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NOTES:
Source
(Aug. 14, 1935, ch. 531, title XVIII, § 1833, as added , title I, § 102(a), July 30, 1965, ; amended , title I, §§ 129(c)(7), (8),
, (b),
,
, Jan. 2, 1968, , 853; , title II, §§ 204(a),
,
,
,
,
, (3),
,
299K
(a), Oct. 30, 1972, , 1384, 1404, 1411, 1424, 1445, 1454, 1464; , § 16(a), Oct. 25, 1977, ; , § 1(b), Dec. 13, 1977, ; , § 4(b), (c), June 13, 1978, ; , § 6(j), Oct. 19, 1980, ; , title IX, §§ 918(a)(4),
930
(h),
932
(a)(1),
934
(b), (d)(1), (3),
935
(a),
942,
943
(a), Dec. 5, 1980, , 2631, 2634, 2637, 2639, 2641; , § 1(b)(1), (2), Dec. 28, 1980, ; , title XXI, §§ 2106(a),
,
, Aug. 13, 1981, , 797; , title I, §§ 101(c)(2),
, (b),
117
(a)(2),
, Sept. 3, 1982, , 340, 355, 394; , div. B, title III, §§ 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, , 1069, 1070, 1074, 1084–1086, 1100; , § 3(b)(2), (3), Nov. 8, 1984, ; , title IX, §§ 9303(a)(1), (b)(1)–(3), 9401(b)–(2)(E), Apr. 7, 1986, , 189, 198, 199; , title IX, §§ 9320(e)(1), (2),
9337
(b),
9339
(a)(1), (b)(1), (2), (c)(1),
9343
(a), (b), (e)(2), Oct. 21, 1986, , 2033, 2036, 2039–2041; , title IV, §§ 4042(b)(2)(B),
4043
(a),
4045
(c)(2)(A),
4049
(a)(1),
, 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, , 1330–88, 1330–90, 1330–108 to 1330–115, 1330–117, 1330–118, 1330–120, 1330–121, 1330–129 to 1330–133, as amended , title IV, § 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, , 779, 781, 783, 784, 786–789; , title I, § 104(d)(7), title II, §§ 201(a),
–(3), 203(c)(1)(A)–(E), 204(d)(1), 205(c), 212(c)(2), title IV, § 411(f)(8)(C), (g)(1)(E), (2)(D), (3)(D), (4)(C), (5), (h)(1)(A), (i)(4)(B), July 1, 1988, , 704, 722, 729, 730, 741, 779, 782–785, 789, as amended , title VI, § 608(d)(3)(G), Oct. 13, 1988, ; , title VI, § 608(d)(4), (22)(B), (D), (23)(A), Oct. 13, 1988, , 2420, 2421; , title VIII, §§ 8421(a),
, Nov. 10, 1988, ; , title II, §§ 201(a),
, Dec. 13, 1989, ; , title VI, §§ 6003(e)(2)(A), (g)(3)(D)(vii),
, (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, , 2153, 2184, 2187–2189, 2213, 2214, 2217, 2219, 2221, 2222, 2241; , title IV, §§ 4008(m)(2)(C),
,
4118
(f)(2)(D),
, (2),
, (C),
, (b)(1), (c)(1), (e)(1),
, (3),
4160,
4161
(a)(3)(B),
4163
(d)(1),
4206
(b)(2),
, Nov. 5, 1990, , 1388–59, 1388–70, 1388–73, 1388–83 to 1388–87, 1388–91, 1388–93, 1388–100, 1388–116, 1388–125; , title IV, § 401(c)(2), Nov. 16, 1990, ; , title XIII, §§ 13516(b),
13532
(a),
13544
(b)(2),
,
, Aug. 10, 1993, , 586, 590, 592; , title I, §§ 123(b)(2)(A), (e),
, (c)(1),
, (d), (e)(2), (3), (f)(6)(C), (D),
156
(a)(2)(B),
160
(d)(1), Oct. 31, 1994, , 4412, 4424, 4425, 4429, 4430, 4432, 4440, 4443; , title IV, §§ 4002(j)(1)(A),
,
,
,
, (2),
,
4205
(a)(1)(A), (2),
4315
(b),
,
,
,
, (b),
, (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, , 360–362, 365, 373, 376, 390, 421, 442–445, 449, 450, 454, 456, 460, 462, 463, 470; , div. B, § 1000(a)(6) [title II, §§ 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, § 321(g)(2), (k)(2), title IV, §§ 401(b)(1),
], Nov. 29, 1999, , 1501A–336 to 1501A–342, 1501A–345, 1501A–348, 1501A–351, 1501A–353, 1501A–366, 1501A–369, 1501A–371; , § 1(a)(6) [title I, §§ 105(c),
, title II, §§ 201(b)(1),
,
,
, title IV, §§ 401(a), (b)(1),
, (b),
,
,
,
,
, title V, § 531(a)], Dec. 21, 2000, , 2763A–472, 2763A–481, 2763A–483, 2763A–489, 2763A–490, 2763A–502, 2763A–503, 2763A–505 to 2763A–508, 2763A–516, 2763A–524, 2763A–547.)
