
second opinion required under section 1320c-13(c)(2) of this title, or a 
third opinion, if the second opinion was in disagreement with the first 
opinion)'' after ``section 1395x(s)(10)(A) of this title''.
    Subsec. (b)(2). Pub. L. 103-432, Sec. 147(f)(6)(D), inserted 
``(other than a covered osteoporosis drug (as defined in section 
1395x(kk) of this title))'' after ``services''.
    Subsec. (b)(4), (5). Pub. L. 103-432, Sec. 156(a)(2)(B)(vi), 
redesignated par. (5) as (4) and struck out former par. (4) which read 
as follows: ``such deductible shall not apply with respect to items and 
services furnished in connection with obtaining a second opinion 
required under section 1320c-13(c)(2) of this title (or a third opinion, 
if the second opinion was in disagreement with the first opinion),''.
    Subsec. (h)(5)(D). Pub. L. 103-432, Sec. 123(e), substituted 
``paragraph (2) of section 1395u(j)'' for ``paragraphs (2) and (3) of 
section 1395u(j)'' and inserted at end ``Paragraph (4) of such section 
shall apply in this subparagraph in the same manner as such paragraph 
applies to such section.''
    Subsec. (i)(1). Pub. L. 103-432, Sec. 141(a)(3), inserted before 
period at end of last sentence ``, in consultation with appropriate 
trade and professional organizations''.
    Subsec. (i)(2)(A). Pub. L. 103-432, Sec. 141(a)(2)(A), struck out 
``and may be adjusted by the Secretary, when appropriate,'' after 
``annually thereafter'' in last sentence.
    Subsec. (i)(2)(A)(i). Pub. L. 103-432, Sec. 141(a)(1), inserted 
before comma at end ``, as determined in accordance with a survey (based 
upon a representative sample of procedures and facilities) taken not 
later than January 1, 1995, and every 5 years thereafter, of the actual 
audited costs incurred by such centers in providing such services''.
    Subsec. (i)(2)(B). Pub. L. 103-432, Sec. 141(a)(2)(A), struck out 
``and may be adjusted by the Secretary, when appropriate,'' after 
``annually thereafter'' in last sentence.
    Subsec. (i)(2)(C). Pub. L. 103-432, Sec. 141(a)(2)(B), added subpar. 
(C).
    Subsec. (i)(3)(B)(ii). Pub. L. 103-432, Sec. 141(c)(1), in subcls. 
(I) and (II) substituted ``for portions of cost reporting periods'' for 
``for reporting periods'' and ``and ending on or before December 31, 
1990'' for ``and on or before December 31, 1990''.
    Subsec. (l)(5)(B), (C). Pub. L. 103-432, Sec. 123(b)(2)(A)(i), 
redesignated subpar. (C) as (B) and struck out former subpar. (B) which 
read as follows:
    ``(B)(i) Payment for the services of a certified registered nurse 
anesthetist under this part may be made only on an assignment-related 
basis, and any such assignment agreed to by a certified registered nurse 
anesthetist shall be binding upon any other person presenting a claim or 
request for payment for such services.
    ``(ii) Except for deductible and coinsurance amounts applicable 
under this section, any person who knowingly and willfully presents, or 
causes to be presented, to an individual enrolled under this part a bill 
or request for payment for services of a certified registered nurse 
anesthetist for which payment may be made under this part only on an 
assignment-related basis is subject to a civil money penalty of not to 
exceed $2,000 for each such bill or request. The provisions of section 
1320a-7a of this title (other than subsections (a) and (b)) shall apply 
to a civil money penalty under the previous sentence in the same manner 
as such provisions apply to a penalty or proceeding under section 1320a-
7a(a) of this title.''
    Subsec. (n)(1)(B)(i)(II). Pub. L. 103-432, Sec. 147(d)(2), 
substituted ``April 1, 1989'' for ``January 1, 1989''.
    Pub. L. 103-432, Sec. 147(d)(1), inserted ``and for services 
described in subsection (a)(2)(E)(ii) of this section furnished on or 
after January 1, 1992'' after ``January 1, 1989'' and ``(or, in the case 
of services furnished on or after January 1, 1992, under section 1395w-4 
of this title)'' before period at end.
    Subsec. (p). Pub. L. 103-432, Sec. 123(b)(2)(A)(ii), struck out 
subsec. (p) which read as follows: ``In the case of certified nurse-
midwife services for which payment may be made under this part only 
pursuant to section 1395x(s)(2)(L) of this title, in the case of 
qualified psychologists services for which payment may be made under 
this part only pursuant to section 1395x(s)(2)(M) of this title, and in 
the case of clinical social worker services for which payment may be 
made under this part only pursuant to section 1395x(s)(2)(N) of this 
title, payment may only be made under this part for such services on an 
assignment-related basis. Except for deductible and coinsurance amounts 
applicable under this section, whoever knowingly and willfully presents, 
or causes to be presented, to an individual enrolled under this part a 
bill or request for payment for services described in the previous 
sentence, is subject to a civil money penalty of not to exceed $2,000 
for each such bill or request. The provisions of section 1320a-7a of 
this title (other than subsections (a) and (b)) shall apply to a civil 
money penalty under the previous sentence in the same manner as such 
provisions apply to a penalty or proceeding under section 1320a-7a(a) of 
this title.''
    Subsec. (q)(1). Pub. L. 103-432, Sec. 147(a), substituted ``unique 
physician identification number'' for ``provider number'' and struck out 
``and indicate whether or not the referring physician is an interested 
investor (within the meaning of section 1395nn(h)(5) of this title)'' 
after ``for the referring physician''.
    Subsec. (r). Pub. L. 103-432, Sec. 160(d)(1), redesignated subsec. 
(r), relating to other prepaid organizations, as (s).
    Subsec. (r)(1). Pub. L. 103-432, Sec. 147(e)(2), substituted ``or 
ambulatory'' for ``ambulatory'' in two places and ``center'' for 
``center,'' before ``with which the nurse''.
    Subsec. (r)(2)(A). Pub. L. 103-432, Sec. 147(e)(3), substituted 
``subsection (a)(1)(O) of this section'' for ``subsection (a)(1)(M) of 
this section''.
    Subsec. (r)(3), (4). Pub. L. 103-432, Sec. 123(b)(2)(A)(iii), 
redesignated par. (4) as (3) and struck out former par. (3) which read 
as follows:
    ``(3)(A) Payment under this part for services described in section 
1395x(s)(2)(K)(iii) of this title may be made only on an assignment-
related basis, and any such assignment agreed to by a nurse practitioner 
or clinical nurse specialist shall be binding upon any other person 
presenting a claim or request for payment for such services.
    ``(B) Except for deductible and coinsurance amounts applicable under 
this section, any person who knowingly and willfully presents, or causes 
to be presented, to an individual enrolled under this part a bill or 
request for payment for services described in section 
1395x(s)(2)(K)(iii) of this title in violation of subparagraph (A) is 
subject to a civil money penalty of not to exceed $2,000 for each such 
bill or request. The provisions of section 1320a-7a of this title (other 
than subsections (a) and (b)) shall apply to a civil money penalty under 
the previous sentence in the same manner as such provisions apply to a 
penalty or proceeding under section 1320a-7a(a) of this title.''
    Subsec. (s). Pub. L. 103-432, Sec. 160(d)(1), redesignated subsec. 
(r), relating to other prepaid organizations, as (s).
    1993--Subsec. (a)(1). Pub. L. 103-66, Sec. 13544(b)(2), redesignated 
cl. (M) relating to nurse practitioner and clinical nurse specialist 
services as (O), inserted comma before ``(O)'', transferred and inserted 
such cl. to appear before semicolon at end, struck out ``and'' before 
``(N)'', and inserted ``, and'' and cl. (P) following cl. (O) and before 
semicolon at end.
    Subsec. (g). Pub. L. 103-66, Sec. 13555(a), substituted ``$900'' for 
``$750'' in two places.
    Subsec. (h)(2)(A)(ii)(IV). Pub. L. 103-66, Sec. 13551(a), added 
subcl. (IV).
    Subsec. (h)(4)(B)(iv) to (vii). Pub. L. 103-66, Sec. 13551(b), added 
cls. (iv) to (vii), and struck out former cl. (iv) which read as 
follows: ``after December 31, 1990, is equal to 88 percent of the median 
of all the fee schedules established for that test for that laboratory 
setting under paragraph (1).''
    Subsec. (i)(3)(B)(ii). Pub. L. 103-66, Sec. 13532(a)(1), in 
introductory provisions substituted ``paragraph (4)'' for ``the last 
sentence of this clause'' and struck out concluding provisions which 
read as follows: ``In the case of a hospital that makes application to 
the Secretary and demonstrates that it specializes in eye services or 
eye and ear services (as determined by the Secretary), receives more 
than 30 percent of its total revenues from outpatient services and was 
an eye specialty hospital or an eye and ear specialty hospital on 
October 1, 1987, the cost proportion and ASC proportion in effect under 
subclauses (I) and (II) for cost reporting periods beginning in fiscal 
year 1988 shall remain in effect for cost reporting periods beginning on 
or after October 1, 1988, and before January 1, 1995.''
    Subsec. (i)(4). Pub. L. 103-66, Sec. 13532(a)(2), added par. (4).
    Subsec. (l)(4)(B)(i). Pub. L. 103-66, Sec. 13516(b)(1), inserted 
``and before January 1, 1994,'' after ``1991,''.
    Subsec. (l)(4)(B)(ii). Pub. L. 103-66, Sec. 13516(b)(2), inserted 
``and'' at end of subcl. (II), substituted a period for the comma at end 
of subcl. (III), and struck out subcls. (IV) to (VII) which read as 
follows:
    ``(IV) for services furnished in 1994, $11.25,
    ``(V) for services furnished in 1995, $11.50,
    ``(VI) for services furnished in 1996, $11.70, and
    ``(VII) for services furnished in calendar years after 1997, the 
previous year's conversion factor increased by the update determined 
under section 1395w-4(d)(3) of this title for physician anesthesia 
services for that year.''
    Subsec. (l)(4)(B)(iii). Pub. L. 103-66, Sec. 13516(b)(3), added cl. 
(iii).
    1990--Subsec. (a)(1)(H). Pub. L. 101-508, Sec. 4118(f)(2)(D), struck 
out ``, as the case may be'' after ``section 1395w-4 of this title''.
    Subsec. (a)(1)(J). Pub. L. 101-508, Sec. 4104(b)(1), struck out ``or 
physician pathology services'' after ``1395m(b)(6) of this title)'' and 
``or section 1395m(f) of this title, respectively'' after ``1395m(b) of 
this title''.
    Subsec. (a)(1)(K). Pub. L. 101-508, Sec. 4155(b)(2)(A), which 
directed amendment of cl. (K) by striking ``and'' at the end, could not 
be executed because of prior amendment by Pub. L. 101-508, 
Sec. 4153(a)(2)(B)(i), see below.
    Pub. L. 101-508, Sec. 4153(a)(2)(B)(i), struck out ``and'' after 
``by a physician),''.
    Subsec. (a)(1)(L). Pub. L. 101-508, Sec. 4153(a)(2)(B)(ii), 
substituted ``subparagraph,'' for ``subparagraph and'' at end.
    Subsec. (a)(1)(M). Pub. L. 101-508, Sec. 4155(b)(2)(B), added cl. 
(M) relating to nurse practitioner and clinical nurse specialist 
services.
    Pub. L. 101-508, Sec. 4153(a)(2)(B)(ii), added cl. (M) relating to 
prosthetic devices and orthotics.
    Subsec. (a)(2). Pub. L. 101-508, Sec. 4153(a)(2)(C)(i), substituted 
``(H), and (I)'' for ``and (H)'' in introductory provisions.
    Subsec. (a)(2)(E)(i). Pub. L. 101-508, Sec. 4163(d)(1), inserted ``, 
but excluding screening mammography'' after ``imaging services''.
    Subsec. (a)(7). Pub. L. 101-508, Sec. 4153(a)(2)(C)(ii)-(iv), added 
par. (7).
    Subsec. (b). Pub. L. 101-508, Sec. 4302, inserted ``for calendar 
years before 1991 and $100 for 1991 and subsequent years'' after 
``$75''.
    Subsec. (b)(5). Pub. L. 101-508, Sec. 4161(a)(3)(B), added cl. (5) 
at end of first sentence.
    Subsec. (h)(2)(A)(ii). Pub. L. 101-508, Sec. 4154(a)(1), substituted 
``clause (i)'' for ``any other provision of this subsection'' in 
introductory provisions.
    Subsec. (h)(2)(A)(ii)(III). Pub. L. 101-508, Sec. 4154(a)(2)-(4), 
added subcl. (III).
    Subsec. (h)(4)(B). Pub. L. 101-508, Sec. 4154(b)(1)(B), struck out 
``and'' at end of cl. (ii), inserted ``and before January 1, 1991,'' 
after ``1989,'' in cl. (iii), substituted ``, and'' for period at end of 
cl. (iii), and added cl. (iv).
    Subsec. (h)(5)(A)(ii)(II). Pub. L. 101-508, Sec. 4154(e)(1)(A), 
substituted ``wholly owned by'' for ``a wholly-owned subsidiary of''.
    Subsec. (h)(5)(A)(ii)(III). Pub. L. 101-508, Sec. 4154(e)(1)(C), 
substituted ``receives requests for testing during the year in which the 
test is performed'' for ``submits bills or requests for payment in any 
year''.
    Pub. L. 101-508, Sec. 4154(e)(1)(B), which directed substitution of 
``laboratory (but not including a laboratory described in subclause 
(II)),'' for ``laboratory'', was executed by making the substitution for 
``laboratory'' the second time appearing to reflect the probable intent 
of Congress.
    Subsec. (h)(5)(A)(iii). Pub. L. 101-508, Sec. 4008(m)(2)(C), which 
directed technical correction to Pub. L. 101-239, 
Sec. 6003(g)(3)(C)(vii)(I), was executed by making technical correction 
to Pub. L. 101-239, Sec. 6003(g)(3)(D)(vii)(I), resulting in no change 
in text. See 1989 Amendment note below.
    Subsec. (h)(5)(C). Pub. L. 101-508, Sec. 4154(c)(1)(A), substituted 
``test, including a test performed in a physician's office but excluding 
a test performed by a rural health clinic'' for ``test performed by a 
laboratory other than a rural health clinic''.
    Subsec. (h)(5)(D). Pub. L. 101-508, Sec. 4154(c)(1)(B), substituted 
``test, including a test performed in a physician's office but excluding 
a test performed by a rural health clinic,'' for ``test performed by a 
laboratory, other than a rural health clinic''.
    Subsec. (i)(3)(B)(ii). Pub. L. 101-508, Sec. 4151(c)(1)(B), 
substituted ``on or after October 1, 1988, and before January 1, 1995'' 
for ``in fiscal year 1989 or fiscal year 1990'' in last sentence.
    Subsec. (i)(3)(B)(ii)(I). Pub. L. 101-508, Sec. 4151(c)(1)(A)(i), 
substituted ``50 percent for reporting periods beginning on or after 
October 1, 1988, and on or before December 31, 1990, and 42 percent for 
portions of cost reporting periods beginning on or after January 1, 
1991'' for ``and 50 percent for other cost reporting periods''.
    Subsec. (i)(3)(B)(ii)(II). Pub. L. 101-508, Sec. 4151(c)(1)(A)(ii), 
substituted ``50 percent for reporting periods beginning on or after 
October 1, 1988, and on or before December 31, 1990, and 58 percent for 
portions of cost reporting periods beginning on or after January 1, 
1991'' for ``and 50 percent for other cost reporting periods''.
    Subsec. (l)(1). Pub. L. 101-508, Sec. 4160(1), designated existing 
provisions as subpar. (A) and added subpars. (B) and (C).
    Subsec. (l)(2). Pub. L. 101-508, Sec. 4160(2), struck out at end 
``The fee schedule shall be adjusted annually (to become effective on 
January 1 of each calendar year) by the percentage increase in the MEI 
(as defined in section 1395u(i)(3) of this title) for that year.''
    Subsec. (l)(4). Pub. L. 101-508, Sec. 4160(3), added par. (4) and 
struck out former par. (4) which read as follows: ``In establishing the 
fee schedule under paragraph (1), the Secretary may utilize a system of 
time units, a system of base and time units, or any appropriate 
methodology. The Secretary may establish a nationwide fee schedule or 
adjust the fee schedule for geographic areas (as the Secretary may 
determine to be appropriate).''
    Subsec. (m). Pub. L. 101-597 substituted ``health professional 
shortage area'' for ``health manpower shortage area''.
    Subsec. (n)(1)(B)(ii)(I). Pub. L. 101-508, Sec. 4151(c)(2), inserted 
before period at end ``, and such term means 42 percent in the case of 
outpatient radiology services for portions of cost reporting periods 
beginning on or after January 1, 1991''.
    Subsec. (r). Pub. L. 101-508, Sec. 4206(b)(2), added subsec. (r) 
relating to other prepaid organizations.
    Pub. L. 101-508, Sec. 4155(b)(3), added subsec. (r) relating to cap 
on prevailing charge and billing on assignment-related basis.
    1989--Subsec. (a). Pub. L. 101-234, Sec. 202(a), repealed Pub. L. 
100-360, Sec. 212(c)(2), and provided that the provisions of law amended 
or repealed by such section are restored or revised as if such section 
had not been enacted, see 1988 Amendment note below.
    Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 100-360, 
Sec. 205(c)(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.
    Subsec. (a)(1)(F). Pub. L. 101-239, Sec. 6113(b)(3)(A), added cl. 
(F).
    Subsec. (a)(1)(H). Pub. L. 101-239, Sec. 6102(e)(5), inserted ``(or, 
for services furnished on or after January 1, 1992, the fee schedule 
amount provided under section 1395w-4 of this title, as the case may 
be)'' after ``prevailing charge that would be recognized''.
    Subsec. (a)(1)(J). Pub. L. 101-239, Sec. 6102(f)(2), inserted ``or 
physician pathology services'' after ``1395m(b)(6) of this title)'' and 
``or section 1395m(f) of this title, respectively'' after ``1395m(b) of 
this title''.
    Pub. L. 101-239, Sec. 6102(e)(6)(A), inserted ``subject to section 
1395w-4 of this title,'' before ``the amounts''.
    Subsec. (a)(1)(K). Pub. L. 101-239, Sec. 6102(e)(7), inserted ``, 
or, for services furnished on or after January 1, 1992, 65 percent of 
the fee schedule amount provided under section 1395w-4 of this title for 
the same service performed by a physician'' after ``for the same service 
