
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[CITE: 42USC1395n]

 
                 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. 1395n. Procedure for payment of claims of providers of 
        services
        

(a) Conditions for payment for services described in section 1395k(a)(2) 
        of this title

    Except as provided in subsections (b), (c), and (e) of this section, 
payment for services described in section 1395k(a)(2) of this title 
furnished an individual may be made only to providers of services which 
are eligible therefor under section 1395cc(a) of this title, and only 
if--
        (1) written request, signed by such individual, except in cases 
    in which the Secretary finds it impracticable for the individual to 
    do so, is filed for such payment in such form, in such manner and by 
    such person or persons as the Secretary may by regulation prescribe, 
    no later than the close of the period of 3 calendar years following 
    the year in which such services are furnished (deeming any services 
    furnished in the last 3 calendar months of any calendar year to have 
    been furnished in the succeeding calendar year) except that, where 
    the Secretary deems that efficient administration so requires, such 
    period may be reduced to not less than 1 calendar year; and
        (2) a physician certifies (and recertifies, where such services 
    are furnished over a period of time, in such cases, with such 
    frequency, and accompanied by such supporting material, appropriate 
    to the case involved, as may be provided by regulations) that--
            (A) in the case of home health services (i) such services 
        are or were required because the individual is or was confined 
        to his home (except when receiving items and services referred 
        to in section 1395x(m)(7) of this title) and needs or needed 
        skilled nursing care (other than solely venipuncture for the 
        purpose of obtaining a blood sample) on an intermittent basis or 
        physical or speech therapy or, in the case of an individual who 
        has been furnished home health services based on such a need and 
        who no longer has such a need for such care or therapy, 
        continues or continued to need occupational therapy, (ii) a plan 
        for furnishing such services to such individual has been 
        established and is periodically reviewed by a physician, and 
        (iii) such services are or were furnished while the individual 
        is or was under the care of a physician;
            (B) in the case of medical and other health services, except 
        services described in subparagraphs (B), (C), and (D) of section 
        1395x(s)(2) of this title, such services are or were medically 
        required;
            (C) in the case of outpatient physical therapy services or 
        outpatient occupational therapy services, (i) such services are 
        or were required because the individual needed physical therapy 
        services or occupational therapy services, respectively, (ii) a 
        plan for furnishing such services has been established by a 
        physician or by the qualified physical therapist or qualified 
        occupational therapist, respectively, providing such services 
        and is periodically reviewed by a physician, and (iii) such 
        services are or were furnished while the individual is or was 
        under the care of a physician;
            (D) in the case of outpatient speech pathology services, (i) 
        such services are or were required because the individual needed 
        speech pathology services, (ii) a plan for furnishing such 
        services has been established by a physician or by the speech 
        pathologist providing such services and is periodically reviewed 
        by a physician, and (iii) such services are or were furnished 
        while the individual is or was under the care of a physician;
            (E) in the case of comprehensive outpatient rehabilitation 
        facility services, (i) such services are or were required 
        because the individual needed skilled rehabilitation services, 
        (ii) a plan for furnishing such services has been established 
        and is periodically reviewed by a physician, and (iii) such 
        services are or were furnished while the individual is or was 
        under the care of a physician; and
            (F) in the case of partial hospitalization services, (i) the 
        individual would require inpatient psychiatric care in the 
        absence of such services, (ii) an individualized, written plan 
        for furnishing such services has been established by a physician 
        and is reviewed periodically by a physician, and (iii) such 
        services are or were furnished while the individual is or was 
        under the care of a physician.

    For purposes of this section, the term ``provider of services'' 
    shall include a clinic, rehabilitation agency, or public health 
    agency if, in the case of a clinic or rehabilitation agency, such 
    clinic or agency meets the requirements of section 1395x(p)(4)(A) of 
    this title (or meets the requirements of such section through the 
    operation of section 1395x(g) of this title), or if, in the case of 
    a public health agency, such agency meets the requirements of 
    section 1395x(p)(4)(B) of this title (or meets the requirements of 
    such section through the operation of section 1395x(g) of this 
    title), but only with respect to the furnishing of outpatient 
    physical therapy services (as therein defined) or (through the 
    operation of section 1395x(g) of this title) with respect to the 
    furnishing of outpatient occupational therapy services.