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
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 , as amended, which is set out as a note under section
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 , which amended sections
,
,
,
,
,
,
,
,
,
, and
of this title and provisions set out as a note under section
of this title.
Clause (iii), referred to in subsec. (t)(3)(C)(ii), was redesignated cl. (iv), and a new cl. (iii) was added, by , § 1(a)(6) [title IV, § 401(b)(1)], Dec. 21, 2000, , 2763A–502.
Section 4521 of The Balanced Budget Act of 1997, referred to in subsec. (t)(7)(F), is section 4521 of , Aug. 5, 1997, , which amended this section and enacted provisions set out as a note under this section.
Amendments
2000—Subsec. (a)(1)(D)(i). , § 1(a)(6) [title II, § 201(b)(1)], struck out “or which are furnished on an outpatient basis by a critical access hospital” after “on an assignment-related basis”.
Subsec. (a)(1)(R). , § 1(a)(6) [title II, § 205(b)], substituted “ambulance services, (i)” for “ambulance service,” and inserted before comma at end “and (ii) with respect to ambulance services described in section
of this title, the amounts paid shall be the amounts determined under section
of this title for outpatient critical access hospital services”.
Subsec. (a)(1)(T). , § 1(a)(6) [title I, § 105(c)], added cl. (T).
Subsec. (a)(1)(U). , § 1(a)(6) [title II, § 223(c)], added cl. (U).
Subsec. (a)(2)(D)(i). , § 1(a)(6) [title II, § 201(b)(1)], struck out “or which are furnished on an outpatient basis by a critical access hospital” after “on an assignment-related basis”.
Subsec. (f). , § 1(a)(6) [title II, § 224(a)], substituted “hospitals” for “rural hospitals” in introductory provisions.
Subsec. (g)(4). , § 1(a)(6) [title IV, § 421(a)], substituted “2000, 2001, and 2002.” for “2000 and 2001.”
Subsec. (h)(4)(B)(viii). , § 1(a)(6) [title V, § 531(a)], inserted before period at end “(or 100 percent of such median in the case of a clinical diagnostic laboratory test performed on or after January 1, 2001, that the Secretary determines is a new test for which no limitation amount has previously been established under this subparagraph)”.
Subsec. (t)(2)(G). , § 1(a)(6) [title IV, § 430(a)], added subpar. (G).
Subsec. (t)(3)(C)(iii). , § 1(a)(6) [title IV, § 401(b)(1)(B)], added cl. (iii). Former cl. (iii) redesignated (iv).
, § 1(a)(6) [title IV, § 401(a)], substituted “in each of 2000 and 2002” for “in each of 2000, 2001, and 2002”.
Subsec. (t)(3)(C)(iv). , § 1(a)(6) [title IV, § 401(b)(1)(A)], redesignated cl. (iii) as (iv).
Subsec. (t)(6)(A)(ii). , § 1(a)(6) [title IV, § 406(a)], inserted “or temperature monitored cryoablation” after “device of brachytherapy”.
Subsec. (t)(6)(A)(iv)(II). , § 1(a)(6) [title IV, § 402(b)(1)], substituted “the cost of the drug or biological or the average cost of the category of devices” for “the cost of the device, drug, or biological”.
Subsec. (t)(6)(B). , § 1(a)(6) [title IV, § 402(a)(2)], added subpar. (B) and struck out heading and text of former subpar. (B). Text read as follows: “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.”
Subsec. (t)(6)(C). , § 1(a)(6) [title IV, § 402(a)(2)], added subpar. (C). Former subpar. (C) redesignated (D).
Subsec. (t)(6)(D). , § 1(a)(6) [title IV, § 402(b)(2)], substituted “subparagraph (E)(iii)” for “subparagraph (D)(iii)” in introductory provisions.
, § 1(a)(6) [title IV, § 402(a)(1)], redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E).
Subsec. (t)(6)(E). , § 1(a)(6) [title IV, § 402(a)(1)], redesignated subpar. (D) as (E).
Subsec. (t)(7)(D)(ii). , § 1(a)(6) [title IV, § 405(a)], in heading, inserted “and children’s hospitals” after “cancer hospitals” and in text, substituted “clause (iii) or (v) of section
of this title” for “section
of this title”.
Subsec. (t)(7)(F)(ii)(I). , § 1(a)(6) [title IV, § 403(a)], inserted “(or in the case of a hospital that did not submit a cost report for such period, during the first subsequent cost reporting period ending before 2001 for which the hospital submitted a cost report)” after “1996”.
Subsec. (t)(8)(C). , § 1(a)(6) [title I, § 111(a)(1)], amended heading and text of subpar. (C) generally. Prior to amendment, text read as follows: “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
of this title for that year.”
Subsec. (t)(11). , § 1(a)(6) [title IV, § 405(a)(2)], substituted “clause (iii) or (v) of section
of this title” for “section
of this title” in introductory provisions.