performed by a physician''.
    Subsec. (a)(1)(M). Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 
100-360, Sec. 201(b)(1), 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)(1)(N). Pub. L. 101-239, Sec. 6102(e)(1)(B), added cl. 
(N).
    Subsec. (a)(2). Pub. L. 101-239, Sec. 6116(b)(1)(A), substituted 
``(G), and (H)'' for ``and (G)'' in introductory provisions.
    Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 100-360, 
Secs. 202(b)(2), 203(c)(1)(A)-(D), 204(d)(1), and 205(c)(1), 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)(3). Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 100-
360, Sec. 205(c)(2), 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)(6). Pub. L. 101-239, Sec. 6116(b)(1)(B)-(D), added par. 
(6).
    Subsec. (b). Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 100-360, 
Secs. 202(b)(3), 203(c)(1)(E), 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. (c). Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 100-360, 
Sec. 201(a)(1), (4), 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. (d). Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 100-360, 
Sec. 201(a)(1)(D), (2), 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. (d)(1). Pub. L. 101-239, Sec. 6113(d), substituted ``62\1/2\ 
percent of such expenses.'' for ``whichever of the following amounts is 
the smaller:
        ``(A) $1375.00, or
        ``(B) 62\1/2\ percent of such expenses.''
    Subsec. (g). Pub. L. 101-239, Sec. 6133(a), substituted ``$750'' for 
``$500'' in two places.
    Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 100-360, 
Sec. 201(a)(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.
    Subsec. (h)(1)(B), (C). Pub. L. 101-239, Sec. 6111(a)(1), 
substituted ``on or after July 1, 1984'' for ``during the period 
beginning on July 1, 1984, and ending on December 31, 1989. For such 
tests furnished on or after January 1, 1990, the fee schedule shall be 
established on a nationwide basis.''
    Subsec. (h)(1)(D). Pub. L. 101-239, Sec. 6003(e)(2)(A), substituted 
``section 1395ww(d)(5)(D)(iii) of this title'' for ``the last sentence 
of section 1395ww(d)(5)(C)(ii) of this title''.
    Subsec. (h)(4)(B)(ii). Pub. L. 101-239, Sec. 6111(a)(3)(A), (B), 
substituted ``after March 31, 1988, and before January 1, 1990,'' for 
``after March 31, 1988, and so long as a fee schedule for the test has 
not been established on a nationwide basis,''.
    Subsec. (h)(4)(B)(iii). Pub. L. 101-239, Sec. 6111(a)(2), (3)(C), 
(4), added cl. (iii).
    Subsec. (h)(5)(A)(ii). Pub. L. 101-239, Sec. 6111(b)(1), substituted 
``referring laboratory but only if--'' for ``referring laboratory, and'' 
in introductory provisions, and added subcls. (I) through (III).
    Subsec. (h)(5)(A)(iii). Pub. L. 101-239, Sec. 6003(g)(3)(D)(vii)(I), 
as amended by Pub. L. 101-508, Sec. 4008(m)(2)(C), substituted 
``hospital or rural primary care hospital,'' for ``hospital,''.
    Subsec. (i)(1)(A). Pub. L. 101-239, Sec. 6003(g)(3)(D)(vii)(II), 
inserted ``, rural primary care hospital,'' after ``section 
1395k(a)(2)(F)(i) of this title)''.
    Subsec. (i)(3)(A). Pub. L. 101-239, Sec. 6003(g)(3)(D)(vii)(III), 
inserted ``or rural primary care hospital services'' after ``facility 
services'' in introductory provisions.
    Subsec. (l)(5)(A). Pub. L. 101-239, Sec. 6003(g)(3)(D)(vii)(IV), 
inserted ``rural primary care hospital,'' after ``hospital,'' in two 
places.
    Subsec. (l)(5)(C). Pub. L. 101-239, Sec. 6003(g)(3)(D)(vii)(V), 
substituted ``hospital or rural primary care hospital'' for ``hospital'' 
in two places.
    Subsec. (m). Pub. L. 101-239, Sec. 6102(c)(1), struck out ``class 1 
or class 2'' before ``health manpower shortage area'' and substituted 
``10 percent'' for ``5 percent''.
    Subsec. (o)(1). Pub. L. 101-239, Sec. 6131(a)(1)(C), inserted ``(or 
inserts)'' after ``shoes'' in two places in last sentence.
    Subsec. (o)(1)(A). Pub. L. 101-239, Sec. 6131(a)(1)(A), amended 
subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: 
``no payment may be made under this part for the furnishing of more than 
one pair of shoes for any individual for any calendar year, and''.
    Subsec. (o)(1)(B), (2)(A). Pub. L. 101-239, Sec. 6131(a)(1)(B), 
substituted ``limits'' for ``limit''.
    Subsec. (o)(2)(A)(i). Pub. L. 101-239, Sec. 6131(a)(1)(D), amended 
cl. (i) generally. Prior to amendment, cl. (i) read as follows: ``for 
the furnishing of one pair of custom molded shoes is $300''.
    Subsec. (o)(2)(A)(ii)(II). Pub. L. 101-239, Sec. 6131(a)(1)(E), 
inserted ``any pairs of'' after ``$50 for''.
    Subsec. (o)(2)(D). Pub. L. 101-239, Sec. 6131(b), added subpar. (D).
    Subsec. (p). Pub. L. 101-239, Sec. 6113(b)(3)(B), substituted 
``1395x(s)(2)(L) of this title,'' for ``1395x(s)(2)(L) of this title 
and'' and inserted ``and in the case of clinical social worker services 
for which payment may be made under this part only pursuant to section 
1395x(s)(2)(N) of this title,'' after ``section 1395x(s)(2)(M) of this 
title,''.
    Subsec. (q). Pub. L. 101-239, Sec. 6204(b), added subsec. (q).
    1988--Subsec. (a). Pub. L. 100-360, Sec. 212(c)(2), inserted ``or, 
as provided in section 1395t-1(c) of this title, from the Federal 
Catastrophic Drug Insurance Trust Fund'' after ``Fund'' in introductory 
provisions.
    Pub. L. 100-360, Sec. 205(c)(3), inserted provision at end relating 
to payment for in-home care for chronically dependent individuals.
    Subsec. (a)(1)(D)(i). Pub. L. 100-360, Sec. 411(i)(4)(C)(i), amended 
Pub. L. 100-203, Sec. 4085(i)(1)(A), see 1987 Amendment note below.
    Subsec. (a)(1)(F). Pub. L. 100-360, Sec. 411(f)(12)(A), (14), added 
and renumbered Pub. L. 100-203, Sec. 4055(a)(1), see 1987 Amendment note 
below.
    Pub. L. 100-360, Sec. 411(i)(4)(C)(iv), made technical amendment to 
directory language of Pub. L. 100-203, Sec. 4085(i)(21)(D)(i), see 1987 
Amendment note below.
    Pub. L. 100-360, Sec. 411(i)(4)(C)(ii), repealed Pub. L. 100-203, 
Sec. 4085(i)(1)(B), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(h)(4)(B)(i), (ii), redesignated and 
amended directory language of Pub. L. 100-203, Sec. 4073(b)(1)(A), see 
1987 Amendment note below.
    Subsec. (a)(1)(G). Pub. L. 100-360, Sec. 411(h)(7)(C)(ii), repealed 
Pub. L. 100-203, Sec. 4077(b)(3)(A), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(h)(4)(B)(iii), repealed Pub. L. 100-203, 
Sec. 4073(b)(2)(B), see 1987 Amendment note below.
    Subsec. (a)(1)(H). Pub. L. 100-360, Sec. 411(h)(7)(C)(ii), repealed 
Pub. L. 100-203, Sec. 4077(b)(3)(B), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(g)(1)(E), which directed the amendment of 
cl. (H) by striking ``and'' before ``(I)'' could not be executed because 
of the prior amendment by section 4049(a)(1) of Pub. L. 100-203, see 
1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(i)(3), added Pub. L. 100-203, 
Sec. 4084(c)(2), see 1987 Amendment note below.
    Subsec. (a)(1)(J). Pub. L. 100-360, Sec. 411(f)(8)(B)(i), made 
technical amendment to directory language of Pub. L. 100-203, 
Sec. 4049(a)(1), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(f)(8)(C), substituted ``section 
1395m(b)(6) of this title'' for ``section 1395m(b)(5) of this title''.
    Subsec. (a)(1)(K). Pub. L. 100-360, Sec. 411(h)(7)(C)(iii), (F), 
redesignated and amended Pub. L. 100-203, Sec. 4077(b)(2)(A), see 1987 
Amendment note below.
    Pub. L. 100-360, Sec. 411(h)(4)(B)(i), (iv), (v), redesignated and 
amended Pub. L. 100-203, Sec. 4073(b)(1)(B), see 1987 Amendment note 
below.
    Subsec. (a)(1)(L). Pub. L. 100-360, Sec. 411(h)(7)(C)(i), (iv), (v), 
(F), redesignated and amended Pub. L. 100-203, Sec. 4077(b)(2)(B), see 
1987 Amendment note below.
    Subsec. (a)(1)(M). Pub. L. 100-360, Sec. 202(b)(1), added cl. (M) 
relating to expenses incurred for covered outpatient drugs.
    Subsec. (a)(2). Pub. L. 100-360, Sec. 205(c)(1), inserted 
``(A)(ii),'' after ``subparagraphs'' in introductory provisions.
    Pub. L. 100-360, Sec. 202(b)(2), inserted ``(other than covered 
outpatient drugs)'' after ``in the case of services'' in introductory 
provisions.
    Subsec. (a)(2)(B). Pub. L. 100-360, Sec. 203(c)(1)(A), substituted 
``(E), or (F)'' for ``or (E)'' in introductory provisions.
    Subsec. (a)(2)(D)(i). Pub. L. 100-360, Sec. 411(i)(4)(C)(i), amended 
Pub. L. 100-203, Sec. 4085(i)(1)(A), see 1987 Amendment note below.
    Subsec. (a)(2)(E)(i). Pub. L. 100-360, Sec. 204(d)(1), inserted ``, 
but excluding screening mammography'' after ``imaging services''.
    Subsec. (a)(2)(F). Pub. L. 100-360, Sec. 203(c)(1)(B)-(D), added cl. 
(F) relating to home intravenous drug therapy services.
    Subsec. (a)(3). Pub. L. 100-360, Sec. 205(c)(2), substituted 
``subparagraphs (A)(ii), (D),'' for ``subparagraphs (D)''.
    Subsec. (b). Pub. L. 100-360, Sec. 104(d)(7), as added by Pub. L. 
100-485, Sec. 608(d)(3)(G), inserted at end ``The deductible under the 
previous sentence for blood or blood cells furnished an individual in a 
year shall be reduced to the extent that a deductible has been imposed 
under section 1395e(a)(2) of this title to blood or blood cells 
furnished the individual in the year.''
    Subsec. (b)(1). Pub. L. 100-360, Sec. 202(b)(3)(A), inserted ``or 
for covered outpatient drugs'' after ``section 1395x(s)(10)(A) of this 
title''.
    Subsec. (b)(2). Pub. L. 100-360, Sec. 203(c)(1)(E), substituted 
``services and home intravenous drug therapy services'' for 
``services''.
    Pub. L. 100-360, Sec. 202(b)(3)(B), inserted ``or with respect to 
covered outpatient drugs'' after ``home health services''.
    Subsec. (b)(3) to (5). Pub. L. 100-360, Sec. 411(f)(12)(A), (14), 
added and renumbered Pub. L. 100-203, Sec. 4055(a)(2), see 1987 
Amendment note below.
    Subsec. (c). Pub. L. 100-360, Sec. 201(a)(4), added subsec. (c) 
relating to limitation on out-of-pocket catastrophic cost-sharing, 
adjustment, buy-out plans, and conditions for payments with respect to 
plans other than buy-out plans. Former subsec. (c) redesignated (d)(1).
    Pub. L. 100-360, Sec. 411(h)(1)(A), substituted ``monitoring or 
changing drug prescriptions'' for ``prescribing or monitoring 
prescription drugs'' in last sentence.
    Pub. L. 100-360, Sec. 201(a)(1)(A), as amended by Pub. L. 100-485, 
Sec. 608(d)(4), substituted ``subsections (a) through (c)'' for 
``subsections (a) and (b)'' in introductory provisions.
    Pub. L. 100-360, Sec. 201(a)(1)(B), (C), redesignated former pars. 
(1) and (2) as subpars. (A) and (B) and substituted ``this paragraph'' 
for ``this subsection'' in last sentence.
    Subsec. (d)(1). Pub. L. 100-360, Sec. 201(a)(1)(D), redesignated 
former subsec. (c) as subsec. (d)(1). Former subsec. (d) redesignated 
subsec. (d)(2).
    Subsec. (d)(2). Pub. L. 100-360, Sec. 201(a)(2), redesignated former 
subsec. (d) as subsec. (d)(2).
    Subsec. (f). Pub. L. 100-360, Sec. 411(g)(5), substituted ``MEI (as 
defined in section 1395u(i)(3) of this title) applicable to primary care 
services (as defined in section 1395u(i)(4) of this title)'' for 
``medicare economic index (referred to in the fourth sentence of section 
1395u(b)(3) of this title) applicable to physicians' services''.
    Subsec. (g). Pub. L. 100-360, Sec. 201(a)(3), substituted 
``subsections (a) through (c) of this section'' for ``subsections (a) 
and (b) of this section'' in two places.
    Subsec. (h)(1)(D). Pub. L. 100-360, Sec. 411(g)(3)(E), (F), amended 
and redesignated Pub. L. 100-203, Sec. 4064(c)(1), see 1987 Amendment 
note below.
    Subsec. (h)(2)(A)(i). Pub. L. 100-360, Sec. 411(g)(3)(A), added Pub. 
L. 100-203, Sec. 4064(a)(1), see 1987 Amendment note below.
    Subsec. (h)(2)(A)(ii). Pub. L. 100-360, Sec. 411(g)(3)(A), added 
Pub. L. 100-203, Sec. 4064(a)(3), see 1987 Amendment note below.
    Subsec. (h)(2)(A)(iii). Pub. L. 100-360, Sec. 411(g)(3)(B), (C), 
amended Pub. L. 100-203, Sec. 4064(b)(1), see 1987 Amendment note below.
    Subsec. (h)(2)(B). Pub. L. 100-360, Sec. 411(g)(3)(A), added Pub. L. 
100-203, Sec. 4064(a)(2), see 1987 Amendment note below.
    Subsec. (h)(3). Pub. L. 100-647, Sec. 8421(a), inserted at end ``In 
establishing a fee to cover the transportation and personnel expenses 
for trained personnel to travel to the location of an individual to 
collect a sample, the Secretary shall provide a method for computing the 
fee based on the number of miles traveled and the personnel costs 
associated with the collection of each individual sample, but the 
Secretary shall only be required to apply such method in the case of 
tests furnished during the period beginning on April 1, 1989, and ending 
on December 31, 1990, by a laboratory that establishes to the 
satisfaction of the Secretary (based on data for the 12-month period 
ending June 30, 1988) that (i) the laboratory is dependent upon payments 
under this subchapter for at least 80 percent of its collected revenues 
for clinical diagnostic laboratory tests, (ii) at least 85 percent of 
its gross revenues for such tests are attributable to tests performed 
with respect to individuals who are homebound or who are residents in a 
nursing facility, and (iii) the laboratory provided such tests for 
residents in nursing facilities representing at least 20 percent of the 
number of such facilities in the State in which the laboratory is 
located.''
    Subsec. (h)(4)(B)(ii). Pub. L. 100-360, Sec. 411(g)(3)(D), inserted 
``after'' before ``March 31, 1988''.
    Subsec. (h)(5)(A). Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), added 
Pub. L. 100-203, Sec. 4085(i)(22)(B), see 1987 Amendment note below.
    Subsec. (h)(5)(C). Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), added 
Pub. L. 100-203, Sec. 4085(i)(22)(B), see 1987 Amendment note below.
    Subsec. (h)(5)(D). Pub. L. 100-360, Sec. 411(i)(4)(B), substituted 
``A person may not bill for a clinical diagnostic laboratory test 
performed by a laboratory, other than a rural health clinic, other than 
on an assignment-related basis. If a person knowingly and willfully and 
on a repeated basis bills for a clinical diagnostic laboratory test in 
violation of the previous sentence'' for ``If a person knowingly and 
willfully and on a repeated basis bills an individual enrolled under 
this part for charges for a clinical diagnostic laboratory test for 
which payment may only be made on an assignment-related basis under 
subparagraph (C)'' and ``paragraphs (2) and (3) of section 1395u(j) of 
this title in the same manner such paragraphs apply with respect to a 
physician'' for ``section 1395u(j)(2) of this title''.
    Subsec. (i)(2)(A)(iii). Pub. L. 100-360, Sec. 411(g)(2)(D), 
substituted ``insertion'' for ``implantation'' and inserted ``or 
subsequent to'' after ``during''.
    Subsec. (i)(4). Pub. L. 100-360, Sec. 411(f)(12)(A), (14), added and 
renumbered Pub. L. 100-203, Sec. 4055(a)(3), see 1987 Amendment note 
below.
    Subsec. (i)(6). Pub. L. 100-485, Sec. 608(d)(22)(B), substituted 
``Any person, including'' for ``Any person, other than''.
    Pub. L. 100-360, Sec. 411(g)(2)(E), added Pub. L. 100-203, 
Sec. 4063(e)(1), see 1987 Amendment note below.
    Subsec. (l)(2). Pub. L. 100-360, Sec. 411(f)(2)(D), added Pub. L. 
100-203, Sec. 4042(b)(2)(B), see 1987 Amendment note below.
    Subsec. (l)(3)(B). Pub. L. 100-647, Sec. 8422(a), inserted ``plus 
applicable coinsurance'' after ``would have been paid''.
    Subsec. (l)(5)(B)(ii). Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), added 
Pub. L. 100-203, Sec. 4085(i)(23), see 1987 Amendment note below.
    Subsec. (n)(1)(A). Pub. L. 100-360, Sec. 411(g)(4)(C)(i), as amended 
by Pub. L. 100-485, Sec. 608(d)(22)(D), substituted ``for services 
described in subsection (a)(2)(E)(i) of this section furnished under 
this part on or after October 1, 1988, and for services described in 
subsection (a)(2)(E)(ii) of this section furnished under this part on or 
after October 1, 1989,'' for ``beginning on or after October 1, 1988 
under this part for services described in subsection (a)(2)(E) of this 
section'' in introductory provisions.
    Subsec. (n)(1)(B)(i)(II). Pub. L. 100-360, Sec. 411(g)(4)(C)(ii), 
inserted ``or (for services described in subsection (a)(2)(E)(i) of this 
section furnished on or after January 1, 1989) the fee schedule amount 
established'' after ``the prevailing charge''.
    Subsec. (n)(1)(B)(ii). Pub. L. 100-360, Sec. 411(g)(4)(C)(iii), 
amended subcls. (I) and (II) generally. Prior to amendment, subcls. (I) 
and (II) read as follows:
    ``(I) The term `cost proportion' means 65 percent for all or any 
part of cost reporting periods which occur in fiscal year 1989 and 50 
percent for other cost reporting periods.
    ``(II) The term `charge proportion' means 35 percent for all or any 
parts of cost reporting periods which occur in fiscal year 1989 and 50 
percent for other cost reporting periods.''
    Subsec. (o). Pub. L. 100-360, Sec. 411(h)(3)(B), as amended by Pub. 
L. 100-485, Sec. 608(d)(23)(A), amended Pub. L. 100-203, Sec. 4072(b), 
see 1987 Amendment note below.
    Subsec. (p). Pub. L. 100-360, Sec. 411(h)(7)(D), (F), redesignated 
and amended Pub. L. 100-203, Sec. 4077(b)(3), see 1987 Amendment note 
below.
    Pub. L. 100-360, Sec. 411(h)(4)(C), redesignated and amended Pub. L. 
100-203, Sec. 4073(b)(2), see 1987 Amendment note below.