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

(b) Conditions for payment for services described in section 1395x(s) of 
        this title

    (1) Payment may also be made to any hospital for services described 
in section 1395x(s) of this title furnished as an outpatient service by 
a hospital or by others under arrangements made by it to an individual 
entitled to benefits under this part even though such hospital does not 
have an agreement in effect under this subchapter if (A) such services 
were emergency services, (B) the Secretary would be required to make 
such payment if the hospital had such an agreement in effect and 
otherwise met the conditions of payment hereunder, and (C) such hospital 
has made an election pursuant to section 1395f(d)(1)(C) of this title 
with respect to the calendar year in which such emergency services are 
provided. Such payments shall be made only in the amounts provided under 
section 1395l(a)(2) of this title and then only if such hospital agrees 
to comply, with respect to the emergency services provided, with the 
provisions of section 1395cc(a) of this title.
    (2) Payment may also be made on the basis of an itemized bill to an 
individual for services described in paragraph (1) of this subsection if 
(A) payment cannot be made under such paragraph (1) solely because the 
hospital does not elect, in accordance with section 1395f(d)(1)(C) of 
this title, to claim such payments and (B) such individual files 
application (submitted within such time and in such form and manner, and 
containing and supported by such information as the Secretary shall by 
regulations prescribe) for reimbursement. The amounts payable under this 
paragraph shall, subject to the provisions of section 1395l of this 
title, be equal to 80 percent of the hospital's reasonable charges for 
such services.

(c) Collection of charges from individuals for services specified in 
        section 1395x(s) of this title

    Notwithstanding the provisions of this section and sections 1395k, 
1395l, and 1395cc(a)(1)(A) of this title, a hospital or a critical 
access hospital may, subject to such limitations as may be prescribed by 
regulations, collect from an individual the customary charges for 
services specified in section 1395x(s) of this title and furnished to 
him by such hospital as an outpatient, but only if such charges for such 
services do not exceed the applicable supplementary medical insurance 
deductible, and such customary charges shall be regarded as expenses 
incurred by such individual with respect to which benefits are payable 
in accordance with section 1395l(a)(1) of this title. Payments under 
this subchapter to hospitals which have elected to make collections from 
individuals in accordance with the preceding sentence shall be adjusted 
periodically to place the hospital in the same position it would have 
been had it instead been reimbursed in accordance with section 
1395l(a)(2) of this title (or, in the case of a critical access 
hospital, in accordance with section 1395l(a)(6) of this title).

(d) Payment to Federal provider of services or other Federal agencies 
        prohibited

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

(e) Payment to fund designated by medical staff or faculty of medical 
        school

    For purposes of services (1) which are inpatient hospital services 
by reason of paragraph (7) of section 1395x(b) of this title or for 
which entitlement exists by reason of clause (II) of section 
1395k(a)(2)(B)(i) of this title, and (2) for which the reasonable cost 
thereof is determined under section 1395x(v)(1)(D) of this title (or 
would be if section 1395ww of this title did not apply), payment under 
this part shall be made to such fund as may be designated by the 
organized medical staff of the hospital in which such services were 
furnished or, if such services were furnished in such hospital by the 
faculty of a medical school, to such fund as may be designated by such 
faculty, but only if--
        (A) such hospital has an agreement with the Secretary under 
    section 1395cc of this title, and
        (B) the Secretary has received written assurances that (i) such 
    payment will be used by such fund solely for the improvement of care 
    to patients in such hospital or for educational or charitable 
    purposes and (ii) the individuals who were furnished such services 
    or any other persons will not be charged for such services (or if 
    charged provision will be made for return of any moneys incorrectly 
    collected).