Subsec. (t)(12)(E). , § 1(a)(6) [title IV, § 402(b)(3)], substituted “additional payments, the determination and deletion of initial and new categories (consistent with subparagraphs (B) and (C) of paragraph (6))” for “additional payments (consistent with paragraph (6)(B))”.
1999—Subsec. (a)(1)(D)(i). , § 1000(a)(6) [title IV, § 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). , § 1000(a)(6) [title III, § 321(k)(2)], substituted a comma for the semicolon at end.
Subsec. (a)(2)(D)(i). , § 1000(a)(6) [title IV, § 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). , § 1000(a)(6) [title II, § 221(a)(1)(A)], substituted “Subject to paragraph (4), in the case” for “In the case”.
Subsec. (g)(4). , § 1000(a)(6) [title II, § 221(a)(1)(B)], added par. (4).
Subsec. (h)(5)(A)(iii). , § 1000(a)(6) [title III, § 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). , § 1000(a)(6) [title II, § 224(a)], added par. (7).
Subsec. (l)(4)(A)(i)(VII). , § 1000(a)(6) [title II, § 211(a)(3)(B)], substituted “1395w–4(d) of this title” for “1395w–4(d)(3) of this title”.
Subsec. (t)(1)(B)(ii). , § 1000(a)(6) [title II, § 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). , § 1000(a)(6) [title II, § 201(e)(1)(B)], added cl. (iii) and redesignated former cl. (iii) as (iv).
Subsec. (t)(2). , § 1000(a)(6) [title II, § 201(g)], inserted concluding provisions.
Subsec. (t)(2)(B). , § 1000(a)(6) [title II, § 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). , § 1000(a)(6) [title II, § 201(f)], inserted “(or, at the election of the Secretary, mean)” after “median”.
Subsec. (t)(2)(E). , § 1000(a)(6) [title II, § 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). , § 1000(a)(6) [title II, § 202(a)(1)], inserted “, subject to paragraph (7),” after “is determined” in introductory provisions.
Subsec. (t)(4)(C). , § 1000(a)(6) [title II, § 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). , § 1000(a)(6) [title II, § 201(a)(2)], added par. (5). Former par. (5) redesignated (7).
Subsec. (t)(6). , § 1000(a)(6) [title II, § 201(b)], added par. (6). Former par. (6) redesignated (8).
Subsec. (t)(7). , § 1000(a)(6) [title II, § 202(a)(3)], added par. (7). Former par. (7) redesignated (8).
, § 1000(a)(6) [title II, § 201(a)(1)], redesignated par. (5) as (7). Former par. (7) redesignated (9).
Subsec. (t)(7)(D). , § 1000(a)(6) [title II, § 201(i)], added subpar. (D).
Subsec. (t)(8). , § 1000(a)(6) [title II, § 202(a)(2)], redesignated par. (7) as (8). Former par. (8) redesignated (9).
, § 1000(a)(6) [title II, § 201(a)(1)], redesignated par. (6) as (8). Former par. (8) redesignated (10).
Subsec. (t)(8)(A). , § 1000(a)(6) [title II, § 204(a)(1)], substituted “subparagraphs (B) and (C)” for “subparagraph (B)”.
, § 1000(a)(6) [title II, § 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.”
, § 1000(a)(6) [title II, § 201(h)(1)(A)], substituted “shall review not less often than annually” for “may periodically review”.
Subsec. (t)(8)(C) to (E). , § 1000(a)(6) [title II, § 204(a)(2), (3)], added subpar. (C) and redesignated former subpars. (C) and (D) as (D) and (E), respectively.
Subsec. (t)(9). , § 1000(a)(6) [title II, § 202(a)(2)], redesignated par. (8) as (9). Former par. (9) redesignated (10).
, § 1000(a)(6) [title II, § 201(j)], substituted “section
of this title” for “the matter in subsection (a)(1) of this section preceding subparagraph (A)”.
, § 1000(a)(6) [title II, § 201(a)(1)], redesignated par. (7) as (9). Former par. (9) redesignated (11).
Subsec. (t)(10). , § 1000(a)(6) [title II, § 202(a)(2)], redesignated par. (9) as (10). Former par. (10) redesignated (11).
, § 1000(a)(6) [title II, § 201(a)(1)], redesignated par. (8) as (10).
Subsec. (t)(11). , § 1000(a)(6) [title II, § 202(a)(2)], redesignated par. (10) as (11). Former par. (11) redesignated (12).
, § 1000(a)(6) [title II, § 201(a)(1)], redesignated par. (9) as (11).
Subsec. (t)(11)(E). , § 1000(a)(6) [title II, § 201(d)], added subpar. (E).
Subsec. (t)(12). , § 1000(a)(6) [title II, § 202(a)(2)], redesignated par. (11) as (12).
Subsec. (t)(13). , § 1000(a)(6) [title IV, § 401(b)(1)], added par. (13).