    1987--Subsec. (a)(1)(D)(i). Pub. L. 100-203, Sec. 4085(i)(1)(A), as 
amended by Pub. L. 100-360, Sec. 411(i)(4)(C)(i), substituted ``on an 
assignment-related basis,'' for ``on the basis of an assignment 
described in section 1395u(b)(3)(B)(ii) of this title, under the 
procedure described in section 1395gg(f)(1) of this title,''.
    Subsec. (a)(1)(F). Pub. L. 100-203, Sec. 4055(a)(1), formerly 
Sec. 4054(a)(1), as added and renumbered by Pub. L. 100-360, 
Sec. 411(f)(12)(A), (14), struck out cl. (F) which read as follows: 
``with respect to expenses incurred for services described in subsection 
(i)(4) of this section under the conditions specified in such 
subsection, the amounts paid shall be the reasonable charge for such 
services,''.
    Pub. L. 100-203, Sec. 4085(i)(21)(D)(i), as amended by Pub. L. 100-
360, Sec. 411(i)(4)(C)(iv), amended Pub. L. 99-509, Sec. 9343(e)(2)(A), 
see 1986 Amendment note below.
    Pub. L. 100-203, Sec. 4085(i)(1)(B), which directed striking out 
``and'' at end, was repealed by Pub. L. 100-360, Sec. 411(i)(4)(C)(ii).
    Pub. L. 100-203, Sec. 4073(b)(1)(A), formerly Sec. 4073(b)(2)(A), as 
redesignated and amended by Pub. L. 100-360, Sec. 411(h)(4)(B)(i), (ii), 
struck out ``and'' at end.
    Subsec. (a)(1)(G). Pub. L. 100-203, Sec. 4077(b)(3)(A), which 
directed striking out ``and'' at end, was repealed by Pub. L. 100-360, 
Sec. 411(h)(7)(C)(ii).
    Pub. L. 100-203, Sec. 4073(b)(2)(B), which directed substituting 
``services,'' for ``services; and'', was repealed by Pub. L. 100-360, 
Sec. 411(h)(4)(B)(iii).
    Pub. L. 100-203, Sec. 4062(d)(3)(A)(i), substituted ``services,'' 
for ``services; and''.
    Subsec. (a)(1)(H). Pub. L. 100-203, Sec. 4077(b)(3)(B), which 
directed substituting ``services,'' for ``services; and'', was repealed 
by Pub. L. 100-360, Sec. 411(h)(7)(C)(ii).
    Pub. L. 100-203, Sec. 4084(c)(2), as added by Pub. L. 100-360, 
Sec. 411(i)(3), substituted ``least of the actual charge, the prevailing 
charge that would be recognized if the services had been performed by an 
anesthesiologist,'' for ``lesser of the actual charge''.
    Pub. L. 100-203, Sec. 4062(d)(3)(A)(ii), inserted ``and'' before the 
cl. (I) added by section 4062(d)(3)(A)(ii) of Pub. L. 100-203, see 
below.
    Pub. L. 100-203, Sec. 4049(a)(1), struck out ``and'' before the cl. 
(I) added by section 4062(d)(3)(A)(ii) of Pub. L. 100-203, see below.
    Subsec. (a)(1)(I). Pub. L. 100-203, Sec. 4062(d)(3)(A)(ii), added 
cl. (I).
    Subsec. (a)(1)(J). Pub. L. 100-203, Sec. 4049(a)(1), as amended by 
Pub. L. 100-360, Sec. 411(f)(8)(B)(i), added cl. (J).
    Subsec. (a)(1)(K). Pub. L. 100-203, Sec. 4077(b)(2)(A), formerly 
Sec. 4077(b)(3)(C), as redesignated and amended by Pub. L. 100-360, 
Sec. 411(h)(7)(C)(iii), (F), inserted ``and'' after ``performed by a 
physician),''.
    Pub. L. 100-203, Sec. 4073(b)(1)(B), formerly Sec. 4073(b)(2)(C), as 
redesignated and amended by Pub. L. 100-360, Sec. 411(h)(4)(B)(i), (iv), 
(v), added cl. (K), formerly (I), relating to amounts paid with respect 
to certified nurse-midwife services under section 1395x(s)(2)(L) of this 
title.
    Subsec. (a)(1)(L). Pub. L. 100-203, Sec. 4077(b)(2)(B), formerly 
Sec. 4077(b)(3)(D), as redesignated and amended by Pub. L. 100-360, 
Sec. 411(h)(7)(C)(i), (iv), (v), (F), added cl. (L), formerly (J), 
relating to amounts paid with respect to qualified psychologist services 
under section 1395x(s)(2)(M) of this title.
    Subsec. (a)(2). Pub. L. 100-203, Sec. 4062(d)(3)(B)(i), inserted 
reference to subpar. (G).
    Subsec. (a)(2)(A). Pub. L. 100-203, Sec. 4062(d)(3)(B)(ii), struck 
out ``(other than durable medical equipment)'' after ``home health 
services''.
    Subsec. (a)(2)(B). Pub. L. 100-203, Sec. 4066(b), inserted reference 
to subpar. (E).
    Subsec. (a)(2)(D)(i). Pub. L. 100-203, Sec. 4085(i)(1)(A), as 
amended by Pub. L. 100-360, Sec. 411(i)(4)(C)(i), substituted ``on an 
assignment-related basis,'' for ``on the basis of an assignment 
described in section 1395u(b)(3)(B)(ii) of this title, under the 
procedure described in section 1395gg(f)(1) of this title,''.
    Subsec. (a)(2)(E). Pub. L. 100-203, Sec. 4066(a)(1), added subpar. 
(E).
    Subsec. (a)(5). Pub. L. 100-203, Sec. 4062(d)(3)(C)-(E), added par. 
(5).
    Subsec. (b)(3). Pub. L. 100-203, Sec. 4055(a)(2), formerly 
Sec. 4054(a)(2), as added and renumbered by Pub. L. 100-360, 
Sec. 411(f)(12)(A), (14), redesignated par. (4) as (3) and struck out 
former par. (3) which read as follows: ``such total amount shall not 
include expenses incurred for services the amount of payment for which 
is determined under subsection (a)(1)(F) of this section,''.
    Pub. L. 100-203, Sec. 4085(i)(21)(D)(i), amended Pub. L. 99-509, 
Sec. 9343(e)(2)(A), see 1986 Amendment note below.
    Subsec. (b)(4). Pub. L. 100-203, Sec. 4055(a)(2), formerly 
Sec. 4054(a)(2), as added and renumbered by Pub. L. 100-360, 
Sec. 411(f)(12)(A), (14), redesignated cl. (5) as (4). Former cl. (4) 
redesignated (3).
    Subsec. (b)(4)(A). Pub. L. 100-203, Sec. 4085(i)(1)(C), substituted 
``on an assignment-related basis'' for ``on the basis of an assignment 
described in section 1395u(b)(3)(B)(ii) of this title, under the 
procedure described in section 1395gg(f)(1) of this title''.
    Subsec. (b)(5). Pub. L. 100-203, Sec. 4055(a)(2), formerly 
Sec. 4054(a)(2), as added and renumbered by Pub. L. 100-360, 
Sec. 411(f)(12)(A), (14), redesignated cl. (5) as (4).
    Subsec. (c). Pub. L. 100-203, Sec. 4070(b)(4), inserted ``or partial 
hospitalization services that are not directly provided by a physician'' 
before period at end of last sentence.
    Pub. L. 100-203, Sec. 4070(a)(2), inserted sentence at end defining 
``treatment''.
    Subsec. (c)(1). Pub. L. 100-203, Sec. 4070(a)(1), substituted 
``$1375.00'' for ``$312.50''.
    Subsec. (f). Pub. L. 100-203, Sec. 4067(a), added subsec. (f).
    Subsec. (h)(1)(C). Pub. L. 100-203, Sec. 4085(i)(2), inserted before 
period at end ``, and ending on December 31, 1989. For such tests 
furnished on or after January 1, 1990, the fee schedule shall be 
established on a nationwide basis''.
    Subsec. (h)(1)(D). Pub. L. 100-203, Sec. 4064(c)(1), formerly 
Sec. 4064(c), as amended and redesignated by Pub. L. 100-360, 
Sec. 411(g)(3)(E), (F), inserted ``, in a sole community hospital (as 
defined in the last sentence of section 1395ww(d)(5)(C)(ii) of this 
title),''.
    Subsec. (h)(2). Pub. L. 100-203, Sec. 4064(c), which had directed 
that ``laboratory in a sole community hospital'' be substituted for 
``hospital laboratory'' in subsec. (h)(2), was redesignated 
Sec. 4064(c)(1) by section 411(g)(3)(F) of Pub. L. 100-360 and amended 
by section 411(g)(3)(E) of Pub. L. 100-360 to provide for amendment of 
subsec. (h)(1)(D) instead of subsec. (h)(2).
    Subsec. (h)(2)(A)(i). Pub. L. 100-203, Sec. 4064(a)(1), as added by 
Pub. L. 100-360, Sec. 411(g)(3)(A), inserted ``(A)(i)'' after ``(2)''.
    Subsec. (h)(2)(A)(ii). Pub. L. 100-203, Sec. 4064(a)(3), as added by 
Pub. L. 100-360, Sec. 411(g)(3)(A), added cl. (ii).
    Subsec. (h)(2)(A)(iii). Pub. L. 100-203, Sec. 4064(b)(1), as amended 
by Pub. L. 100-360, Sec. 411(g)(3)(B), (C), set out as cl. (iii) 
provisions formerly set out in an otherwise undesignated sentence in 
par. (2) relating to the rebasing of fee schedules for certain automated 
and similar tests for 1988 and for the continuation of such reduced fee 
schedules as the base for 1989 and subsequent years.
    Subsec. (h)(2)(B). Pub. L. 100-203, Sec. 4064(a)(2), as added by 
Pub. L. 100-360, Sec. 411(g)(3)(A), inserted subpar. (B) designation 
preceding second sentence and redesignated former subpars. (A) and (B) 
of par. (2) as cls. (i) and (ii).
    Subsec. (h)(4)(B)(i). Pub. L. 100-203, Sec. 4064(b)(2)(A), 
substituted ``April'' for ``January''.
    Subsec. (h)(4)(B)(ii). Pub. L. 100-203, Sec. 4064(b)(2)(B), amended 
cl. (ii) generally. Prior to amendment, cl. (ii) read as follows: 
``after December 31, 1987, and so long as a fee schedule for the test 
has not been established on a nationwide basis, is equal to 110 percent 
of the median of all the fee schedules established for that test for 
that laboratory setting under paragraph (1).''
    Subsec. (h)(5)(A). Pub. L. 100-203, Sec. 4085(i)(22)(B), as added by 
Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), substituted ``on an assignment-
related basis'' for ``on the basis of an assignment described in section 
1395u(b)(3)(B)(ii) of this title, under the procedure described in 
section 1395gg(f)(1) of this title,'' in introductory provisions.
    Subsec. (h)(5)(A)(iii). Pub. L. 100-203, Sec. 4085(i)(3), added cl. 
(iii).
    Subsec. (h)(5)(C). Pub. L. 100-203, Sec. 4085(i)(22)(B), as added by 
Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), substituted ``on an assignment-
related basis'' for ``on the basis of an assignment described in section 
1395u(b)(3)(B)(ii) of this title, in accordance with section 
1395u(b)(6)(B) of this title, under the procedure described in section 
1395gg(f)(1) of this title,''.
    Subsec. (h)(5)(D). Pub. L. 100-203, Sec. 4085(b)(1), added subpar. 
(D).
    Subsec. (i)(2)(A)(iii). Pub. L. 100-203, Sec. 4063(b), added cl. 
(iii).
    Subsec. (i)(3)(B)(ii). Pub. L. 100-203, Sec. 4068(a)(1), substituted 
``Subject to the last sentence of this clause, in'' for ``In''.
    Pub. L. 100-203, Sec. 4068(a)(2), inserted sentence at end relating 
to cost and ASC proportions in the case of an eye or eye and ear 
specialty hospital.
    Subsec. (i)(4). Pub. L. 100-203, Sec. 4055(a)(3), formerly 
Sec. 4054(a)(3), as added and renumbered by Pub. L. 100-360, 
Sec. 411(f)(12)(A), (14), struck out par. (4) which read as follows: 
``In the case of 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 surgical procedures 
(specified pursuant to paragraph (1) of this subsection) in a 
physician's office, an ambulatory surgical center described in such 
paragraph, or a hospital outpatient department, payment for such 
services shall be determined in accordance with subsection (a)(1)(F) of 
this section if the physician accepts an assignment described in section 
1395u(b)(3)(B)(ii) of this title with respect to payment for such 
services.''
    Subsec. (i)(6). Pub. L. 100-203, Sec. 4063(e)(1), as added by Pub. 
L. 100-360, Sec. 411(g)(2)(E), added par. (6).
    Subsec. (l)(2). Pub. L. 100-203, Sec. 4084(a)(1), substituted ``1985 
and such other data as the Secretary determines necessary'' for 
``1985''.
    Pub. L. 100-203, Sec. 4042(b)(2)(B), as added by Pub. L. 100-360, 
Sec. 411(f)(2)(D), substituted ``1395u(i)(3)'' for 
``1395u(b)(4)(E)(ii)''.
    Subsec. (l)(5)(A). Pub. L. 100-203, Sec. 4084(a)(2), substituted 
``group practice, or ambulatory surgical center'' for ``or group 
practice'' in two places.
    Subsec. (l)(5)(B)(ii). Pub. L. 100-203, Sec. 4085(i)(23), as added 
by Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), substituted ``money penalty'' 
for ``monetary penalty'' and amended second sentence generally. Prior to 
amendment, second sentence read as follows: ``Such a penalty shall be 
imposed in the same manner as civil monetary penalties are imposed under 
section 1320a-7a of this title with respect to actions described in 
subsection (a) of that section.''
    Subsec. (l)(6). Pub. L. 100-203, Sec. 4045(c)(2)(A)(i), (ii), struck 
out subpar. (A) designation and substituted ``after the effective date 
of the reduction, the physician's actual charge is subject to a limit 
under section 1395u(j)(1)(D) of this title.'' for ``(subject to 
subparagraph (D)), the physician may not charge the individual more than 
the limiting charge (as defined in subparagraph (B)) plus (for services 
furnished during the 12-month period beginning on the effective date of 
the reduction) \1/2\ of the amount by which the physician's actual 
charges for the service for the previous 12-month period exceeds the 
limiting charge.''
    Pub. L. 100-203, Sec. 4045(c)(2)(A)(iii), struck out subpars. (B) to 
(D) which read as follows:
    ``(B) In subparagraph (A), the term `limiting charge' means, with 
respect to a service, 125 percent of the prevailing charge for the 
service after the reduction referred to in subparagraph (A).
    ``(C) If a physician knowingly and willfully imposes charges in 
violation of subparagraph (A), the Secretary may apply sanctions against 
such physician in accordance with subsection (j)(2) of this section.
    ``(D) This paragraph shall not apply to services furnished after the 
earlier of (i) December 31, 1990, or (ii) one-year after the date the 
Secretary reports to Congress, under section 1395w-1(e)(3) of this 
title, on the development of the relative value scale under section 
1395w-1 of this title.''
    Subsec. (m). Pub. L. 100-203, Sec. 4043(a), added subsec. (m).
    Subsec. (n). Pub. L. 100-203, Sec. 4066(a)(2), added subsec. (n).
    Subsec. (o). Pub. L. 100-203, Sec. 4072(b), as amended by Pub. L. 
100-360, Sec. 411(h)(3)(B), as amended by Pub. L. 100-485, 
Sec. 608(d)(23)(A), added subsec. (o) [originally added as subsec. (f)].
    Subsec. (p). Pub. L. 100-203, Sec. 4077(b)(3), formerly 
Sec. 4077(b)(4), as redesignated and amended by Pub. L. 100-360, 
Sec. 411(h)(7)(D), (F), inserted ``and in the case of qualified 
psychologists services for which payment may be made under this part 
only pursuant to section 1395x(s)(2)(M) of this title''.
    Pub. L. 100-203, Sec. 4073(b)(2), formerly Sec. 4073(b)(3), as 
redesignated and amended by Pub. L. 100-360, Sec. 411(h)(4)(C), added 
subsec. (p) [originally added as subsec. (m)] and inserted provision 
relating to monetary penalty for whoever knowingly and willfully 
presents, or causes to be presented, to an enrolled individual a bill or 
request for payment for described services.
    1986--Subsec. (a)(1)(D). Pub. L. 99-272, Sec. 9401(b)(2)(B), 
substituted ``, under the procedure described in section 1395gg(f)(1) of 
this title, or for tests furnished in connection with obtaining a second 
opinion required under section 1320c-13(c)(2) of this title (or a third 
opinion, if the second opinion was in disagreement with the first 
opinion)'' for ``or under the procedure described in section 
1395gg(f)(1) of this title''.
    Subsec. (a)(1)(D)(i). Pub. L. 99-272, Sec. 9303(b)(1), inserted ``, 
the limitation amount for that test determined under subsection 
(h)(4)(B) of this section,'' after ``lesser of the amount determined 
under such fee schedule''.
    Subsec. (a)(1)(F). Pub. L. 99-509, Sec. 9343(e)(2)(A), as amended by 
Pub. L. 100-203, Sec. 4085(i)(21)(D)(i), substituted ``(i)(4)'' for 
``(i)(3)''.
    Subsec. (a)(1)(G). Pub. L. 99-272, Sec. 9401(b)(2)(A), added cl. 
(G).
    Subsec. (a)(1)(H). Pub. L. 99-509, Sec. 9320(e)(1), added cl. (H).
    Subsec. (a)(2)(A). Pub. L. 99-272, Sec. 9401(b)(2)(C), inserted ``, 
to items and services (other than clinical diagnostic laboratory tests) 
furnished in connection with obtaining a second opinion required under 
section 1320c-13(c)(2) of this title (or a third opinion, if the second 
opinion was in disagreement with the first opinion),'' after ``(other 
than durable medical equipment)''.
    Subsec. (a)(2)(D). Pub. L. 99-272, Sec. 9401(b)(2)(D), substituted 
``to a provider having an agreement under section 1395cc of this title, 
or for tests furnished in connection with obtaining a second opinion 
required under section 1320c-13(c)(2) of this title (or a third opinion, 
if the second opinion was in disagreement with the first opinion)'' for 
``or to a provider having an agreement under section 1395cc of this 
title''.
    Subsec. (a)(2)(D)(i). Pub. L. 99-272, Sec. 9303(b)(1), inserted ``, 
the limitation amount for that test determined under subsection 
(h)(4)(B) of this section,'' after ``lesser of the amount determined 
under such fee schedule''.
    Subsec. (a)(3). Pub. L. 99-272, Sec. 9401(b)(2)(E), inserted ``and 
for items and services furnished in connection with obtaining a second 
opinion required under section 1320c-13(c)(2) of this title, or a third 
opinion, if the second opinion was in disagreement with the first 
opinion'' after ``1395x(s)(10)(A) of this title''.
    Subsec. (a)(4). Pub. L. 99-509, Sec. 9343(a)(1)(A), amended par. (4) 
generally. Prior to amendment, par. (4) read as follows: ``in the case 
of facility services described in subparagraph (F) of section 
1395k(a)(2) of this title, the applicable amount described in paragraph 
(2) of subsection (i) of this section.''
    Subsec. (b)(3). Pub. L. 99-509, Sec. 9343(e)(2)(A), as amended by 
Pub. L. 100-203, Sec. 4085(i)(21)(D)(i), which directed that cl. (3) be 
amended by striking ``or under subsection (i)(2) or (i)(4) of this 
section'', was executed by striking ``or under subsection (i)(2) or 
(i)(5) of this section'', to reflect the probable intent of Congress and 
an earlier amendment by Pub. L. 99-509, Sec. 9343(a)(2), see below.
    Pub. L. 99-509, Sec. 9343(a)(2), substituted ``(i)(5)'' for 
``(i)(4)''.
    Subsec. (b)(5). Pub. L. 99-272, Sec. 9401(b)(1), added cl. (5).
    Subsec. (g). Pub. L. 99-509, Sec. 9337(b), substituted ``second 
sentence'' for ``next to last sentence'', and inserted at end ``In the 
case of outpatient occupational therapy services which are described in 
the second sentence of section 1395x(p) of this title through the 
operation of section 1395x(g) of this title, with respect to expenses 