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1835, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 303; amended Pub. L. 90-
248, title I, Secs. 126(b), 129(c)(9)(A), (B), 130(a), (b), 133(e), Jan. 
2, 1968, 81 Stat. 846, 848, 849, 851; Pub. L. 92-603, title II, 
Secs. 204(b), 227(e)(2), 251(b)(2), 281(f), 283(b), Oct. 30, 1972, 86 
Stat. 1377, 1406, 1445, 1456; Pub. L. 94-437, title IV, Sec. 401(a), 
Sept. 30, 1976, 90 Stat. 1408; Pub. L. 96-499, title IX, Secs. 930(e), 
(j), 933(b), 944(a), Dec. 5, 1980, 94 Stat. 2631, 2632, 2635, 2642; Pub. 
L. 97-35, title XXI, Secs. 2106(b)(1), 2122(a)(1), Aug. 13, 1981, 95 
Stat. 792, 796; Pub. L. 98-21, title VI, Sec. 602(b), Apr. 20, 1983, 97 
Stat. 163; Pub. L. 98-369, div. B, title III, Secs. 2336(a), (b), 
2342(b), 2354(b)(1), (8), (9), July 18, 1984, 98 Stat. 1091, 1094, 1100; 
Pub. L. 98-617, Sec. 3(a)(3), Nov. 8, 1984, 98 Stat. 3295; Pub. L. 99-
509, title IX, Sec. 9337(c), Oct. 21, 1986, 100 Stat. 2034; Pub. L. 100-
203, title IV, Secs. 4024(b), 4070(b)(3), 4085(i)(4), Dec. 22, 1987, 101 
Stat. 1330-74, 1330-115, 1330-132; Pub. L. 100-360, title II, 
Secs. 203(d)(1), 205(d), July 1, 1988, 102 Stat. 724, 731; Pub. L. 101-
234, title II, Sec. 201(a), Dec. 13, 1989, 103 Stat. 1981; Pub. L. 101-
239, title VI, Sec. 6003(g)(3)(D)(viii), Dec. 19, 1989, 103 Stat. 2153; 
Pub. L. 101-508, title IV, Sec. 4008(m)(2)(D), Nov. 5, 1990, 104 Stat. 
1388-53; Pub. L. 105-33, title IV, Secs. 4201(c)(1), 4615(a), Aug. 5, 
1997, 111 Stat. 373, 475.)