1997—Subsec. (a)(1)(A). , § 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). , § 4104(c), inserted “or section
of this title” after “subsection (h)(1) of this section”.
Subsec. (a)(1)(O). , § 4512(b)(1), substituted “section
of this title” for “section
of this title” and “services furnished by physician assistants, nurse practitioners, or clinic nurse specialists” for “nurse practitioner or clinical nurse specialist services”.
, § 4511(b)(1), amended cl. (O) generally. Prior to amendment, cl. (O) read as follows: “with respect to services described in section
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
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). , § 4315(b), added cl. (Q).
Subsec. (a)(1)(R). , § 4531(b)(1), added cl. (R).
Subsec. (a)(1)(S). , § 4556(b), added cl. (S).
Subsec. (a)(2). , § 4541(a)(1)(A), inserted “(C),” before “(D)” in introductory provisions.
Subsec. (a)(2)(A). , § 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
of this title)) and to items and services described in section
of this title, the lesser of—
“(i) the reasonable cost of such services, as determined under section
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
of this title;”.
Subsec. (a)(2)(B). , § 4432(b)(5)(C), inserted “or section
of this title” after “1395ww of this title” in introductory provisions.
, § 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). , § 4104(c)(1), inserted “or section
of this title” after “subsection (h)(1) of this section”.
Subsec. (a)(2)(E). , § 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). , § 4603(c)(2)(A)(ii)–(iv), added subpar. (G).
Subsec. (a)(3). , § 4541(a)(1)(B), substituted “section
of this title” for “subparagraphs (D) and (E) of section
of this title”.
Subsec. (a)(4). , § 4523(d)(1)(B), inserted “or subsection (t) of this section” before semicolon at end.
Subsec. (a)(6). , § 4201(c)(1), substituted “critical access” for “rural primary care”.
Subsec. (a)(8), (9). , § 4541(a)(1)(C)–(E), added pars. (8) and (9).
Subsec. (b)(5). , § 4101(b), added cl. (5) at end of first sentence.
Subsec. (b)(6). , § 4102(b), added cl. (6) at end of first sentence.
Subsec. (f). , § 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). , § 4205(a)(2), inserted “per visit” after “$46”.
Subsec. (g). , § 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).
, § 4541(c), (d)(1)(A), substituted, in first sentence, “physical therapy services of the type described in section
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
of this title”, and substituted, in last sentence, “occupational therapy services (of the type that are described in section
of this title (but not described in subsection (a)(8)(B) of this section) through the operation of section
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
of this title through the operation of section
of this title”.
Subsec. (h)(1)(A). , § 4104(c)(2), substituted “Subject to section
of this title, the Secretary” for “The Secretary”.
, § 4103(b), inserted “(including prostate cancer screening tests under section
of this title consisting of prostate-specific antigen blood tests)” after “laboratory tests”.
Subsec. (h)(2)(A)(ii)(IV). , § 4553(a), inserted “and 1998 through 2002” after “1995”.
Subsec. (h)(4)(B)(vii). , § 4553(b)(2)(A), inserted “and before January 1, 1998,” after “December 31, 1995,”.
Subsec. (h)(4)(B)(viii). , § 4553(b)(1), (2)(B), (3), added cl. (viii).
Subsec. (h)(5)(A)(iii). , § 4201(c)(1), substituted “critical access” for “rural primary care”.
Subsec. (i)(1)(A). , § 4201(c)(1), substituted “critical access” for “rural primary care”.
Subsec. (i)(2)(C). , § 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). , § 4523(d)(1)(A)(i), inserted “before January 1, 1999,” after “furnished” and struck out “in a cost reporting period” after “paragraph (1)(A)”.
, § 4201(c)(1), substituted “critical access” for “rural primary care”.
Subsec. (i)(3)(B)(i)(II). , § 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
of this title”.
Subsec. (l)(5). , § 4201(c)(1), substituted “critical access” for “rural primary care” wherever appearing.
Subsec. (n)(1)(A). , § 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). , § 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
of this title”.
Subsec. (r)(1). , § 4511(b)(2)(A), substituted “section
of this title (relating to nurse practitioner or clinical nurse specialist services)” for “section
of this title (relating to nurse practitioner or clinical nurse specialist services provided in a rural area)”.
, § 4201(c)(1), substituted “critical access” for “rural primary care”.
Subsec. (r)(2). , § 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
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
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). , § 4511(b)(2)(C), (D), redesignated par. (3) as (2) and substituted “section
of this title” for “section
of this title”.
, § 4201(c)(1), substituted “critical access” for “rural primary care”.
Subsec. (t). , § 4523(a), added subsec. (t).
1994—Subsec. (a)(1)(D)(i). , § 156(a)(2)(B)(i), struck out “, or for tests furnished in connection with obtaining a second opinion required under section
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). , § 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
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). , § 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
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.
, § 147(f)(6)(C)(i), substituted “health services (other than a covered osteoporosis drug (as defined in section
of this title))” for “health services” in introductory provisions.