incurred in any calendar year, no more than $500 shall be considered as 
incurred expenses for purposes of subsections (a) and (b) of this 
section.''
    Subsec. (h)(1)(B). Pub. L. 99-509, Sec. 9339(b)(1), substituted 
``December 31, 1989'' and ``January 1, 1990'' for ``December 31, 1987'' 
and ``January 1, 1988'', respectively.
    Pub. L. 99-509, Sec. 9339(a)(1)(A), substituted ``qualified hospital 
laboratory (as defined in subparagraph (D))'' for ``hospital 
laboratory''.
    Pub. L. 99-272, Sec. 9303(a)(1)(A), substituted ``December 31, 
1987'' for ``June 30, 1987'' and ``January 1, 1988'' for ``July 1, 
1987''.
    Subsec. (h)(1)(C). Pub. L. 99-509, Sec. 9339(a)(1)(B), substituted 
``qualified hospital laboratory (as defined in subparagraph (D))'' for 
``hospital laboratory'', struck out ``, and ending on December 31, 
1987'' after ``July 1, 1984'', and struck out ``For such tests furnished 
on or after January 1, 1988, the fee schedule under subparagraph (A) 
shall not apply with respect to clinical diagnostic laboratory tests 
performed by a hospital laboratory for outpatients of such hospital.'' 
which constituted second sentence.
    Pub. L. 99-272, Sec. 9303(a)(1)(A), substituted ``December 31, 
1987'' for ``June 30, 1987'' and ``January 1, 1988'' for ``July 1, 
1987''.
    Subsec. (h)(1)(D). Pub. L. 99-509, Sec. 9339(a)(1)(C), added subpar. 
(D).
    Subsec. (h)(2). Pub. L. 99-509, Sec. 9339(b)(2), struck out ``(or, 
effective January 1, 1988, for the United States)'' after ``applicable 
region, State, or area''.
    Pub. L. 99-509, Sec. 9339(a)(1)(D), substituted ``qualified hospital 
laboratory (as defined in paragraph (1)(D))'' for ``hospital 
laboratory''.
    Pub. L. 99-272, Sec. 9303(a)(1), substituted ``January 1, 1988'' for 
``July 1, 1987'', and inserted ``(to become effective on January 1 of 
each year)'' after ``adjusted annually''.
    Subsec. (h)(3). Pub. L. 99-509, Sec. 9339(c)(1), inserted cl. (A) 
designation after ``provide for and establish'', and added cl. (B).
    Subsec. (h)(4). Pub. L. 99-272, Sec. 9303(b)(2), designated existing 
provisions as subpar. (A) and added subpar. (B).
    Subsec. (h)(5)(C). Pub. L. 99-272, Sec. 9303(b)(3), substituted 
``laboratory other than'' for ``laboratory which is independent of a 
physician's office or''.
    Subsec. (i)(1). Pub. L. 99-509, Sec. 9343(b)(2), inserted at end 
``The lists of procedures established under subparagraphs (A) and (B) 
shall be reviewed and updated not less often than every 2 years.''
    Subsec. (i)(2). Pub. L. 99-509, Sec. 9343(e)(2)(B), inserted ``80 
percent of'' before ``a standard overhead amount'' in introductory 
provisions of subpars. (A) and (B).
    Pub. L. 99-509, Sec. 9343(b)(1), substituted ``shall be reviewed and 
updated not later than July 1, 1987, and annually thereafter'' for 
``shall be reviewed periodically'' in concluding provisions of subpars. 
(A) and (B).
    Subsec. (i)(3) to (5). Pub. L. 99-509, Sec. 9343(a)(1)(B), added 
par. (3) and redesignated former pars. (3) and (4) as (4) and (5), 
respectively.
    Subsec. (l). Pub. L. 99-509, Sec. 9320(e)(2), added subsec. (l).
    1984--Subsec. (a)(1). Pub. L. 98-369, Sec. 2354(b)(7), struck out 
``and'' at the end.
    Subsec. (a)(1)(B). Pub. L. 98-369, Sec. 2323(b)(1), substituted 
``section 1395x(s)(10)(A) of this title'' for ``section 1395x(s)(10) of 
this title''.
    Subsec. (a)(1)(D). Pub. L. 98-369, Sec. 2303(a), amended cl. (D) 
generally. Prior to amendment, cl. (D) read as follows: ``with respect 
to diagnostic tests performed in a laboratory for which payment is made 
under this part to the laboratory, the amounts paid shall be equal to 
100 percent of the negotiated rate for such tests (as determined 
pursuant to subsection (h) of this section),''.
    Subsec. (a)(1)(F), (G). Pub. L. 98-369, Sec. 2305(a), redesignated 
cl. (G) as (F), and struck out former cl. (F) which related to payment 
of reasonable charges for preadmission diagnostic services furnished by 
a physician to individuals enrolled under this part which are furnished 
in the outpatient department of a hospital within seven days of such 
individual's admission to the same hospital or another hospital or 
furnished in the physician's office within seven days of such 
individual's admission to a hospital as an inpatient.
    Subsec. (a)(2). Pub. L. 98-369, Sec. 2305(c), struck out ``and in 
paragraph (5) of this subsection'' after ``of such section''.
    Subsec. (a)(2)(A). Pub. L. 98-617, Sec. 3(b)(2), 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 provision),''.
    Pub. L. 98-369, Sec. 2354(b)(5), realigned margin of subpar. (A).
    Pub. L. 98-369, Sec. 2321(b)(1), inserted in provision preceding cl. 
(i) ``(other than durable medical equipment)''.
    Pub. L. 98-369, Sec. 2323(b)(1), substituted ``section 
1395x(s)(10)(A) of this title'' for ``section 1395x(s)(10) of this 
title''.
    Subsec. (a)(2)(B). Pub. L. 98-369, Sec. 2354(b)(5), realigned margin 
of subpar. (B).
    Pub. L. 98-369, Sec. 2321(b)(2), inserted in provision preceding cl. 
(i) ``items and'' after ``to other''.
    Pub. L. 98-369, Sec. 2303(b)(1), inserted ``or (D)'' after 
``subparagraph (C)''.
    Subsec. (a)(2)(B)(ii). Pub. L. 98-369, Sec. 2308(b)(2)(B), 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 clause),''.
    Subsec. (a)(2)(D). Pub. L. 98-369, Sec. 2303(b)(2)-(4), added 
subpar. (D).
    Subsec. (a)(3). Pub. L. 98-369, Sec. 2323(b)(1), substituted 
``section 1395x(s)(10)(A) of this title'' for ``section 1395x(s)(10) of 
this title''.
    Subsec. (a)(5). Pub. L. 98-369, Sec. 2305(b), struck out par. (5) 
which related to payment of reasonable costs for preadmission diagnostic 
services described in section 1395x(s)(2)(C) of this title furnished to 
an individual by the outpatient department of a hospital within seven 
days of such individual's admission to the same hospital as an inpatient 
or to another hospital.
    Subsec. (b)(1). Pub. L. 98-369, Sec. 2323(b)(2), substituted 
``section 1395x(s)(10)(A) of this title'' for ``section 1395x(s)(10) of 
this title''.
    Subsec. (b)(3). Pub. L. 98-369, Sec. 2305(d), substituted 
``subsection (a)(1)(F)'' for ``subsection (a)(1)(G)''.
    Subsec. (b)(4). Pub. L. 98-369, Sec. 2303(c), added cl. (4).
    Subsec. (f). Pub. L. 98-369, Sec. 2321(d)(4)(A), transferred subsec. 
(f) to part C of this subchapter and redesignated its provisions as 
section 1889 of the Social Security Act, which is classified to section 
1395zz of this title.
    Subsec. (h). Pub. L. 98-369, Sec. 2303(d), amended subsec. (h) 
generally, substituting provisions directing the Secretary to establish 
fee schedules for clinical diagnostic laboratory tests at a percentage 
of the prevailing charge level and nominal fees to cover costs in 
collecting samples and authorizing the Secretary to make adjustments in 
the fee schedule, setting forth the recipients of payments, and 
authorizing the Secretary to establish a negotiated payment rate for 
provision authorizing the Secretary to establish a negotiated rate of 
payment with the laboratory which would be considered the full charge 
for such tests.
    Subsec. (h)(5)(C). Pub. L. 98-617, Sec. 3(b)(3), inserted a comma 
before ``under the procedure described in section''.
    Subsec. (i)(3). Pub. L. 98-369, Sec. 2305(d), substituted 
``subsection (a)(1)(F)'' for ``subsection (a)(1)(G)''.
    Subsec. (k). Pub. L. 98-369, Sec. 2323(b)(4), added subsec. (k).
    1982--Subsec. (a)(1)(B). Pub. L. 97-248, Sec. 112(a)(1), substituted 
provisions that with respect to items and services described in section 
1395x(s)(10) of this title, amounts paid shall be 100 percent of 
reasonable charges for such items and services for provision that with 
respect to expenses incurred for radiological or pathological services 
for which payment could be made under this part, furnished to any 
inpatient of a hospital by a physician in field of radiology or 
pathology who had in effect an agreement with Secretary by which the 
physician agreed to accept an assignment (as provided for in section 
1395u(b)(3)(B)(ii) of this title) for all physicians' services furnished 
by him to hospital inpatients enrolled under this part, the amounts paid 
would be equal to 100 percent of the reasonable charges for such 
services.
    Subsec. (a)(1)(H). Pub. L. 97-248, Sec. 112(a)(2), (3), struck out 
cl. (H) which provided that, with respect to items and services 
described in section 1395x(s)(10) of this title, the amount of benefits 
paid would be 100 percent of reasonable charges for such items and 
services.
    Subsec. (a)(2)(B). Pub. L. 97-248, Sec. 101(c)(2), inserted ``and 
except as may be provided in section 1395ww of this title''.
    Subsec. (b)(1). Pub. L. 97-248, Sec. 112(b), struck out subcl. (A) 
provision that total amount of expenses shall not include expenses 
incurred for radiological or pathological services furnished an 
individual as an inpatient of a hospital by a physician in field of 
radiology or pathology who has an agreement with Secretary by which 
physician agrees to accept an assignment (as provided for in section 
1395u(b)(3)(B)(ii) of this title) for all physicians' services furnished 
by him to hospital inpatients under this part, and redesignated subcl. 
(B) provisions as cl. (1).
    Subsec. (i)(1). Pub. L. 97-248, Sec. 148(d), struck out requirement 
of consultation with National Professional Standards Review Council.
    Subsec. (j). Pub. L. 97-248, Sec. 117(a)(2), added subsec. (j).
    1981--Subsec. (a)(2)(A). Pub. L. 97-35, Sec. 2106(a), substituted 
provisions that with respect to home health services and to items and 
services described in section 1395x(s)(10) of this title, the lesser of 
reasonable cost of such services as determined under section 1395x(v) of 
this title or customary charges with respect to such services, or if 
such services are furnished by a public provider of services free of 
charge or at nominal charges to the public, the amount determined in 
accordance with section 1395f(b)(2) of this title for provisions that 
with respect to home health services and to items and services described 
in section 1395x(s)(10) of this title, the reasonable cost of such 
services, as determined under section 1395x(v) of this title.
    Subsec. (a)(2)(B). Pub. L. 97-35, Sec. 2106(a), substituted new 
formula in cls. (i) to (iii) with respect to other services for 
provisions providing for reasonable costs of such services less the 
amount a provider may charge as described in section 1395cc(a)(2)(A) of 
this title and that in no case may payment for such other services 
exceed 80 percent of such costs.
    Subsec. (b). Pub. L. 97-35, Secs. 2133(a), 2134(a), redesignated 
cls. (2) to (4) as (1) to (3), and struck out former cl. (1), which 
provided that amount of deductible for such calendar year as so 
determined shall first be reduced by amount of any expenses incurred by 
such individual in last three months of preceding calendar year and 
applied toward such individual's deductible under this section for such 
preceding year.
    Pub. L. 97-35, Sec. 2134(a), substituted ``by a deductible of $75'' 
for ``by a deductible of $60''.
    1980--Subsec. (a)(1)(B). Pub. L. 96-499, Sec. 943(a), inserted ``who 
has in effect an agreement with the Secretary by which the physician 
agrees to accept an assignment (as provided for in section 
1395u(b)(3)(B)(ii) of this title) for all physicians' services furnished 
by him to hospital inpatients enrolled under this part'' after 
``radiology or pathology''.
    Subsec. (a)(1)(D). Pub. L. 96-499, Sec. 918(a)(4), substituted 
``subsection (h)'' for ``subsection (g)''.
    Subsec. (a)(1)(F). Pub. L. 96-499, Sec. 932(a)(1)(B), added cl. (F).
    Subsec. (a)(1)(G). Pub. L. 96-499, Sec. 934(d)(1), added cl. (G).
    Subsec. (a)(1)(H). Pub. L. 96-611, Sec. 1(b)(1)(A), (B), added cl. 
(H).
    Subsec. (a)(2). Pub. L. 96-611, Sec. 1(b)(1)(C), inserted in subpar. 
(A) ``and to items and services described in section 1395x(s)(10) of 
this title''.
    Pub. L. 96-499, Sec. 942, authorized payment of reasonable cost of 
home health services and prescribed formulae for determining payment 
amounts for services other than home health services.
    Subsec. (a)(3). Pub. L. 96-611, Sec. 1(b)(1)(D), inserted ``(other 
than for items and services described in section 1395x(s)(10) of this 
title)''.
    Pub. L. 96-499, Sec. 942, prescribed a formula for determining 
payment amounts for services described in subpars. (D) and (E) of 
section 1395k(a)(2) of this title.
    Subsec. (a)(4), (5). Pub. L. 96-499, Sec. 942, added pars. (4) and 
(5).
    Subsec. (b)(2). Pub. L. 96-611, Sec. 1(b)(2), inserted ``(A)'' after 
``expenses incurred'' and added cl. (B).
    Pub. L. 96-499, Sec. 943(a), inserted ``who has in effect an 
agreement with the Secretary by which the physician agrees to accept an 
assignment (as provided for in section 1395u(b)(3)(B)(ii) of this title) 
for all physicians' services furnished by him to hospital inpatients 
enrolled under this part''.
    Subsec. (b)(3). Pub. L. 96-499, Sec. 930(h)(2), added cl. (3).
    Subsec. (b)(4). Pub. L. 96-499, Sec. 934(d)(3), added cl. (4).
    Subsec. (g). Pub. L. 96-499, Sec. 935(a), substituted ``$500'' for 
``$100''.
    Subsec. (h). Pub. L. 96-473 redesignated subsec. (g) as added by 
section 279(b) of Pub. L. 92-603 as (h), which for purposes of 
codification had been editorially set out as subsec. (h), thereby 
requiring no change in text. See 1972 Amendment note below.
    Subsec. (i). Pub. L. 96-499, Sec. 934(b), added subsec. (i).
    1978--Subsec. (a)(1)(E). Pub. L. 95-292, Sec. 4(b)(2), added cl. 
(E).
    Subsec. (a)(2). Pub. L. 95-292, Sec. 4(c), inserted ``(unless 
otherwise specified in section 1395rr of this title)'' after ``and with 
respect to other services'' in provisions preceding subpar. (A).
    1977--Subsec. (a)(2). Pub. L. 95-210, Sec. 1(b)(2), inserted 
parenthetical provisions preceding subpar. (A) excepting those services 
described in subparagraph (D) of section 1395k(a)(2) of this title.
    Subsec. (a)(3). Pub. L. 95-210, Sec. 1(b)(1), (3), (4), added par. 
(3).
    Subsec. (f)(1). Pub. L. 95-142 substituted provisions relating to 
determinations by Secretary with respect to presumptions regarding 
purchase price or practicality of buying or renting durable medical 
equipment, for provisions relating to purchase price of durable medical 
equipment authorized to be paid by Secretary.
    Subsec. (f)(2). Pub. L. 95-142 substituted provisions relating to 
waiver of coinsurance amount in purchase of used durable medical 
equipment, for provisions relating to reimbursement procedures 
established by Secretary in cases of rental of durable medical 
equipment.
    Subsec. (f)(3), (4). Pub. L. 95-142 added pars. (3) and (4).
    1972--Subsec. (a). Pub. L. 92-603, Sec. 226(c)(2), inserted 
reference to section 1395mm of this title in provisions preceding par. 
(1).
    Subsec. (a)(1). Pub. L. 92-603, Secs. 211(c)(4), 279(a), added cls. 
(C) and (D).
    Subsec. (a)(2). Pub. L. 92-603, Secs. 233(b), 251(a)(3), 299K(a), 
substituted subpars. (A) and (B) for provisions relating to the amount 
payable by reference to section 1395x(v) of this title, added subpar. 
(C), and in provisions preceding subpar. (A), inserted ``with respect to 
home health services, 100 percent, and with respect to other services,'' 
before ``80 percent''.
    Subsec. (b). Pub. L. 92-603, Sec. 204(a), substituted ``$60'' for 
``$50''.
    Subsec. (f). Pub. L. 92-603, Sec. 245(d), designated existing 
provisions as par. (1)(A) and added par. (1)(B) and (2).
    Subsec. (g). Pub. L. 92-603, Sec. 251(a)(2), added subsec. (g).
    Subsec. (h). Pub. L. 92-603, Sec. 279(b), added subsec. (h). Subsec. 
was in the original (g) and was changed to accommodate subsec. (g) as 
added by section 251(a)(2) of Pub. L. 92-603.
    1968--Subsec. (a)(1). Pub. L. 90-248, Sec. 131(a)(1), (2), 
designated existing provisions as subpar. (A) and added subpar. (B).
    Subsec. (b). Pub. L. 90-248, Secs. 129(c)(7), 131(b), struck out 
reference in cl. (1) to expenses regarded under former cl. (2) as 
incurred for services furnished in last three months of preceding year, 
struck out former cl. (2) which provided that amount of any deduction 
imposed by section 1395e(a)(2)(A) of this title for outpatient hospital 
diagnostic services furnished in any calendar year is to be regarded as 
an incurred expense for such year; and added cl. (2).
    Pub. L. 90-248, Sec. 135(c), inserted last sentence providing that 
there shall be a deductible equal to expenses incurred for first three 
pints of whole blood (or equivalent quantities of packed red blood cells 
as defined under regulations) furnished to an individual during a 
calendar year which deductible is to be appropriately reduced to extent 
that such blood has been replaced, and such blood will be deemed to have 
been replaced when institution or person furnishing such blood is given 
one pint of blood for each pint of blood (or equivalent quantities of 
packed red blood cells) furnished individual to which three pint 
deductible applies.
    Subsec. (d). Pub. L. 90-248, Sec. 129(c)(8), struck out reference to 
subsection (a)(2)(A) of section 1395e of this title.
    Subsec. (f). Pub. L. 90-248, Sec. 132(b), added subsec. (f).