                               Amendments

    1997--Subsec. (a)(2)(A). Pub. L. 105-33, Sec. 4615(a), inserted 
``(other than solely venipuncture for the purpose of obtaining a blood 
sample)'' after ``skilled nursing care''.
    Subsec. (c). Pub. L. 105-33, Sec. 4201(c)(1), substituted ``critical 
access'' for ``rural primary care'' in two places.
    1990--Subsec. (c). Pub. L. 101-508 substituted ``a hospital or a 
rural primary care hospital may'' for ``a hospital may'' in first 
sentence, substituted ``section 1395l(a)(2) of this title (or, in the 
case of a rural primary care hospital, in accordance with section 
1395l(a)(6) of this title)'' for ``section 1395l(a)(2) of this title'' 
in second sentence, and struck out at end ``A rural primary care 
hospital shall be considered a hospital for purposes of this 
subsection.''
    1989--Subsec. (a)(2)(G), (H). Pub. L. 101-234 repealed Pub. L. 100-
360, Secs. 203(d)(1), 205(d), 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. 101-239 inserted at end ``A rural primary care 
hospital shall be considered a hospital for purposes of this 
subsection.''
    1988--Subsec. (a)(2)(G). Pub. L. 100-360, Sec. 203(d)(1), added 
subpar. (G) relating to home intravenous drug therapy services.
    Subsec. (a)(2)(H). Pub. L. 100-360, Sec. 205(d), added subpar. (H) 
relating to in-home care provided to chronically dependent individuals.
    1987--Subsec. (a). Pub. L. 100-203, Sec. 4024(b), inserted two 
sentences at end clarifying ``confined to his home'' for purposes of 
par. (2)(A).
    Subsec. (a)(2)(C)(i). Pub. L. 100-203, Sec. 4085(i)(4), struck out 
second comma at end.
    Subsec. (a)(2)(F). Pub. L. 100-203, Sec. 4070(b)(3), added subpar. 
(F).
    1986--Subsec. (a)(2). Pub. L. 99-509, Sec. 9337(c)(2), inserted in 
second sentence ``(or meets the requirements of such section through the 
operation of section 1395x(g) of this title)'' in two places, and ``or 
(through the operation of section 1395x(g) of this title) with respect 
to the furnishing of outpatient occupational therapy services''.
    Subsec. (a)(2)(C). Pub. L. 99-509, Sec. 9337(c)(1), inserted ``or 
outpatient occupational therapy services'' in introductory provisions, 
``or occupational therapy services, respectively,'' in cl. (i), and ``or 
qualified occupational therapist, respectively,'' in cl. (ii).
    1984--Subsec. (a). Pub. L. 98-369, Sec. 2354(b)(1), as amended by 
Pub. L. 98-617, Sec. 3(a)(3), in concluding provisions, substituted 
``contractual'' for ``contractural''.
    Pub. L. 98-369, Sec. 2336(b), inserted before period at end of 
fourth sentence ``, except that such prohibition shall not apply with 
respect to a home health agency which is a sole community home health 
agency (as determined by the Secretary)''.
    Pub. L. 98-369, Sec. 2336(a), inserted sentence at end that for 
purposes of the preceding sentence, service by a physician as an 
uncompensated officer or director of a home health agency shall not 
constitute having a significant ownership interest in, or a significant 
financial or contractual relationship with, such agency.
    Subsec. (a)(2)(B), (C). Pub. L. 98-369, Sec. 2354(b)(8)(A), struck 
out ``and'' at end.
    Subsec. (a)(2)(C)(ii). Pub. L. 98-369, Sec. 2342(b), substituted 
``by a physician or by the qualified physical therapist providing such 
services and is periodically reviewed by a physician'' for ``, and is 
periodically reviewed, by a physician''.
    Subsec. (a)(2)(D). Pub. L. 98-369, Sec. 2354(b)(8)(B), realigned 
margin of subpar. (D).
    Subsec. (e)(2). Pub. L. 98-369, Sec. 2354(b)(9), designated 
concluding pars. (1) and (2) as (A) and (B), respectively, and in par. 
(B) inserted ``(i)'' after ``written assurances that'' and substituted 
``(ii) the individuals who'' for ``(B) the individuals who'' and 
``return of'' for ``return for''.
    1983--Subsec. (e). Pub. L. 98-21 inserted ``(or would be if section 
1395ww of this title did not apply)'' after ``section 1395(v)(1)(D) of 
this title''.
    1981--Subsec. (a)(2)(A). Pub. L. 97-35, Sec. 2122(a)(1), substituted 
``needs or needed skilled nursing care on an intermittent basis or 
physical or speech therapy or, in the case of an individual who has been 
furnished home health services based on such a need and who no longer 
has such a need for such care or therapy, continues or continued to need 
occupational therapy'' for ``needed skilled nursing care on an 
intermittent basis, or physical, occupational, or speech therapy''.
    Subsec. (a)(2)(D). Pub. L. 97-35, Sec. 2106(b)(1), inserted ``and'' 
after ``physician;''.
    Subsec. (a)(2)(E). Pub. L. 97-35, Sec. 2106(b)(1), substituted a 
period for ``; and'' at the end.
    1980--Subsec. (a). Pub. L. 96-499, Sec. 930(e), inserted sentence at 
end authorizing Secretary to prescribe regulations to prohibit 
significantly interested physicians from performing physician 
certification required by par. (2) for home health services.
    Subsec. (a)(2)(A). Pub. L. 96-499, Sec. 930(j), substituted 
``physical, occupational, or speech'' for ``physical or speech''.
    Subsec. (a)(2)(D)(ii). Pub. L. 96-499, Sec. 944(a), inserted ``by a 
physician or by the speech pathologist providing such services'', after 
``has been established''.
    Subsec. (a)(2)(E). Pub. L. 96-499, Sec. 933(b), added subpar. (E).
    1976--Subsec. (d). Pub. L. 94-437 substituted ``Subject to section 
1395qq of this title, no payment'' for ``No payment''.
    1972--Subsec. (a). Pub. L. 92-603, Sec. 227(e)(2)(A), inserted 
reference to subsec. (e) of this section in introductory provisions.
    Subsec. (a)(1). Pub. L. 92-603, Sec. 281(f), placed a 3-year time 
limitation on time within which a written request for payment is filed, 
with provision for reduction of limit to 1 year.
    Subsec. (a)(2)(C). Pub. L. 92-603, Sec. 251(b)(2), substituted 
``because the individual needed physical therapy services'' for 
``because the individual needed physical therapy services on an 
outpatient basis''.
    Subsec. (a)(2)(D). Pub. L. 92-603, Sec. 283(b), added subpar. (D).
    Subsec. (c). Pub. L. 92-603, Sec. 204(b), substituted ``the 
applicable supplementary medical insurance deductible'' for ``$50''.
    Subsec. (e). Pub. L. 92-603, Sec. 227(e)(2)(B), added subsec. (e).
    1968--Subsec. (a). Pub. L. 90-248, Secs. 129(c)(9)(A), 130(a), 
inserted introductory exception phrase and included reference to subsec. 
(c).
    Subsec. (a)(2). Pub. L. 90-248, Sec. 133(e)(5), inserted sentence at 
end defining ``provider of services''.
    Subsec. (a)(2)(B). Pub. L. 90-248, Secs. 126(b), 133(e)(4), inserted 
``except services described in subparagraphs (B) and (C) of section 
1395x(s)(2) of this title,'' after ``health services,'' and inserted 
reference to subpar. (d).
    Subsec. (a)(2)(C). Pub. L. 90-248, Sec. 133(e)(1)-(3), added subpar. 
(C).
    Subsec. (b). Pub. L. 90-248, Sec. 129(c)(9)(B), added subsec. (b). 
Former subsec. (b) redesignated (c), in turn redesignated (d).
    Subsec. (c). Pub. L. 90-248, Sec. 130(b), added subsec. (c). Former 
subsec. (c), previously designated (b), redesignated (d).
    Subsec. (d). Pub. L. 90-248, Secs. 129(c)(9)(B), 130(b), 
redesignated former subsec. (b) as (c), in turn as (d), respectively.