Subsec. (a)(2)(D)(i). , § 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
of this title (or a third opinion, if the second opinion was in disagreement with the first opinion)” after “section
of this title”.
Subsec. (a)(2)(F). , § 147(f)(6)(C)(ii)–(iv), added subpar. (F).
Subsec. (a)(3). , § 156(a)(2)(B)(v), struck out “and for items and services furnished in connection with obtaining a second opinion required under section
of this title, or a third opinion, if the second opinion was in disagreement with the first opinion)” after “section
of this title”.
Subsec. (b)(2). , § 147(f)(6)(D), inserted “(other than a covered osteoporosis drug (as defined in section
of this title))” after “services”.
Subsec. (b)(4), (5). , § 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
of this title (or a third opinion, if the second opinion was in disagreement with the first opinion),”.
Subsec. (h)(5)(D). , § 123(e), substituted “paragraph (2) of section
” for “paragraphs (2) and (3) of section
” 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). , § 141(a)(3), inserted before period at end of last sentence “, in consultation with appropriate trade and professional organizations”.
Subsec. (i)(2)(A). , § 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). , § 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). , § 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). , § 141(a)(2)(B), added subpar. (C).
Subsec. (i)(3)(B)(ii). , § 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). , § 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
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
of this title.”
Subsec. (n)(1)(B)(i)(II). , § 147(d)(2), substituted “April 1, 1989” for “January 1, 1989”.
, § 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
of this title)” before period at end.
Subsec. (p). , § 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
of this title, in the case of qualified psychologists services for which payment may be made under this part only pursuant to section
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
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
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
of this title.”
Subsec. (q)(1). , § 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
of this title)” after “for the referring physician”.
Subsec. (r). , § 160(d)(1), redesignated subsec. (r), relating to other prepaid organizations, as (s).
Subsec. (r)(1). , § 147(e)(2), substituted “or ambulatory” for “ambulatory” in two places and “center” for “center,” before “with which the nurse”.
Subsec. (r)(2)(A). , § 147(e)(3), substituted “subsection (a)(1)(O) of this section” for “subsection (a)(1)(M) of this section”.
Subsec. (r)(3), (4). , § 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
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
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
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
of this title.”
Subsec. (s). , § 160(d)(1), redesignated subsec. (r), relating to other prepaid organizations, as (s).
1993—Subsec. (a)(1). , § 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). , § 13555(a), substituted “$900” for “$750” in two places.
Subsec. (h)(2)(A)(ii)(IV). , § 13551(a), added subcl. (IV).
Subsec. (h)(4)(B)(iv) to (vii). , § 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). , § 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). , § 13532(a)(2), added par. (4).
Subsec. (l)(4)(B)(i). , § 13516(b)(1), inserted “and before January 1, 1994,” after “1991,”.
Subsec. (l)(4)(B)(ii). , § 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
of this title for physician anesthesia services for that year.”
Subsec. (l)(4)(B)(iii). , § 13516(b)(3), added cl. (iii).
1990—Subsec. (a)(1)(H). , § 4118(f)(2)(D), struck out “, as the case may be” after “section
of this title”.
Subsec. (a)(1)(J). , § 4104(b)(1), struck out “or physician pathology services” after “1395m(b)(6) of this title)” and “or section
of this title, respectively” after “1395m(b) of this title”.
Subsec. (a)(1)(K). , § 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 , § 4153(a)(2)(B)(i), see below.
, § 4153(a)(2)(B)(i), struck out “and” after “by a physician),”.
Subsec. (a)(1)(L). , § 4153(a)(2)(B)(ii), substituted “subparagraph,” for “subparagraph and” at end.
Subsec. (a)(1)(M). , § 4155(b)(2)(B), added cl. (M) relating to nurse practitioner and clinical nurse specialist services.
, § 4153(a)(2)(B)(ii), added cl. (M) relating to prosthetic devices and orthotics.
Subsec. (a)(2). , § 4153(a)(2)(C)(i), substituted “(H), and (I)” for “and (H)” in introductory provisions.
Subsec. (a)(2)(E)(i). , § 4163(d)(1), inserted “, but excluding screening mammography” after “imaging services”.
Subsec. (a)(7). , § 4153(a)(2)(C)(ii)–(iv), added par. (7).
Subsec. (b). , § 4302, inserted “for calendar years before 1991 and $100 for 1991 and subsequent years” after “$75”.
Subsec. (b)(5). , § 4161(a)(3)(B), added cl. (5) at end of first sentence.
Subsec. (h)(2)(A)(ii). , § 4154(a)(1), substituted “clause (i)” for “any other provision of this subsection” in introductory provisions.
Subsec. (h)(2)(A)(ii)(III). , § 4154(a)(2)–(4), added subcl. (III).
Subsec. (h)(4)(B). , § 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). , § 4154(e)(1)(A), substituted “wholly owned by” for “a wholly-owned subsidiary of”.
Subsec. (h)(5)(A)(ii)(III). , § 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”.