                    Effective Date of 1999 Amendment

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 201(h)(2)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-340, provided that: ``The Secretary 
of Health and Human Services shall first conduct the annual review under 
the amendment made by paragraph (1)(A) [amending this section] in 2001 
for application in 2002 and the amendment made by paragraph (1)(B) 
[amending this section] takes effect on the date of the enactment of 
this Act [Nov. 29, 1999].''
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 201(m)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-341, provided that: ``Except as 
provided in this section, the amendments made by this section [amending 
this section and sections 1395m and 1395x of this title] shall be 
effective as if included in the enactment of BBA [the Balanced Budget 
Act of 1997, Pub. L. 105-33].''
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 202(b)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-344, provided that: ``The 
amendments made by this section [amending this section] shall be 
effective as if included in the enactment of BBA [the Balanced Budget 
Act of 1997, Pub. L. 105-33].''
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 204(c)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-345, provided that: ``The 
amendments made by this section [amending this section] apply as if 
included in the enactment of BBA [the Balanced Budget Act of 1997, Pub. 
L. 105-33] and shall only apply to procedures performed for which 
payment is made on the basis of the prospective payment system under 
section 1833(t) of the Social Security Act [subsec. (t) of this 
section].''
    Amendment by section 1000(a)(6) [title III, Sec. 321(g)(2), (k)(2)] 
of Pub. L. 106-113 effective as if included in the enactment of the 
Balanced Budget Act of 1997, Pub. L. 105-33, except as otherwise 
provided, see section 1000(a)(6) [title III, Sec. 321(m)] of Pub. L. 
106-113, set out as a note under section 1395d of this title.
    Amendment by section 1000(a)(6) [title IV, Sec. 401(b)(1)] of Pub. 
L. 106-113 effective Jan. 1, 2000, see section 1000(a)(6) [title IV, 
Sec. 401(c)] of Pub. L. 106-113, set out as a note under section 1395i-4 
of this title.
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title IV, Sec. 403(e)(2)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-371, provided that: ``The 
amendments made by paragraph (1) [amending this section] shall apply to 
services furnished on or after the date of the enactment of this Act 
[Nov. 29, 1999].''


                    Effective Date of 1997 Amendment

    Section 4002(j)(1)(B) of Pub. L. 105-33 provided that: ``The 
amendment made by subparagraph (A) [amending this section] applies to 
new contracts entered into after the date of enactment of this Act [Aug. 
5, 1997] and, with respect to contracts in effect as of such date, shall 
apply to payment for services furnished after December 31, 1998.''
    Section 4101(d) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and section 1395m of this 
title] shall apply to items and services furnished on or after January 
1, 1998.''
    Section 4102(e) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1395w-4, 1395x, 
and 1395y of this title] shall apply to items and services furnished on 
or after January 1, 1998.''
    Section 4103(e) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1395w-4, 1395x, 
and 1395y of this title] shall apply to items and services furnished on 
or after January 1, 2000.''
    Section 4104(e) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1395m, 1395w-4, 
1395x, and 1395y of this title] shall apply to items and services 
furnished on or after January 1, 1998.''
    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.
    Section 4205(a)(1)(B) of Pub. L. 105-33 provided that: ``The 
amendment made by subparagraph (A) [amending this section] applies to 
services furnished on or after January 1, 1998.''
    Section 4315(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and section 1395u of this 
title] to the extent such amendments substitute fee schedules for 
reasonable charges, shall apply to particular services as of the date 
specified by the Secretary of Health and Human Services.''
    Amendment by section 4432(b)(5)(C) 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.
    Amendment by section 4511(b) of Pub. L. 105-33 applicable with 
respect to services furnished and supplies provided on and after Jan. 1, 
1998, see section 4511(e) of Pub. L. 105-33, set out as a note under 
section 1395k of this title.
    Section 4512(d) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1395u and 1395x 
of this title] shall apply with respect to services furnished and 
supplies provided on and after January 1, 1998.''
    Section 4521(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section] shall apply to services 
furnished during portions of cost reporting periods occurring on or 
after October 1, 1997.''
    Section 4523(d)(1)(A)(ii) of Pub. L. 105-33 provided that: ``The 
amendment made by clause (i) [amending this section] shall apply to 
services furnished on or after January 1, 1999.''
    Section 4531(b)(3) of Pub. L. 105-33 provided that: ``The amendments 
made by this subsection [amending this section and section 1395m of this 
title] shall apply to services furnished on or after January 1, 2000.''
    Section 4541(e) of Pub. L. 105-33 provided that:
    ``(1) The amendments made by subsections (a)(1), (a)(2), and (b) 
[amending this section and sections 1395m and 1395y of this title] apply 
to services furnished on or after January 1, 1998, including portions of 
cost reporting periods occurring on or after such date, except that 
section 1834(k) of the Social Security Act [section 1395m(k) of this 
title] (as added by subsection (a)(2)) shall not apply to services 
described in section 1833(a)(8)(B) of such Act [subsec. (a)(8)(B) of 
this section] (as added by subsection (a)(1)) that are furnished during 
1998.
    ``(2) The amendments made by subsections (a)(3) and (c) [amending 
this section and section 1395cc of this title] apply to services 
furnished on or after January 1, 1999.
    ``(3) The amendments made by subsection (d)(1) [amending this 
section] apply to expenses incurred on or after January 1, 1999.''
    Section 4556(d) of Pub. L. 105-33 provided that: ``The amendments 
made by subsections (a) and (b) [amending this section and section 1395u 
of this title] shall apply to drugs and biologicals furnished on or 
after January 1, 1998.''
    Amendment by section 4603(c)(2)(A) 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 1994 Amendment

    Section 123(f)(1), (2) of Pub. L. 103-432 provided that:
    ``(1) Enforcement; miscellaneous and technical amendments.--The 
amendments made by subsections (a) and (e) [amending this section and 
section 1395w-4 of this title] shall apply to services furnished on or 
after the date of the enactment of this Act [Oct. 31, 1994]; except that 
the amendments made by subsection (a) [amending section 1395w-4 of this 
title] shall not apply to services of a nonparticipating supplier or 
other person furnished before January 1, 1995.
    ``(2) Practitioners.--The amendments made by subsection (b) 
[amending this section and section 1395u of this title] shall apply to 
services furnished on or after January 1, 1995.''
    Section 141(c)(2) of Pub. L. 103-432 provided that: ``The amendments 
made by paragraph (1) [amending this section] shall take effect as if 
included in the enactment of OBRA-1990 [Pub. L. 101-508].''
    Amendment by section 147(a), (e)(2), (3), (f)(6)(C), (D) of Pub. L. 
103-432 effective as if included in the enactment of Pub. L. 101-508, 
see section 147(g) of Pub. L. 103-432, set out as a note under section 
1320a-3a of this title.
    Section 147(d)(1), (2) of Pub. L. 103-432 provided that the 
amendment made by that section is effective as if included in the 
enactment of Pub. L. 101-239.
    Amendment by section 156(a)(2)(B) of Pub. L. 103-432 applicable to 
services provided on or after Oct. 31, 1994, see section 156(a)(3) of 
Pub. L. 103-432, set out as a note under section 1320c-3 of this title.


                    Effective Date of 1993 Amendment

    Section 13532(b) of Pub. L. 103-66 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply to portions 
of cost reporting periods beginning on or after January 1, 1994.''
    Section 13544(b)(3) of Pub. L. 103-66 provided that: ``The 
amendments made by this subsection [amending this section and section 
1395m of this title] shall apply to items furnished on or after January 
1, 1994.''
    Section 13555(b) of Pub. L. 103-66 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to services 
furnished on or after January 1, 1994.''


                    Effective Date of 1990 Amendment

    Section 4104(d) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and sections 1395m and 
1395w-4 of this title] shall apply to services furnished on or after 
January 1, 1991.''
    Amendment by section 4153(a)(2)(B), (C) of Pub. L. 101-508 
applicable to items furnished on or after Jan. 1, 1991, see section 
4153(a)(3) of Pub. L. 101-508, set out as a note under section 1395k of 
this title.
    Section 4154(b)(2) of Pub. L. 101-508 provided that: ``The 
amendments made by paragraph (1) [amending this section] shall apply to 
tests furnished on or after January 1, 1991.''
    Section 4154(c)(2) of Pub. L. 101-508 provided that: ``The amendment 
made by paragraph (1)(A) [amending this section] shall take effect as if 
included in the enactment of the Consolidated Omnibus Budget 
Reconciliation Act of 1985 [Pub. L. 99-272], and the amendment made by 
paragraph (1)(B) [amending this section] shall take effect as if 
included in the enactment of the Omnibus Budget Reconciliation Act of 
1987 [Pub. L. 100-203].''
    Section 4154(e)(5) of Pub. L. 101-508, as amended by Pub. L. 103-
432, title I, Sec. 147(f)(2), Oct. 31, 1994, 108 Stat. 4431, provided 
that: ``The amendments made by paragraphs (1)(A), (1)(B), (2), and (4) 
[amending this section, section 1395w-2 of this title, and provisions 
set out as a note below] shall take effect as if included in the 
enactment of the Omnibus Budget Reconciliation Act of 1989 [Pub. L. 101-
239], and the amendment made by paragraph (1)(C) [amending this section] 
shall take effect January 1, 1991.''
    Amendment by section 4155(b)(2), (3) of Pub. L. 101-508 applicable 
to services furnished on or after Jan. 1, 1991, see section 4155(e) of 
Pub. L. 101-508, set out as a note under section 1395k of this title.
    Amendment by section 4161(a)(3)(B) of Pub. L. 101-508 applicable to 
services furnished on or after Oct. 1, 1991, see section 4161(a)(8) of 
Pub. L. 101-508, set out as a note under section 1395k of this title.
    Section 4163(e) of Pub. L. 101-508, as amended by Pub. L. 103-432, 
title I, Sec. 147(f)(5)(B), Oct. 31, 1994, 108 Stat. 4431, provided 
that: ``Except as provided in subsection (d)(3) [enacting provisions set 
out as a note under section 1395y of this title], the amendments made by 
this section [amending this section and sections 1395m, 1395x, 1395y, 
1395z, 1395aa, and 1395bb of this title] shall apply to screening 
mammography performed on or after January 1, 1991.''
    Section 4206(e)(2) of Pub. L. 101-508 provided that: ``The 
amendments made by subsection (b) [amending this section and section 
1395mm of this title] shall apply to contracts under section 1876 of the 
Social Security Act [section 1395mm of this title] and payments under 
section 1833(a)(1)(A) of such Act [subsec. (a)(1)(A) of this section] as 
of first day of the first month beginning more than 1 year after the 
date of the enactment of this Act [Nov. 5, 1990].''


                    Effective Date of 1989 Amendments

    Section 6102(c)(2) of Pub. L. 101-239 provided that: ``The 
amendments made by paragraph (1) [amending this section] shall apply to 
services furnished on or after January 1, 1991.''
    Section 6102(f)(3) of Pub. L. 101-239 provided that: ``The 
amendments made by this subsection [amending this section and section 
1395m of this title] shall apply to services furnished on or after 
January 1, 1991.''
    Section 6102(g) of Pub. L. 101-239 provided that: ``Except as 
otherwise provided in this section, this section, and the amendments 
made by this section [enacting section 1395w-4 of this title, amending 
this section and sections 1395m, 1395u, and 1395rr of this title, and 
enacting provisions set out as notes under this section and sections 
1395m, 1395u, and 1395w-4 of this title], shall take effect on the date 
of the enactment of this Act [Dec. 19, 1989].''
    Section 6111(b)(2) of Pub. L. 101-239, as amended by Pub. L. 101-
508, title IV, Sec. 4154(e)(4), Nov. 5, 1990, 104 Stat. 1388-86, 
provided that: ``The amendment made by paragraph (1) [amending this 
section] shall apply with respect to clinical diagnostic laboratory 
tests performed on or after May 1, 1990.''
    Section 6113(e) of Pub. L. 101-239 provided that: ``The amendments 
made by this section [amending this section and section 1395x of this 
title], and the provisions of subsection (c) [set out below], shall 
apply to services furnished on or after July 1, 1990, and the amendments 
made by subsection (d) [amending this section] shall apply to expenses 
incurred in a year beginning with 1990.''
    Section 6131(c) of Pub. L. 101-239 provided that:
    ``(1) The amendments made by this section [amending this section and 
section 1395x of this title] shall apply with respect to therapeutic 
shoes and inserts furnished on or after July 1, 1989.
    ``(2) In applying the amendments made by this section, the increase 
under subparagraph (C) of section 1833(o)(2) of the Social Security Act 
[subsec. (o)(2)(C) of this section] shall apply to the dollar amounts 
specified under subparagraph (A) of such section (as amended by this 
section) in the same manner as the increase would have applied to the 
dollar amounts specified under subparagraph (A) of such section (as in 
effect before the date of the enactment of this Act [Dec. 19, 1989]).''
    Section 6133(b) of Pub. L. 101-239 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to services 
furnished on or after January 1, 1990.''
    Amendment by section 6204(b) of Pub. L. 101-239 effective with 
respect to referrals made on or after Jan. 1, 1992, see section 6204(c) 
of Pub. L. 101-239, set out as a note under section 1395nn 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.
    Amendment by section 202(a) of Pub. L. 101-234 effective Jan. 1, 
1990, see section 202(b) of Pub. L. 101-234, set out as a note under 
section 401 of this title.