                    Effective Date of 1997 Amendment

    Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to 
services furnished on or after Oct. 1, 1997, see section 4201(d) of Pub. 
L. 105-33, set out as a note under section 1395f of this title.
    Amendment by section 4615(a) of Pub. L. 105-33 applicable to home 
health services furnished after 6-month period beginning after Aug. 5, 
1997, see section 4615(b) of Pub. L. 105-33, set out as a note under 
section 1395f of this title.


                    Effective Date of 1989 Amendment

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


                    Effective Date of 1988 Amendment

    Amendment by section 203(d)(1) 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 205(d) 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.


                    Effective Date of 1987 Amendment

    Amendment by section 4024(b) of Pub. L. 100-203 applicable to items 
and services provided on or after Jan. 1, 1988, see section 4024(c) of 
Pub. L. 100-203, set out as a note under section 1395f of this title.


                    Effective Date of 1986 Amendment

    Amendment by 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.


                    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.
    Amendment by section 2336(a) of Pub. L. 98-369 applicable to 
certifications and plans of care made or established on or after July 
18, 1984, see section 2336(c)(1) of Pub. L. 98-369, set out as a note 
under section 1395f of this title.
    Section 2342(c) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section and section 1395x of this 
title] apply to plans of care established on or after the date of the 
enactment of this Act [July 18, 1984].''
    Amendment by section 2354(b)(1), (8), (9) 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 1983 Amendment

    Amendment by Pub. L. 98-21 applicable to items and services 
furnished by or under arrangement with a hospital beginning with its 
first cost reporting period that begins on or after Oct. 1, 1983, any 
change in a hospital's cost reporting period made after November 1982 to 
be recognized for such purposes only if the Secretary finds good cause 
therefor, see section 604(a)(1) of Pub. L. 98-21, set out as a note 
under section 1395ww of this title.


                    Effective Date of 1981 Amendment

    Amendment by section 2122(a)(1) of Pub. L. 97-35 applicable to 
services furnished pursuant to plans of treatment implemented after the 
third month beginning after Aug. 13, 1981, see section 2122(b) of Pub. 
L. 97-35, set out as a note under section 1395f of this title.