, § 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). , § 4008(m)(2)(C), which directed technical correction to , § 6003(g)(3)(C)(vii)(I), was executed by making technical correction to , § 6003(g)(3)(D)(vii)(I), resulting in no change in text. See 1989 Amendment note below.
Subsec. (h)(5)(C). , § 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). , § 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). , § 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). , § 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). , § 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). , § 4160(1), designated existing provisions as subpar. (A) and added subpars. (B) and (C).
Subsec. (l)(2). , § 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
of this title) for that year.”
Subsec. (l)(4). , § 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). substituted “health professional shortage area” for “health manpower shortage area”.
Subsec. (n)(1)(B)(ii)(I). , § 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). , § 4206(b)(2), added subsec. (r) relating to other prepaid organizations.
, § 4155(b)(3), added subsec. (r) relating to cap on prevailing charge and billing on assignment-related basis.
1989—Subsec. (a). , § 202(a), repealed , § 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.
, § 201(a), repealed , § 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). , § 6113(b)(3)(A), added cl. (F).
Subsec. (a)(1)(H). , § 6102(e)(5), inserted “(or, for services furnished on or after January 1, 1992, the fee schedule amount provided under section
of this title, as the case may be)” after “prevailing charge that would be recognized”.
Subsec. (a)(1)(J). , § 6102(f)(2), inserted “or physician pathology services” after “1395m(b)(6) of this title)” and “or section
of this title, respectively” after “1395m(b) of this title”.
, § 6102(e)(6)(A), inserted “subject to section
of this title,” before “the amounts”.
Subsec. (a)(1)(K). , § 6102(e)(7), inserted “, or, for services furnished on or after January 1, 1992, 65 percent of the fee schedule amount provided under section
of this title for the same service performed by a physician” after “for the same service performed by a physician”.
Subsec. (a)(1)(M). , § 201(a), repealed , § 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). , § 6102(e)(1)(B), added cl. (N).
Subsec. (a)(2). , § 6116(b)(1)(A), substituted “(G), and (H)” for “and (G)” in introductory provisions.
, § 201(a), repealed , §§ 202(b)(2),
–(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). , § 201(a), repealed , § 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). , § 6116(b)(1)(B)–(D), added par. (6).
Subsec. (b). , § 201(a), repealed , §§ 202(b)(3),
, 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). , § 201(a), repealed , § 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). , § 201(a), repealed , § 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). , § 6113(d), substituted “621/2 percent of such expenses.” for “whichever of the following amounts is the smaller:
“(A) $1375.00, or
“(B) 621/2 percent of such expenses.”
Subsec. (g). , § 6133(a), substituted “$750” for “$500” in two places.
, § 201(a), repealed , § 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). , § 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). , § 6003(e)(2)(A), substituted “section
of this title” for “the last sentence of section
of this title”.
Subsec. (h)(4)(B)(ii). , § 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). , § 6111(a)(2), (3)(C), (4), added cl. (iii).
Subsec. (h)(5)(A)(ii). , § 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). , § 6003(g)(3)(D)(vii)(I), as amended by , § 4008(m)(2)(C), substituted “hospital or rural primary care hospital,” for “hospital,”.
Subsec. (i)(1)(A). , § 6003(g)(3)(D)(vii)(II), inserted “, rural primary care hospital,” after “section
of this title)”.
Subsec. (i)(3)(A). , § 6003(g)(3)(D)(vii)(III), inserted “or rural primary care hospital services” after “facility services” in introductory provisions.
Subsec. (l)(5)(A). , § 6003(g)(3)(D)(vii)(IV), inserted “rural primary care hospital,” after “hospital,” in two places.
Subsec. (l)(5)(C). , § 6003(g)(3)(D)(vii)(V), substituted “hospital or rural primary care hospital” for “hospital” in two places.
Subsec. (m). , § 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). , § 6131(a)(1)(C), inserted “(or inserts)” after “shoes” in two places in last sentence.
Subsec. (o)(1)(A). , § 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). , § 6131(a)(1)(B), substituted “limits” for “limit”.
Subsec. (o)(2)(A)(i). , § 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). , § 6131(a)(1)(E), inserted “any pairs of” after “$50 for”.
Subsec. (o)(2)(D). , § 6131(b), added subpar. (D).
Subsec. (p). , § 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
of this title,” after “section
of this title,”.
Subsec. (q). , § 6204(b), added subsec. (q).
1988—Subsec. (a). , § 212(c)(2), inserted “or, as provided in section
of this title, from the Federal Catastrophic Drug Insurance Trust Fund” after “Fund” in introductory provisions.
, § 205(c)(3), inserted provision at end relating to payment for in-home care for chronically dependent individuals.
Subsec. (a)(1)(D)(i). , § 411(i)(4)(C)(i), amended , § 4085(i)(1)(A), see 1987 Amendment note below.
Subsec. (a)(1)(F). , § 411(f)(12)(A), (14), added and renumbered , § 4055(a)(1), see 1987 Amendment note below.
, § 411(i)(4)(C)(iv), made technical amendment to directory language of , § 4085(i)(21)(D)(i), see 1987 Amendment note below.