                    Effective Date of 1988 Amendments

    Section 8422(b) of Pub. L. 100-647 provided that: ``The amendment 
made by subsection (a) [amending this section] shall become effective as 
if included in the amendment made by section 9320(e)(2) of the Omnibus 
Budget Reconciliation Act of 1986 [Pub. L. 99-509].''
    Amendment by Pub. L. 100-485 effective as if included in the 
enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 
100-360, see section 608(g) of Pub. L. 100-485, set out as a note under 
section 704 of this title.
    Amendment by section 202(b)(1)-(3) of Pub. L. 100-360 applicable to 
items dispensed on or after Jan. 1, 1990, see section 202(m)(1) of Pub. 
L. 100-360, set out as a note under section 1395u of this title.
    Amendment by section 203(c)(1)(A)-(E) 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.
    Amendment by section 204(d)(1) of Pub. L. 100-360 applicable to 
screening mammography performed on or after Jan. 1, 1990, see section 
204(e) of Pub. L. 100-360, set out as a note under section 1395m of this 
title.
    Amendment by section 205(c) of Pub. L. 100-360 applicable to items 
and services furnished on or after Jan. 1, 1990, see section 205(f) of 
Pub. L. 100-360, set out as a note under section 1395k of this title.
    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by section 411(f)(2)(D), (8)(B)(i), (C), (12)(A), (14), 
(g)(1)(E), (2)(D), (E), (3)(A)-(F), (4)(C), (5), (h)(1)(A), (3)(B), 
(4)(B), (C), (7)(C), (D), (F), (i)(3), (4)(B)-(C)(ii), (iv), and (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

    Section 4043(c) of Pub. L. 100-203 provided that: ``The amendments 
made by this [sic] subsection (a) [amending this section] shall apply 
with respect to services furnished in a rural area (as defined in 
section 1886(d)(2)(D) of the Social Security Act [section 
1395ww(d)(2)(D) of this title]) on or after January 1, 1989, and to 
other services furnished on or after January 1, 1991.''
    Amendment by section 4045(c)(2)(A) of Pub. L. 100-203 applicable to 
items and services furnished on or after Apr. 1, 1988, see section 
4045(d) of Pub. L. 100-203, set out as a note under section 1395u of 
this title.
    Amendment by section 4049(a)(1) of Pub. L. 100-203 applicable to 
services performed on or after Apr. 1, 1989, see section 4049(b)(2) of 
Pub. L. 100-203, as amended, set out as a note under section 1395m of 
this title.
    Section 4055(b), formerly Sec. 4054(b), of Pub. L. 100-203, as added 
and renumbered by Pub. L. 100-360, title IV, Sec. 411(f)(12)(A), (14), 
July 1, 1988, 102 Stat. 781, provided that: ``The amendments made by 
subsection (a) [amending this section] shall apply to services furnished 
on or after April 1, 1988.''
    Amendment by section 4062(d)(3) 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 4063(c) of Pub. L. 100-203 provided that: ``The amendments 
made by this section [amending this section and section 1395u of this 
title] shall apply to items furnished on or after July 1, 1988.''
    Section 4064(b)(3) of Pub. L. 100-203 provided that: ``The 
amendments made by paragraphs (1) and (2) [amending this section] shall 
apply with respect to services furnished on or after April 1, 1988.''
    Section 4064(c)(2) of Pub. L. 100-203, as added by Pub. L. 100-360, 
title IV, Sec. 411(g)(3)(F), July 1, 1988, 102 Stat. 784, provided that: 
``The amendment made by paragraph (1) [amending this section] shall 
apply with respect to diagnostic laboratory tests furnished on or after 
April 1, 1988.''
    Section 4066(c) of Pub. L. 100-203 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply with respect 
to outpatient hospital radiology services furnished on or after October 
1, 1988, and other diagnostic procedures performed on or after October 
1, 1989.''
    Section 4067(c) of Pub. L. 100-203 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to services 
furnished on or after April 1, 1988.''
    Section 4068(c) of Pub. L. 100-203 provided that: ``The amendments 
made by subsection (a) [amending this section] shall be effective as if 
included in the amendment made by section 9343(a)(1)(B) of the Omnibus 
Budget Reconciliation Act of 1986 [Pub. L. 99-509].''
    Section 4070(c)(1) of Pub. L. 100-203 provided that: ``The amendment 
made by subsection (a)(1) [amending this section] shall apply with 
respect to calendar years beginning with 1988; except that with respect 
to 1988, any reference in section 1833(c) of the Social Security Act 
[subsec. (c) of this section], as amended by subsection (a), to 
`$1375.00' is deemed a reference to `$562.50'. The amendment made by 
subsection (a)(2) [amending this section] shall apply to services 
furnished on or after January 1, 1989.''
    For effective date of amendment by section 4072(b) of Pub. L. 100-
203, see section 4072(e) of Pub. L. 100-203, set out as a note under 
section 1395x of this title.
    Amendment by section 4073(b) of Pub. L. 100-203 effective with 
respect to services performed on or after July 1, 1988, see section 
4073(e) of Pub. L. 100-203, set out as a note under section 1395k of 
this title.
    Amendment by section 4077(b)(2), (3) of Pub. L. 100-203 effective 
with respect to services performed on or after July 1, 1988, see section 
4077(b)(5) of Pub. L. 100-203, set out as a note under section 1395k of 
this title.
    Section 4084(b) of Pub. L. 100-203 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply as if 
included in the amendment made by section 9320(e)(2) of the Omnibus 
Budget Reconciliation Act of 1986 [Pub. L. 99-509].''
    Section 4084(c)(3) of Pub. L. 100-203, as added by Pub. L. 100-360, 
title IV, Sec. 411(i)(3), July 1, 1988, 102 Stat. 788, provided that: 
``The amendments made by this subsection [amending this section and 
section 1395x of this title] shall apply to services furnished after 
December 31, 1988.''
    Section 4085(b)(2) of Pub. L. 100-203 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall apply to procedures 
performed on or after January 1, 1988.''
    Section 4085(i)(21) of Pub. L. 100-203 provided that the amendment 
to section 9343 of Pub. L. 99-509 by section 4085(i)(21)(D) of Pub. L. 
100-203, amending this section and provisions set out as an Effective 
Date of 1986 Amendments note below, is effective as if included in the 
enactment of Pub. L. 99-509.


                    Effective Date of 1986 Amendments

    Amendment by section 9320(e)(1), (2) of Pub. L. 99-509 applicable to 
services furnished on or after Jan. 1, 1989, with exceptions for 
hospitals located in rural areas which meet certain requirements related 
to certified registered nurse anesthetists, see section 9320(i), (k) of 
Pub. L. 99-509, as amended, set out as notes under section 1395k of this 
title.
    Amendment by section 9337(b) of Pub. L. 99-509 applicable to 
expenses incurred for outpatient occupational therapy services furnished 
on or after July 1, 1987, see section 9337(e) of Pub. L. 99-509, set out 
as a note under section 1395k of this title.
    Section 9339(a)(2) of Pub. L. 99-509 provided that: ``The amendments 
made by this subsection [amending this section] apply to clinical 
diagnostic laboratory tests performed on or after January 1, 1987.''
    Section 9339(c)(2) of Pub. L. 99-509 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall apply to samples 
collected on or after January 1, 1987.''
    Section 9343(h) of Pub. L. 99-509, as amended by Pub. L. 100-203, 
title IV, Sec. 4085(i)(21)(D)(ii), (iii), Dec. 22, 1987, 101 Stat. 1330-
134; Pub. L. 100-360, title IV, Sec. 411(i)(4)(C)(v), July 1, 1988, 102 
Stat. 789, provided that:
    ``(1) The amendments made by subsection (a)(1) [amending this 
section] shall apply to cost reporting periods beginning on or after 
October 1, 1987.
    ``(2) The amendments made by subsections (b)(1) and (c) [amending 
this section and sections 1395y and 1395cc of this title] shall apply to 
services furnished after June 30, 1987.
    ``(3) The Secretary of Health and Human Services shall first 
provide, under the amendment made by subsection (b)(2) [amending this 
section], for the review and update of procedure lists within 6 months 
after the date of the enactment of this Act [Oct. 21, 1986].
    ``(4) The amendments made by subsection (d) [amending section 1320c-
3 of this title] shall apply to contracts entered into or renewed after 
January 1, 1987.''
    Section 9303(a)(2) of Pub. L. 99-272 provided that: ``The amendments 
made by paragraph (1) [amending this section] shall apply to clinical 
laboratory diagnostic tests performed on or after July 1, 1986.''
    Section 9303(b)(5)(A), (B) of Pub. L. 99-272 provided that:
    ``(A) The amendments made by paragraphs (1) and (2) [amending this 
section] shall apply to clinical diagnostic laboratory tests performed 
on or after July 1, 1986.
    ``(B) The amendment made by paragraph (3) [amending this section] 
shall apply to clinical diagnostic laboratory tests performed on or 
after January 1, 1987.''


                    Effective Date of 1984 Amendments

    Amendment by Pub. L. 98-617 effective as if originally included in 
the Deficit Reduction Act of 1984, Pub. L. 98-369, see section 3(c) of 
Pub. L. 98-617, set out as a note under section 1395f of this title.
    Section 2303(j) of Pub. L. 98-369 provided that:
    ``(1) Except as provided in paragraphs (2) and (3), the amendments 
made by this section [amending this section and sections 1395u, 1395cc, 
1396a, and 1396b of this title and enacting provisions set out as notes 
under this section and section 1395u of this title] shall apply to 
clinical diagnostic laboratory tests furnished on or after July 1, 1984.
    ``(2) The amendments made by subsection (g)(2) [amending section 
1396b of this title] shall apply to payments for calendar quarters 
beginning on or after October 1, 1984.
    ``(3) The amendments made by this section shall not apply to 
clinical diagnostic laboratory tests furnished to inpatients of a 
provider operating under a waiver granted pursuant to section 602(k) of 
the Social Security Amendments of 1983 [section 602(k) of Pub. L. 98-21, 
set out as a note under section 1395y of this title]. Payment for such 
services shall be made under part B of title XVIII of the Social 
Security Act [this part] at 80 percent (or 100 percent in the case of 
such tests for which payment is made on the basis of an assignment 
described in section 1842(b)(3)(B)(ii) of the Social Security Act 
[section 1395u(b)(3)(B)(ii) of this title] or under the procedure 
described in section 1870(f)(1) of such Act [section 1395gg(f)(1) of 
this title]) of the reasonable charge for such service. The deductible 
under section 1833(b) of such Act [subsec. (b) of this section] shall 
not apply to such tests if payment is made on the basis of such an 
assignment or procedure.''
    Section 2305(e) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section and enacting provisions set 
out below] shall apply to services performed after the date of the 
enactment of this Act [July 18, 1984].''
    Amendment by section 2321(b), (d)(4)(A) of Pub. L. 98-369 applicable 
to items and services furnished on or after July 18, 1984, see section 
2321(g) of Pub. L. 98-369, set out as a note under section 1395f of this 
title.
    Section 2323(d) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section and sections 1395x, 1395cc, 
and 1395rr of this title and enacting provisions set out below] apply to 
services furnished on or after September 1, 1984.''
    Amendment by section 2354(b)(5), (7) 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

    Section 112(c) of Pub. L. 97-248 provided that: ``The amendments 
made by this section [amending this section] shall apply with respect to 
items and services furnished on or after October 1, 1982.''
    Amendment by section 117(a)(2) of Pub. L. 97-248 applicable to final 
determinations made on or after Sept. 3, 1982, see section 117(b) of 
Pub. L. 97-248, set out as a note under section 1395g of this title.
    Amendment by section 148(d) of 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 1981 Amendment

    Section 2106(c) of Pub. L. 97-35 provided that: ``The amendment made 
by subsection (a) [amending this section] is effective as of December 5, 
1980, and the amendment made by subsection (b)(2) [amending section 
1395q(b) of this title], is effective as of April 1, 1981.''
    Section 2133(b) of Pub. L. 97-35 provided that: ``The amendments 
made by subsection (a) [amending this section] first apply to the 
deductible for calendar year 1982 with respect to expenses incurred on 
or after October 1, 1981.''
    Section 2134(b) of Pub. L. 97-35 provided that: ``The amendment made 
by subsection (a) [amending this section] shall take effect on January 
1, 1982, and shall apply to the deductible for calendar years beginning 
with 1982.''


                    Effective Date of 1980 Amendments

    Section 2 of Pub. L. 96-611 provided that: ``The amendments made by 
this Act [probably should be the amendments made by section 1 of this 
Act, which amended this section and sections 1395x, 1395y, 1395aa, and 
1395cc of this title] shall take effect on, and apply to services 
furnished on or after, July 1, 1981.''
    Amendment by section 930(h) 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 935(b) of Pub. L. 96-499 provided that: ``The amendment made 
by subsection (a) [amending this section] shall apply to expenses 
incurred in calendar years beginning with calendar year 1982.''
    Section 943(b) of Pub. L. 96-499 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply to services 
furnished after the sixth calendar month beginning after the date of the 
enactment of this Act [Dec. 5, 1980].''


                    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 Amendments

    Amendment by Pub. L. 95-210 applicable to services rendered on or 
after first day of third calendar month which begins after Dec. 31, 
1977, see section 1(j) of Pub. L. 95-210, set out as a note under 
section 1395k of this title.
    Section 16(b) of Pub. L. 95-142 provided that: ``The amendment made 
by subsection (a) [amending this section] shall apply with respect to 
durable medical equipment purchased or rented on or after October 1, 
1977.''


                    Effective Date of 1972 Amendment

    Section 204(c) of Pub. L. 92-603 provided that: ``The amendments 
made by this section [amending this section and section 1395n of this 
title] shall be effective with respect to calendar years after 1972 
(except that, for purposes of applying clause (1) of the first sentence 
of section 1833(b) of the Social Security Act [subsec. (b) of this 
section], such amendments shall be deemed to have taken effect on 
January 1, 1972).''
    Amendment by section 211(c)(4) of Pub. L. 92-603 applicable to 
services furnished with respect to admissions occurring after Dec. 31, 
1972, see section 211(d) of Pub. L. 92-603, set out as a note under 
section 1395f of this title.
    Amendment by section 226(c)(2) 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 233(b) of Pub. L. 92-603 applicable to services 
furnished by hospitals, extended care facilities, and home health 
agencies in accounting periods beginning after Dec. 31, 1972, see 
section 233(f) of Pub. L. 92-603, set out as a note under section 1395f 
of this title. See, also, Pub. L. 93-233, Sec. 16, Dec. 31, 1973, 87 
Stat. 967, set out as a note under section 1395f of this title.
    Amendment by section 251(a)(2), (3) 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.
    Section 299K(b) of Pub. L. 92-603 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to services 
furnished by home health agencies in accounting periods beginning after 
December 31, 1972.''


                    Effective Date of 1968 Amendment

    Amendment by section 129(c)(7), (8) 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 131(c) of Pub. L. 90-248 provided that: ``The amendments 
made by this section [amending this section] shall apply with respect to 
services furnished after March 31, 1968.''
    Section 132(c) of Pub. L. 90-248 provided that: ``The amendments 
made by this section [amending this section and section 1395x of this 
title] shall apply only with respect to items purchased after December 
31, 1967.''
    Amendment by section 135(c) of Pub. L. 90-248 applicable with 
respect to payment for blood (or packed red blood cells) furnished an 
individual after Dec. 31, 1967, see section 135(d) of Pub. L. 90-248, 
set out as a note under section 1395e of this title.


   Congressional Intention Regarding Base Amounts in Applying HOPD PPS

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 201(l)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-341, provided that: ``With respect 
to determining the amount of copayments described in paragraph 
(3)(A)(ii) of section 1833(t) of the Social Security Act [subsec. (t) of 
this section], as added by section 4523(a) of BBA [the Balanced Budget 
Act of 1997, Pub. L. 105-33], Congress finds that such amount should be 
determined without regard to such section, in a budget neutral manner 
with respect to aggregate payments to hospitals, and that the Secretary 
of Health and Human Services has the authority to determine such amount 
without regard to such section.''