                    Effective Date of 1980 Amendment

    Amendment by section 930(e), (j) of Pub. L. 96-499 effective with 
respect to services furnished on or after July 1, 1981, see section 
930(s)(1) of Pub. L. 96-499, set out as a note under section 1395x of 
this title.
    Amendment by section 933(b) of Pub. L. 96-499 effective with respect 
to a comprehensive outpatient rehabilitation facility's first accounting 
period beginning on or after July 1, 1981, see section 933(h) of Pub. L. 
96-499, set out as a note under section 1395k of this title.
    Section 944(b) of Pub. L. 96-499 provided that: ``The amendment made 
by subsection (a) [amending this section] shall apply to plans for 
furnishing services established on or after January 1, 1981.''


                    Effective Date of 1972 Amendment

    Amendment by section 204(b) of Pub. L. 92-603 effective with respect 
to calendar years after 1972, see section 204(c) of Pub. L. 92-603, set 
out as a note under section 1395l of this title.
    Amendment by section 227(e)(2) of Pub. L. 92-603 applicable with 
respect to accounting periods beginning after June 30, 1973, see section 
227(g) of Pub. L. 92-603, set out as a note under section 1395x of this 
title.
    Amendment by section 251(b)(2) of Pub. L. 92-603 applicable with 
respect to services furnished on or after Oct. 30, 1972, see section 
251(d)(2) of Pub. L. 92-603, set out as a note under section 1395x of 
this title.
    Amendment by section 281(f) of Pub. L. 92-603 applicable in the case 
of services furnished (or deemed to have been furnished) after 1970, see 
section 281(g) of Pub. L. 92-603, set out as a note under section 1395gg 
of this title.
    Section 283(c) of Pub. L. 92-603 provided that: ``The provisions of 
this section [amending this section and section 1395x of this title] 
shall apply with respect to services rendered after December 31, 1972.''


                    Effective Date of 1968 Amendment

    Amendment by section 126(b) of Pub. L. 90-248 applicable with 
respect to services furnished after Jan. 2, 1968, see section 126(c) of 
Pub. L. 90-248, set out as a note under section 1395f of this title.
    Amendment by section 129(c)(9)(A), (B) of Pub. L. 90-248 applicable 
with respect to services furnished after March 31, 1968, see section 
129(d) of Pub. L. 90-248, set out as a note under section 1395d of this 
title.
    Section 130(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.''
    Amendment by section 133(e) of Pub. L. 90-248 applicable with 
respect to services furnished after June 30, 1968, see section 133(g) of 
Pub. L. 90-248, set out as a note under section 1395k of this title.


                               Regulations

    Secretary of Health and Human Services required to provide, not 
later than 90 days after July 18, 1984, for revision of regulations as 
may be required to reflect amendment to subsec. (a) by section 2336(b) 
of Pub. L. 98-369, see section 2336(c)(2) of Pub. L. 98-369, set out as 
a note under section 1395f of this title.


          Home Health Prospective Payment Demonstration Project

    Section 4027 of Pub. L. 100-203, as amended by Pub. L. 100-360, 
title IV, Sec. 411(d)(6), July 1, 1988, 102 Stat. 775, directed 
Secretary of Health and Human Services to provide for a demonstration 
project to develop and test alternative methods of paying home health 
agencies on a prospective basis for services furnished under the 
medicare and medicaid programs, directed that the project be designed in 
a manner to enable the Secretary to evaluate the effects of various 
methods of prospective payment (including payments on a per-visit, per-
case, and per-episode basis) on program expenditures, access to, and 
quality of, home health care, and home health agency operations, 
directed Secretary to assure that services are first furnished under the 
project not later than Apr. 1, 1989, and, for this purpose, authorized 
Secretary to reinstate a previously awarded contract, or award a sole 
source contract, to carry out the project, provided for funding, and 
directed Secretary to submit to Congress, not later than one year after 
Dec. 22, 1987, an interim report on the demonstration project and, not 
later than four years after Dec. 22, 1987, a final report on results of 
the project.

                  Section Referred to in Other Sections

    This section is referred to in sections 1320a-7a, 1395f, 1395k, 
1395x, 1395cc, 1395pp, 1395qq, 1395eee, 1395fff, 1395ggg of this title.