, § 411(i)(4)(C)(ii), repealed , § 4085(i)(1)(B), see 1987 Amendment note below.
, § 411(h)(4)(B)(i), (ii), redesignated and amended directory language of , § 4073(b)(1)(A), see 1987 Amendment note below.
Subsec. (a)(1)(G). , § 411(h)(7)(C)(ii), repealed , § 4077(b)(3)(A), see 1987 Amendment note below.
, § 411(h)(4)(B)(iii), repealed , § 4073(b)(2)(B), see 1987 Amendment note below.
Subsec. (a)(1)(H). , § 411(h)(7)(C)(ii), repealed , § 4077(b)(3)(B), see 1987 Amendment note below.
, § 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 , see 1987 Amendment note below.
, § 411(i)(3), added , § 4084(c)(2), see 1987 Amendment note below.
Subsec. (a)(1)(J). , § 411(f)(8)(B)(i), made technical amendment to directory language of , § 4049(a)(1), see 1987 Amendment note below.
, § 411(f)(8)(C), substituted “section
of this title” for “section
of this title”.
Subsec. (a)(1)(K). , § 411(h)(7)(C)(iii), (F), redesignated and amended , § 4077(b)(2)(A), see 1987 Amendment note below.
, § 411(h)(4)(B)(i), (iv), (v), redesignated and amended , § 4073(b)(1)(B), see 1987 Amendment note below.
Subsec. (a)(1)(L). , § 411(h)(7)(C)(i), (iv), (v), (F), redesignated and amended , § 4077(b)(2)(B), see 1987 Amendment note below.
Subsec. (a)(1)(M). , § 202(b)(1), added cl. (M) relating to expenses incurred for covered outpatient drugs.
Subsec. (a)(2). , § 205(c)(1), inserted “(A)(ii),” after “subparagraphs” in introductory provisions.
, § 202(b)(2), inserted “(other than covered outpatient drugs)” after “in the case of services” in introductory provisions.
Subsec. (a)(2)(B). , § 203(c)(1)(A), substituted “(E), or (F)” for “or (E)” in introductory provisions.
Subsec. (a)(2)(D)(i). , § 411(i)(4)(C)(i), amended , § 4085(i)(1)(A), see 1987 Amendment note below.
Subsec. (a)(2)(E)(i). , § 204(d)(1), inserted “, but excluding screening mammography” after “imaging services”.
Subsec. (a)(2)(F). , § 203(c)(1)(B)–(D), added cl. (F) relating to home intravenous drug therapy services.
Subsec. (a)(3). , § 205(c)(2), substituted “subparagraphs (A)(ii), (D),” for “subparagraphs (D)”.
Subsec. (b). , § 104(d)(7), as added by , § 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
of this title to blood or blood cells furnished the individual in the year.”
Subsec. (b)(1). , § 202(b)(3)(A), inserted “or for covered outpatient drugs” after “section
of this title”.
Subsec. (b)(2). , § 203(c)(1)(E), substituted “services and home intravenous drug therapy services” for “services”.
, § 202(b)(3)(B), inserted “or with respect to covered outpatient drugs” after “home health services”.
Subsec. (b)(3) to (5). , § 411(f)(12)(A), (14), added and renumbered , § 4055(a)(2), see 1987 Amendment note below.
Subsec. (c). , § 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).
, § 411(h)(1)(A), substituted “monitoring or changing drug prescriptions” for “prescribing or monitoring prescription drugs” in last sentence.
, § 201(a)(1)(A), as amended by , § 608(d)(4), substituted “subsections (a) through (c)” for “subsections (a) and (b)” in introductory provisions.
, § 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). , § 201(a)(1)(D), redesignated former subsec. (c) as subsec. (d)(1). Former subsec. (d) redesignated subsec. (d)(2).
Subsec. (d)(2). , § 201(a)(2), redesignated former subsec. (d) as subsec. (d)(2).
Subsec. (f). , § 411(g)(5), substituted “MEI (as defined in section
of this title) applicable to primary care services (as defined in section
of this title)” for “medicare economic index (referred to in the fourth sentence of section
of this title) applicable to physicians’ services”.
Subsec. (g). , § 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). , § 411(g)(3)(E), (F), amended and redesignated , § 4064(c)(1), see 1987 Amendment note below.
Subsec. (h)(2)(A)(i). , § 411(g)(3)(A), added , § 4064(a)(1), see 1987 Amendment note below.
Subsec. (h)(2)(A)(ii). , § 411(g)(3)(A), added , § 4064(a)(3), see 1987 Amendment note below.
Subsec. (h)(2)(A)(iii). , § 411(g)(3)(B), (C), amended , § 4064(b)(1), see 1987 Amendment note below.
Subsec. (h)(2)(B). , § 411(g)(3)(A), added , § 4064(a)(2), see 1987 Amendment note below.
Subsec. (h)(3). , § 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). , § 411(g)(3)(D), inserted “after” before “March 31, 1988”.