 Study and Report to Congress Regarding Special Treatment of Rural and 
 Cancer Hospitals in Prospective Payment System for Hospital Outpatient 
                           Department Services

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 203], Nov. 
29, 1999, 113 Stat. 1536, 1501A-344, provided that:
    ``(a) Study.--
        ``(1) In general.--The Medicare Payment Advisory Commission 
    (referred to in this section as `MedPAC') shall conduct a study to 
    determine the appropriateness (and the appropriate method) of 
    providing payments to hospitals described in paragraph (2) for 
    covered OPD services (as defined in paragraph (1)(B) of section 
    1833(t) of the Social Security Act (42 U.S.C. 1395l(t))) based on 
    the prospective payment system established by the Secretary in 
    accordance with such section.
        ``(2) Hospitals described.--The hospitals described in this 
    paragraph are the following:
            ``(A) A medicare-dependent, small rural hospital (as defined 
        in section 1886(d)(5)(G)(iv) of the Social Security Act (42 
        U.S.C. 1395ww(d)(5)(G)(iv))).
            ``(B) A sole community hospital (as defined in section 
        1886(d)(5)(D)(iii) of such Act (42 U.S.C. 
        1395ww(d)(5)(D)(iii))).
            ``(C) Rural health clinics (as defined in section 
        1861(aa)(2) of such Act (42 U.S.C. 1395x(aa)(2)).
            ``(D) Rural referral centers (as so classified under section 
        1886(d)(5)(C) of such Act (42 U.S.C. 1395ww(d)(5)(C)).
            ``(E) Any other rural hospital with not more than 100 beds.
            ``(F) Any other rural hospital that the Secretary determines 
        appropriate.
            ``(G) A hospital described in section 1886(d)(1)(B)(v) of 
        such Act (42 U.S.C. 1395ww(d)(1)(B)(v)).
    ``(b) Report.--Not later than 2 years after the date of the 
enactment of this Act [Nov. 29, 1999], MedPAC shall submit a report to 
the Secretary of Health and Human Services and Congress on the study 
conducted under subsection (a), together with any recommendations for 
legislation that MedPAC determines to be appropriate as a result of such 
study.
    ``(c) Comments.--Not later than 60 days after the date on which 
MedPAC submits the report under subsection (b) to the Secretary of 
Health and Human Services, the Secretary shall submit comments on such 
report to Congress.''


GAO Study on Resources Required To Provide Safe and Effective Outpatient 
                             Cancer Therapy

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 213], Nov. 
29, 1999, 113 Stat. 1536, 1501A-350, provided that:
    ``(a) Study.--The Comptroller General of the United States shall 
conduct a nationwide study to determine the physician and non-physician 
clinical resources necessary to provide safe outpatient cancer therapy 
services and the appropriate payment rates for such services under the 
medicare program. In making such determination, the Comptroller General 
shall--
        ``(1) determine the adequacy of practice expense relative value 
    units associated with the utilization of those clinical resources;
        ``(2) determine the adequacy of work units in the practice 
    expense formula; and
        ``(3) assess various standards to assure the provision of safe 
    outpatient cancer therapy services.
    ``(b) Report to Congress.--The Comptroller General shall submit to 
Congress a report on the study conducted under subsection (a). The 
report shall include recommendations regarding practice expense 
adjustments to the payment methodology under part B of title XVIII of 
the Social Security Act [this part], including the development and 
inclusion of adequate work units to assure the adequacy of payment 
amounts for safe outpatient cancer therapy services. The study shall 
also include an estimate of the cost of implementing such 
recommendations.''


       Focused Medical Reviews of Claims During Moratorium Period

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 221(a)(2)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-351, provided that: ``During years 
in which paragraph (4) of section 1833(g) of the Social Security Act (42 
U.S.C. 1395l(g)) applies (under the amendment made by paragraph (1)(B) 
[enacting subsec. (g)(4) of this section]), the Secretary of Health and 
Human Services shall conduct focused medical reviews of claims for 
reimbursement for services described in paragraph (1) or (3) of such 
section, with an emphasis on such claims for services that are provided 
to residents of skilled nursing facilities.''


                     Study and Report on Utilization

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 221(d)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-352, provided that:
    ``(1) Study.--
        ``(A) In general.--The Secretary of Health and Human Services 
    shall conduct a study which compares--
            ``(i) utilization patterns (including nationwide patterns, 
        and patterns by region, types of settings, and diagnosis or 
        condition) of outpatient physical therapy services, outpatient 
        occupational therapy services, and speech-language pathology 
        services that are covered under the medicare program under title 
        XVIII of the Social Security Act (42 U.S.C. 1395) [this 
        subchapter] and provided on or after January 1, 2000; with
            ``(ii) such patterns for such services that were provided in 
        1998 and 1999.
        ``(B) Review of claims.--In conducting the study under this 
    subsection the Secretary of Health and Human Services shall review a 
    statistically significant number of claims for reimbursement for the 
    services described in subparagraph (A).
    ``(2) Report.--Not later than June 30, 2001, the Secretary of Health 
and Human Services shall submit a report to Congress on the study 
conducted under paragraph (1), together with any recommendations for 
legislation that the Secretary determines to be appropriate as a result 
of such study.''


             Phase-in of PPS for Ambulatory Surgical Centers

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 226], Nov. 
29, 1999, 113 Stat. 1536, 1501A-354, provided that: ``If the Secretary 
of Health and Human Services implements a revised prospective payment 
system for services of ambulatory surgical facilities under section 
1833(i) of the Social Security Act (42 U.S.C. 1395l(i)), prior to 
incorporating data from the 1999 Medicare cost survey or a subsequent 
cost survey, such system shall be implemented in a manner so that--
        ``(1) in the first year of its implementation, only a proportion 
    (specified by the Secretary and not to exceed \1/3\) of the payment 
    for such services shall be made in accordance with such system and 
    the remainder shall be made in accordance with current regulations; 
    and
        ``(2) in the following year a proportion (specified by the 
    Secretary and not to exceed \2/3\) of the payment for such services 
    shall be made under such system and the remainder shall be made in 
    accordance with current regulations.''


       MedPAC Study on Postsurgical Recovery Care Center Services

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 229(a)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-356, provided that:
    ``(1) In general.--The Medicare Payment Advisory Commission shall 
conduct a study on the cost-effectiveness and efficacy of covering under 
the medicare program under title XVIII of the Social Security Act [this 
subchapter] services of a post-surgical recovery care center (that 
provides an intermediate level of recovery care following surgery). In 
conducting such study, the Commission shall consider data on these 
centers gathered in demonstration projects.
    ``(2) Report.--Not later than 1 year after the date of the enactment 
of this Act [Nov. 29,1999], the Commission shall submit to Congress a 
report on such study and shall include in the report recommendations on 
the feasibility, costs, and savings of covering such services under the 
medicare program.''


             Medicare Reimbursement for Telehealth Services

    Section 4206 of Pub. L. 105-33 provided that:
    ``(a) In General.--Not later than January 1, 1999, the Secretary of 
Health and Human Services shall make payments from the Federal 
Supplementary Medical Insurance Trust Fund under part B of title XVIII 
of the Social Security Act (42 U.S.C. 1395j et seq.) in accordance with 
the methodology described in subsection (b) for professional 
consultation via telecommunications systems with a physician (as defined 
in section 1861(r) of such Act (42 U.S.C. 1395x(r)) or a practitioner 
(described in section 1842(b)(18)(C) of such Act (42 U.S.C. 
1395u(b)(18)(C)) furnishing a service for which payment may be made 
under such part to a beneficiary under the medicare program residing in 
a county in a rural area (as defined in section 1886(d)(2)(D) of such 
Act (42 U.S.C. 1395ww(d)(2)(D))) that is designated as a health 
professional shortage area under section 332(a)(1)(A) of the Public 
Health Service Act (42 U.S.C. 254e(a)(1)(A)), notwithstanding that the 
individual physician or practitioner providing the professional 
consultation is not at the same location as the physician or 
practitioner furnishing the service to that beneficiary.
    ``(b) Methodology for Determining Amount of Payments.--Taking into 
account the findings of the report required under section 192 of the 
Health Insurance Portability and Accountability Act of 1996 (Public Law 
104-191; 110 Stat. 1988), the findings of the report required under 
paragraph (c), and any other findings related to the clinical efficacy 
and cost-effectiveness of telehealth applications, the Secretary shall 
establish a methodology for determining the amount of payments made 
under subsection (a) within the following parameters:
        ``(1) The payment shall [be] shared between the referring 
    physician or practitioner and the consulting physician or 
    practitioner. The amount of such payment shall not be greater than 
    the current fee schedule of the consulting physician or practitioner 
    for the health care services provided.
        ``(2) The payment shall not include any reimbursement for any 
    telephone line charges or any facility fees, and a beneficiary may 
    not be billed for any such charges or fees.
        ``(3) The payment shall be made subject to the coinsurance and 
    deductible requirements under subsections (a)(1) and (b) of section 
    1833 of the Social Security Act (42 U.S.C. 1395l).
        ``(4) The payment differential of section 1848(a)(3) of such Act 
    (42 U.S.C. 1395w-4(a)(3)) shall apply to services furnished by non-
    participating physicians. The provisions of section 1848(g) of such 
    Act (42 U.S.C. 1395w-4(g)) and section 1842(b)(18) of such Act (42 
    U.S.C. 1395u(b)(18)) shall apply. Payment for such service shall be 
    increased annually by the update factor for physicians' services 
    determined under section 1848(d) of such Act (42 U.S.C. 1395w-4(d)).
    ``(c) Supplemental Report.--Not later than January 1, 1999, the 
Secretary shall submit a report to Congress which shall contain a 
detailed analysis of--
        ``(1) how telemedicine and telehealth systems are expanding 
    access to health care services;
        ``(2) the clinical efficacy and cost-effectiveness of 
    telemedicine and telehealth applications;
        ``(3) the quality of telemedicine and telehealth services 
    delivered; and
        ``(4) the reasonable cost of telecommunications charges incurred 
    in practicing telemedicine and telehealth in rural, frontier, and 
    underserved areas.
    ``(d) Expansion of Telehealth Services for Certain Medicare 
Beneficiaries.--
        ``(1) In general.--Not later than January 1, 1999, the Secretary 
    shall submit a report to Congress that examines the possibility of 
    making payments from the Federal Supplementary Medical Insurance 
    Trust Fund under part B of title XVIII of the Social Security Act 
    (42 U.S.C. 1395j et seq.) for professional consultation via 
    telecommunications systems with such a physician or practitioner 
    furnishing a service for which payment may be made under such part 
    to a beneficiary described in paragraph (2), notwithstanding that 
    the individual physician or practitioner providing the professional 
    consultation is not at the same location as the physician or 
    practitioner furnishing the service to that beneficiary.
        ``(2) Beneficiary described.--A beneficiary described in this 
    paragraph is a beneficiary under the medicare program under title 
    XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) who does 
    not reside in a rural area (as so defined) that is designated as a 
    health professional shortage area under section 332(a)(1)(A) of the 
    Public Health Service Act (42 U.S.C. 254e(a)(1)(A)), who is 
    homebound or nursing homebound, and for whom being transferred for 
    health care services imposes a serious hardship.
        ``(3) Report.--The report described in paragraph (1) shall 
    contain a detailed statement of the potential costs and savings to 
    the medicare program of making the payments described in that 
    paragraph using various reimbursement schemes.''


     Report on Coverage of Outpatient Occupational Therapy Services

    Pub. L. 105-33, title IV, Sec. 4541(d)(2), Aug. 5, 1997, 111 Stat. 
457, as amended by Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, 
Sec. 221(c)(1)], Nov. 29, 1999, 113 Stat. 1536, 1501A-351, provided 
that: ``Not later than January 1, 2001, the Secretary of Health and 
Human Services shall submit to Congress a report that includes 
recommendations on--
        ``(A) the establishment of a mechanism for assuring appropriate 
    utilization of outpatient physical therapy services, outpatient 
    occupational therapy services, and speech-language pathology 
    services that are covered under the medicare program under title 
    XVIII of the Social Security Act (42 U.S.C. 1395) [this subchapter]; 
    and
        ``(B) the establishment of an alternative payment policy for 
    such services based on classification of individuals by diagnostic 
    category, functional status, prior use of services (in both 
    inpatient and outpatient settings), and such other criteria as the 
    Secretary determines appropriate, in place of the uniform dollar 
    limitations specified in section 1833(g) of such Act [subsec. (g) of 
    this section], as amended by paragraph (1).
The recommendations shall include how such a mechanism or policy might 
be implemented in a budget-neutral manner.''
    [Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, 
Sec. 221(c)(2)], Nov. 29, 1999, 113 Stat. 1536, 1501A-352, provided 
that: ``The amendment made by paragraph (1) [amending section 4541(d)(2) 
of Pub. L. 105-33, set out above] shall take effect as if included in 
the enactment of section 4541 of BBA [the Balanced Budget Act of 1997, 
Pub. L. 105-33].'']


              Study and Report on Clinical Laboratory Tests

    Section 4553(c) of Pub. L. 105-33 provided that:
    ``(1) In general.--The Secretary shall request the Institute of 
Medicine of the National Academy of Sciences to conduct a study of 
payments under part B of title XVIII of the Social Security Act [this 
part] for clinical laboratory tests. The study shall include a review of 
the adequacy of the current methodology and recommendations regarding 
alternative payment systems. The study shall also analyze and discuss 
the relationship between such payment systems and access to high quality 
laboratory tests for medicare beneficiaries, including availability and 
access to new testing methodologies.
    ``(2) Report to congress.--The Secretary shall, not later than 2 
years after the date of enactment of this section [Aug. 5, 1997], report 
to the Committees on Ways and Means and Commerce of the House of 
Representatives and the Committee on Finance of the Senate the results 
of the study described in paragraph (1), including any recommendations 
for legislation.''


  Adjustments to Payment Amounts for New Technology Intraocular Lenses

    Section 141(b) of Pub. L. 103-432 provided that:
    ``(1) Establishment of process for review of amounts.--Not later 
than 1 year after the date of the enactment of this Act [Oct. 31, 1994], 
the Secretary of Health and Human Services (in this subsection referred 
to as the `Secretary') shall develop and implement a process under which 
interested parties may request review by the Secretary of the 
appropriateness of the reimbursement amount provided under section 
1833(i)(2)(A)(iii) of the Social Security Act [subsec. (i)(2)(A)(iii) of 
this section] with respect to a class of new technology intraocular 
lenses. For purposes of the preceding sentence, an intraocular lens may 
not be treated as a new technology lens unless it has been approved by 
the Food and Drug Administration.
    ``(2) Factors considered.--In determining whether to provide an 
adjustment of payment with respect to a particular lens under paragraph 
(1), the Secretary shall take into account whether use of the lens is 
likely to result in reduced risk of intraoperative or postoperative 
complication or trauma, accelerated postoperative recovery, reduced 
induced astigmatism, improved postoperative visual acuity, more stable 
postoperative vision, or other comparable clinical advantages.
    ``(3) Notice and comment.--The Secretary shall publish notice in the 
Federal Register from time to time (but no less often than once each 
year) of a list of the requests that the Secretary has received for 
review under this subsection, and shall provide for a 30-day comment 
period on the lenses that are the subjects of the requests contained in 
such notice. The Secretary shall publish a notice of the Secretary's 
determinations with respect to intraocular lenses listed in the notice 
within 90 days after the close of the comment period.
    ``(4) Effective date of adjustment.--Any adjustment of a payment 
amount (or payment limit) made under this subsection shall become 
effective not later than 30 days after the date on which the notice with 
respect to the adjustment is published under paragraph (3).''


    Study of Medicare Coverage of Patient Care Costs Associated With 
                 Clinical Trials of New Cancer Therapies

    Section 142 of Pub. L. 103-432 directed Secretary of Health and 
Human Services to conduct a study, and to submit a report to Congress 
not later than 2 years after Oct. 31, 1994, of effects of expressly 
covering under medicare program patient care costs for beneficiaries 
enrolled in clinical trials of new cancer therapies, where protocol for 
the trial has been approved by the National Cancer Institute or met 
similar scientific and ethical standards, including approval by an 
institutional review board.


    Study of Annual Cap on Amount of Medicare Payment for Outpatient 
           Physical Therapy and Occupational Therapy Services

    Section 143 of Pub. L. 103-432 directed Secretary of Health and 
Human Services to submit to Congress, not later than Jan. 1, 1996, study 
and report on appropriateness of continuing annual limitation on amount 
of payment for outpatient services of independently practicing physical 
and occupational therapists under medicare program, which was to include 
such recommendations for changes in such annual limitation as Secretary 
found appropriate.


          Ambulatory Surgical Center Services; Inflation Update

    Section 13531 of Pub. L. 103-66 provided that: ``The Secretary of 
Health and Human Services shall not provide for any inflation update in 
the payment amounts under subparagraphs (A) and (B) of section 
1833(i)(2) of the Social Security Act [subsec. (i)(2)(A) and (B) of this 
section] for fiscal year 1994 or for fiscal year 1995.''


               Freeze in Allowance for Intraocular Lenses

    Section 13533 of Pub. L. 103-66 provided that: ``Notwithstanding 
section 1833(i)(2)(A)(iii) of the Social Security Act [subsec. 
(i)(2)(A)(iii) of this section], the amount of payment determined under 
such section for an intraocular lens inserted subsequent to or during 
cataract surgery in an ambulatory surgical center on or after January 1, 
1994, and before January 1, 1999, shall be equal to $150.''
    Section 4151(c)(3) of Pub. L. 101-508, as amended by Pub. L. 103-
432, title I, Sec. 141(d), Oct. 31, 1994, 108 Stat. 4426, provided that: 
``Notwithstanding section 1833(i)(2)(A)(iii) of the Social Security Act 
[subsec. (i)(2)(A)(iii) of this section], the amount of payment 
determined under such section for an intraocular lens inserted during or 
subsequent to cataract surgery furnished to an individual in an 
ambulatory surgical center on or after the date of the enactment of this 
Act [Nov. 5, 1990] and on or before December 31, 1992, shall be equal to 
$200.''
    [Section 141(d) of Pub. L. 103-432 provided that the amendment made 
by that section to section 4151(c)(3) of Pub. L. 101-508, set out above, 
is effective as if included in the enactment of Pub. L. 101-508.]


   Reduction in Payments Under Part B During Final Two Months of 1990

    Section 4158 of Pub. L. 101-508 provided that:
    ``(a) In General.--Notwithstanding any other provision of law 
(including any other provision of this Act, other than subsection 
(b)(4)), payments under part B of title XVIII of the Social Security Act 
[this part] for items and services furnished during the period beginning 
on November 1, 1990, and ending on December 31, 1990, shall be reduced 
by 2 percent, in accordance with subsection (b).
    ``(b) Special Rules for Application of Reduction.--
        ``(1) Payment on the basis of cost reporting periods.--In the 
    case in which payment for services of a provider of services is made 
    under part B of such title on a basis relating to the reasonable 
    cost incurred for the services during a cost reporting period of the 
    provider, the reduction made under subsection (a) shall be applied 
    to payment for costs for such services incurred at any time during 
    each cost reporting period of the provider any part of which occurs 
    during the period described in such subsection, but only in the same 
    proportion as the fraction of the cost reporting period that occurs 
    during such period.
        ``(2) No increase in beneficiary charges in assignment-related 
    cases.--If a reduction in payment amounts is made under subsection 
    (a) for items or services for which payment under part B of such 
    title is made on an assignment-related basis (as defined in section 
    1842(i)(1) of the Social Security Act [section 1395u(i)(1) of this 
    title]), the person furnishing the items or services shall be 
    considered to have accepted payment of the reasonable charge for the 
    items or services, less any reduction in payment amount made under 
    subsection (a), as payment in full.
        ``(3) Treatment of payments to health maintenance 
    organizations.--Subsection (a) shall not apply to payments under 
    risk-sharing contracts under section 1876 of the Social Security Act 
    [section 1395mm of this title] or under similar contracts under 
    section 402 of the Social Security Amendments of 1967 [Pub. L. 90-
    248, enacting section 1395b-1 of this title and amending section 
    1395ll of this title] or section 222 of the Social Security 
    Amendments of 1972 [Pub. L. 92-603, amending sections 1395b-1 and 
    1395ll of this title and enacting provisions set out as a note under 
    section 1395b-1 of this title].''


                           Effect on State Law

    Conscientious objections of health care provider under State law 
unaffected by enactment of subsecs. (a)(1)(Q) and (f) of this section, 
see section 4206(c) of Pub. L. 101-508, set out as a note under section 
1395cc of this title.


     Development of Criteria Regarding Consultation With a Physician

    Section 6113(c) of Pub. L. 101-239, as amended by Pub. L. 103-432, 
title I, Sec. 147(b), Oct. 31, 1994, 108 Stat. 4429, provided that: 
``The Secretary of Health and Human Services shall, taking into 
consideration concerns for patient confidentiality, develop criteria 
with respect to payment for qualified psychologist services and clinical 
social worker services for which payment may be made directly to the 
psychologist or clinical social worker under part B of title XVIII of 
the Social Security Act [this part] under which such a psychologist or 
clinical social worker must agree to consult with a patient's attending 
physician in accordance with such criteria.''
    [Section 147(b) of Pub. L. 103-432 provided that the amendment made 
by that section to section 6113(c) of Pub. L. 101-239, set out above, is 
effective with respect to services furnished on or after Jan. 1, 1991.]


              Study of Reimbursement for Ambulance Services

    Section 6136 of Pub. L. 101-239 directed Secretary of Health and 
Human Services to conduct a study to determine adequacy and 
appropriateness of payment amounts under this subchapter for ambulance 
services and, not later than one year after Dec. 19, 1989, submit a 
report to Congress on results of the study, with report to include such 
recommendations for changes in medicare payment policy with respect to 
ambulance services as may be needed to ensure access by medicare 
beneficiaries to quality ambulance services in metropolitan and rural 
areas.


PROPAC Study of Payments for Services in Hospital Outpatient Departments

    Section 6137 of Pub. L. 101-239, directed Prospective Payment 
Assessment Commission to conduct a study on payment under this 
subchapter for hospital outpatient services and, not later than July 1, 
1990, and not later than Mar. 1, 1991, to submit reports to Congress on 
specified portions of the study, with the reports to include such 
recommendations as the Commission deemed appropriate, prior to repeal by 
Pub. L. 103-432, title I, Sec. 147(c)(1), Oct. 31, 1994, 108 Stat. 4429.


                            Budget Neutrality

    Section 8421(b) of Pub. L. 100-647 provided that: ``The Secretary of 
Health and Human Services shall adjust the fees for transportation and 
personnel established under section 1833(h)(3)(B) of the Social Security 
Act [subsec. (h)(3)(B) of this section] for tests not covered under the 
amendment made by subsection (a) [amending this section] in such manner 
that the total cost of fees under such section is the same as would have 
been the case without such amendment.''


            Adjustment of Contracts With Prepaid Health Plans

    For requirement that Secretary of Health and Human Services modify 
contracts under subsection (a)(1)(A) of this section to take into 
account amendments made by Pub. L. 100-360 and that such organizations 
make appropriate adjustments in their agreements with medicare 
beneficiaries to take into account such amendments, see section 222 of 
Pub. L. 100-360, set out as a note under section 1395mm of this title.


     Study and Report to Congress Respecting Incentive Payments for 
           Physicians' Services Furnished in Underserved Areas

    Section 4043(b) of Pub. L. 100-203 directed Secretary of Health and 
Human Services to study and report to Congress, by not later than Jan. 
1, 1990, on feasibility of making additional payments described in 
section 1395l(m) of this title with respect to physician services 
performed in health manpower shortage areas located in urban areas, 
prior to repeal by Pub. L. 101-508, title IV, Sec. 4118(g)(1), Nov. 5, 
1990, 104 Stat. 1388-70.


             Fee Schedules for Physician Pathology Services

    Section 4050 of Pub. L. 100-203 directed Secretary of Health and 
Human Services to develop a relative value scale and fee schedules with 
updating index for payment of physician pathology services under this 
part, and to report to committees of Congress not later than Apr. 1, 
1989, on the scale, schedules, and index, prior to repeal by Pub. L. 
101-508, title IV, Sec. 4104(b)(3), Nov. 5, 1990, 104 Stat. 1388-59.


  Applying Copayment and Deductible to Certain Outpatient Physicians' 
                                Services

    Section 4054 of Pub. L. 100-203, relating to payment under part B of 
title XVIII of the Social Security Act (this part) for physicians' 
services specified in subsec. (i) of this section and furnished on or 
after Apr. 1, 1988, in an ambulatory surgical center or hospital 
outpatient department on an assignment-related basis, was negated in the 
amendment of section 4054 by Pub. L. 100-360, title IV, 
Sec. 411(f)(12)(A), July 1, 1988, 102 Stat. 781.


                     Other Physician Payment Studies

    Section 4056(c), formerly Sec. 4055(c), of Pub. L. 100-203, as 
renumbered by Pub. L. 100-360, title IV, Sec. 411(f)(14), July 1, 1988, 
102 Stat. 781, provided directed Secretary to (1) conduct a study of 
changes in the payment system for physicians' services, under part B, 
that would be required for the implementation of a national fee schedule 
for such services furnished on or after Jan. 1, 1990, and report to 
Congress on such study by not later than July 1, 1989, (2) conduct a 
study of issues relating to the volume and intensity of physicians' 
services under part B and submit to Congress an interim report on such 
study not later than May 1, 1988, and a final report on such study not 
later than May 1, 1989, and (3) conduct a survey to determine 
distribution of (A) the liabilities and expenditures for health care 
services of individuals entitled to benefits under this subchapter, 
including liabilities for charges (not paid on an assignment-related 
basis) in excess of the reasonable charge recognized, and (B) the 
collection rates among different classes of physicians for such 
liabilities, including collection rates for required coinsurance and for 
charges (not paid on an assignment-related basis) in excess of the 
reasonable charge recognized, report to Congress on such study by not 
later than July 1, 1990.


        Study of Payment for Chemotherapy in Physicians' Offices

    Section 4056(d), formerly Sec. 4055(d), of Pub. L. 100-203, as 
renumbered by Pub. L. 100-360, title IV, Sec. 411(f)(14), July 1, 1988, 
102 Stat. 781, directed Secretary to study ways of modifying part B to 
permit adequate payment under such part for costs associated with 
providing chemotherapy to cancer patients in physicians' offices, with 
the Secretary to report to Congress on results of study by not later 
than Apr. 1, 1989, prior to repeal by Pub. L. 105-362, title VI, 
Sec. 601(b)(7), Nov. 10, 1998, 112 Stat. 3286.


   Clinical Diagnostic Laboratory Tests; Limitation on Changes in Fee 
                                Schedules

    Section 4064(a) of Pub. L. 100-203 which provided 3-month freeze in 
fee schedules for clinical laboratory diagnostic laboratory tests under 
part B of title XVIII of the Social Security Act (this part) and 
directed the Secretary of Health and Human Services to not adjust the 
fee schedules established under subsec. (h) of this section to take into 
account any increase in the consumer price index, was negated in the 
amendment of section 4064(a) by Pub. L. 100-360, title IV, 
Sec. 411(g)(3)(A), July 1, 1988, 102 Stat. 783.


                       GAO Study of Fee Schedules

    Section 4064(b)(4) of Pub. L. 100-203 directed Comptroller General 
to conduct a study of level of fee schedules established for clinical 
diagnostic laboratory services under subsec. (h)(2) of this section to 
determine, based on costs of, and revenues received for, such tests the 
appropriateness of such schedules, with Comptroller General to report to 
Congress on results of such study by not later than Jan. 1, 1990, and 
with provision that suppliers of such tests which fail to provide 
Comptroller General with reasonable access to necessary records to carry 
out study being subject to exclusion from the medicare program under 
section 1320a-7(a) of this title.


        Amounts Paid for Independent Rural Health Clinic Services

    Section 4067(b) of Pub. L. 100-203 provided that: ``The Secretary of 
Health and Human Services shall report to Congress, by not later than 
March 1, 1989, on the adequacy of the amounts paid under title XVIII of 
the Social Security Act [this subchapter] for rural health clinic 
services provided by independent rural health clinics.''


    Report on Establishment of National Fee Schedules for Payment of 
                  Clinical Diagnostic Laboratory Tests

    Section 9339(b)(3) of Pub. L. 99-509 directed Secretary of Health 
and Human Services to report to Congress, by not later than Apr. 1, 
1988, on advisability and feasibility of, and methodology for, 
establishing national fee schedules for payment for clinical diagnostic 
laboratory tests under section 1395l(h) of this title, prior to repeal 
by Pub. L. 101-508, title IV, Sec. 4154(e)(3), Nov. 5, 1990, 104 Stat. 
1388-86, effective as if included in enactment of Pub. L. 99-509.


         State Standards for Directors of Clinical Laboratories

    Section 9339(d) of Pub. L. 99-509 provided that:
    ``(1) In general.--If a State (as defined for purposes of title 
XVIII of the Social Security Act [this subchapter]) provides for the 
licensing or other standards with respect to the operation of clinical 
laboratories (including such laboratories in hospitals) in the State 
under which such a laboratory may be directed by an individual with 
certain qualifications, nothing in such title shall be construed as 
authorizing the Secretary of Health and Human Services to require such a 
laboratory, as a condition of payment or participation under such title, 
to be directed by an individual with other qualifications.
    ``(2) Effective date.--Paragraph (1) shall take effect on January 1, 
1987.''


  Transitional Provisions for Payment of Fees for Clinical Diagnostic 
                            Laboratory Tests

    Section 9303(a)(3) of Pub. L. 99-272 provided that: ``The Secretary 
of Health and Human Services shall provide that the annual adjustment 
under section 1833(h) of the Social Security Act [subsec. (h) of this 
section] for 1986--
        ``(A) shall take effect on January 1, 1987,
        ``(B) shall apply for the 12-month period beginning on that 
    date, and
        ``(C) shall take into account the percentage increase or 
    decrease in the Consumer Price Index for all urban consumers (United 
    States city average) occurring over an 18-month period, rather than 
    over a 12-month period.''


           Extension of Medicare Physician Payment Provisions

    Amount of payment under this part for physicians' services furnished 
between Oct. 1, 1985, and Mar. 14, 1986, to be determined on the same 
basis as the amount of such services furnished on Sept. 30, 1985, see 
section 5(b) of Pub. L. 99-107, as amended, set out as a note under 
section 1395ww of this title.


Fee Schedules for Diagnostic Laboratory Tests and Feasibility of Direct 
               Payments to Physicians; Report to Congress

    Section 2303(i) of Pub. L. 98-369 provided that:
    ``(1) The Comptroller General shall report to the Congress on--
        ``(A) the appropriateness of the fee schedules under section 
    1833(h) of the Social Security Act [subsec. (h) of this section] and 
    their impact on the volume and quality of clinical diagnostic 
    laboratory tests;
        ``(B) the potential impact of the adoption of a national fee 
    schedule; and
        ``(C) the potential impact of applying a national fee schedule 
    to clinical diagnostic laboratory tests provided by hospitals to 
    their outpatients.
    ``(2) The Secretary of Health and Human Services shall report to the 
Congress with respect to the advisability and feasibility of a system of 
direct payment to any physician for all clinical diagnostic laboratory 
tests ordered by such physician.
    ``(3) The reports required by paragraphs (1) and (2) shall be 
submitted not later than January 1, 1987.''


                Pacemaker Reimbursement Review and Reform

    Section 2304(a) of Pub. L. 98-369 provided that:
    ``(1) The Secretary of Health and Human Services shall issue 
revisions to the current guidelines for the payment under part B of 
title XVIII of the Social Security Act [this part] for the 
transtelephonic monitoring of cardiac pacemakers. Such revised 
guidelines shall include provisions regarding the specifications for and 
frequency of transtelephonic monitoring procedures which will be found 
to be reasonable and necessary.
    ``(2)(A) Except as provided in subparagraph (B), if the guidelines 
required by paragraph (1) have not been issued and put into effect by 
October 1, 1984, and until such guidelines have been issued and put into 
effect, payment may not be made under part B of title XVIII of the 
Social Security Act for transtelephonic monitoring procedures, with 
respect to a single-chamber cardiac pacemaker powered by lithium 
batteries, conducted more frequently than--
        ``(i) weekly during the first month after implantation,
        ``(ii) once every two months during the period representing 80 
    percent of the estimated life of the implanted device, and
        ``(iii) monthly thereafter.
    ``(B) Subparagraph (A) shall not apply in cases where the Secretary 
determines that special medical factors (including possible evidence of 
pacemaker or lead malfunction) justify more frequent transtelephonic 
monitoring procedures.''


  Payment for Preadmission Diagnostic Testing Performed in Physician's 
                                 Office

    Section 2305(f) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section and enacting provisions set 
out above] shall not be construed as prohibiting payment, subject to the 
applicable copayments, under part B of title XVIII of the Social 
Security Act [this part] for preadmission diagnostic testing performed 
in a physician's office to the extent such testing is otherwise 
reimbursable under regulations of the Secretary.''


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

    For provision directing the Secretary to issue regulations requiring 
providers of services to calculate and report the lesser-of-cost-or-
charges determinations separately with respect to payments for services 
under parts A and B of this subchapter other than diagnostic tests under 
subsec. (h) of this section, see section 2308(a) of Pub. L. 98-369, set 
out as a note under section 1395f of this title.


      Determination of Nominal Charges for Applying Nominality Test

    For provision directing the Secretary to provide, in addition to 
other rules deemed appropriate, that charges representing 60 percent or 
less of costs be considered nominal for purposes of applying the 
nominality test under subsec. (a)(2)(B)(ii) of this section, see section 
2308(b)(1) of Pub. L. 98-369, set out as a note under section 1395f of 
this title.


  Study of Medicare Part B Payments; Compilation of Centralized Charge 
                      Data Base; Report to Congress

    Section 2309 of Pub. L. 98-369 directed Director of Office of 
Technology Assessment to conduct a study of physician reimbursement 
under the Medicare program and make a report not later than Dec. 31, 
1985, covering findings and recommendations on methods by which payment 
amounts and other program policies under the program might be modified, 
and directed that Secretary of Health and Human Services compile a 
centralized Medicare part B charge data base to aid in the study.


   Monitoring Provision of Hepatitis B Vaccine; Review of Changes in 
                           Medical Technology

    Section 2323(e) of Pub. L. 98-369 provided that: ``The Secretary 
shall monitor the provision of hepatitis B vaccine under part B of title 
XVIII of the Social Security Act [this part], and shall review any 
changes in medical technology which may have an effect on the amounts 
which should be paid for such service.''


           Report on Preadmission Diagnostic Testing Expenses

    Section 932(b) of Pub. L. 96-499 required a report to Congress, no 
later than one year after Dec. 5, 1980, on the policy respecting 
expenses incurred for preadmission diagnostic testing furnished to an 
individual at a hospital within seven days of an individual's admission 
to another hospital.


Study of Feasibility and Desirability of Imposing Copayment Requirement 
 on Rural Health Clinic Visits; Report Not Later Than December 13, 1978

    Section 1(c) of Pub. L. 95-210 directed Secretary of Health, 
Education, and Welfare to conduct a study of the feasibility and 
desirability of imposing a copayment for each visit to a rural health 
clinic for rural health clinic services under this part and that 
Secretary report to appropriate committee of Congress, not later than 
one year after Dec. 13, 1977, on such study.


   Prohibition Against Payments in Cases of Nonentitlement to Monthly 
Benefits Under Subchapter II or Suspension of Benefits of Aliens Outside 
                            the United States

    Section 104(b)(1) of Pub. L. 89-97 provided that: ``No payments 
shall be made under part B of title XVIII of the Social Security Act 
[this part] with respect to expenses incurred by an individual during 
any month for which such individual may not be paid monthly benefits 
under title II of such Act [subchapter II of this chapter] (or for which 
such monthly benefits would be suspended if he were otherwise entitled 
thereto) by reason of section 202(t) of such Act [section 402(t) of this 
title] (relating to suspension of benefits of aliens who are outside the 
United States).''

                  Section Referred to in Other Sections

    This section is referred to in sections 1320a-7a, 1320c-3, 1395e, 
1395f, 1395k, 1395m, 1395n, 1395u, 1395x, 1395cc, 1395mm, 1395nn, 
1395rr, 1395ss, 1395uu, 1395yy, 1395ccc, 1395eee, 1396a, 1396b, 1396d of 
this title.