Subsec. (h)(5)(A). , § 411(i)(4)(C)(vi), added , § 4085(i)(22)(B), see 1987 Amendment note below.
Subsec. (h)(5)(C). , § 411(i)(4)(C)(vi), added , § 4085(i)(22)(B), see 1987 Amendment note below.
Subsec. (h)(5)(D). , § 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
of this title in the same manner such paragraphs apply with respect to a physician” for “section
of this title”.
Subsec. (i)(2)(A)(iii). , § 411(g)(2)(D), substituted “insertion” for “implantation” and inserted “or subsequent to” after “during”.
Subsec. (i)(4). , § 411(f)(12)(A), (14), added and renumbered , § 4055(a)(3), see 1987 Amendment note below.
Subsec. (i)(6). , § 608(d)(22)(B), substituted “Any person, including” for “Any person, other than”.
, § 411(g)(2)(E), added , § 4063(e)(1), see 1987 Amendment note below.
Subsec. (l)(2). , § 411(f)(2)(D), added , § 4042(b)(2)(B), see 1987 Amendment note below.
Subsec. (l)(3)(B). , § 8422(a), inserted “plus applicable coinsurance” after “would have been paid”.
Subsec. (l)(5)(B)(ii). , § 411(i)(4)(C)(vi), added , § 4085(i)(23), see 1987 Amendment note below.
Subsec. (n)(1)(A). , § 411(g)(4)(C)(i), as amended by , § 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). , § 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). , § 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). , § 411(h)(3)(B), as amended by , § 608(d)(23)(A), amended , § 4072(b), see 1987 Amendment note below.
Subsec. (p). , § 411(h)(7)(D), (F), redesignated and amended , § 4077(b)(3), see 1987 Amendment note below.
, § 411(h)(4)(C), redesignated and amended , § 4073(b)(2), see 1987 Amendment note below.
1987—Subsec. (a)(1)(D)(i). , § 4085(i)(1)(A), as amended by , § 411(i)(4)(C)(i), substituted “on an assignment-related basis,” for “on the basis of an assignment described in section
of this title, under the procedure described in section
of this title,”.
Subsec. (a)(1)(F). , § 4055(a)(1), formerly § 4054(a)(1), as added and renumbered by , § 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,”.
, § 4085(i)(21)(D)(i), as amended by , § 411(i)(4)(C)(iv), amended , § 9343(e)(2)(A), see 1986 Amendment note below.
, § 4085(i)(1)(B), which directed striking out “and” at end, was repealed by , § 411(i)(4)(C)(ii).
, § 4073(b)(1)(A), formerly § 4073(b)(2)(A), as redesignated and amended by , § 411(h)(4)(B)(i), (ii), struck out “and” at end.
Subsec. (a)(1)(G). , § 4077(b)(3)(A), which directed striking out “and” at end, was repealed by , § 411(h)(7)(C)(ii).
, § 4073(b)(2)(B), which directed substituting “services,” for “services; and”, was repealed by , § 411(h)(4)(B)(iii).
, § 4062(d)(3)(A)(i), substituted “services,” for “services; and”.
Subsec. (a)(1)(H). , § 4077(b)(3)(B), which directed substituting “services,” for “services; and”, was repealed by , § 411(h)(7)(C)(ii).
, § 4084(c)(2), as added by , § 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”.
, § 4062(d)(3)(A)(ii), inserted “and” before the cl. (I) added by section 4062(d)(3)(A)(ii) of , see below.
, § 4049(a)(1), struck out “and” before the cl. (I) added by section 4062(d)(3)(A)(ii) of , see below.
Subsec. (a)(1)(I). , § 4062(d)(3)(A)(ii), added cl. (I).
Subsec. (a)(1)(J). , § 4049(a)(1), as amended by , § 411(f)(8)(B)(i), added cl. (J).
Subsec. (a)(1)(K). , § 4077(b)(2)(A), formerly § 4077(b)(3)(C), as redesignated and amended by , § 411(h)(7)(C)(iii), (F), inserted “and” after “performed by a physician),”.
, § 4073(b)(1)(B), formerly § 4073(b)(2)(C), as redesignated and amended by , § 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
of this title.
Subsec. (a)(1)(L). , § 4077(b)(2)(B), formerly § 4077(b)(3)(D), as redesignated and amended by , § 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
of this title.
Subsec. (a)(2). , § 4062(d)(3)(B)(i), inserted reference to subpar. (G).
Subsec. (a)(2)(A). , § 4062(d)(3)(B)(ii), struck out “(other than durable medical equipment)” after “home health services”.
Subsec. (a)(2)(B). , § 4066(b), inserted reference to subpar. (E).
Subsec. (a)(2)(D)(i). , § 4085(i)(1)(A), as amended by , § 411(i)(4)(C)(i), substituted “on an assignment-related basis,” for “on the basis of an assignment described in section
of this title, under the procedure described in section
of this title,”.
Subsec. (a)(2)(E). , § 4066(a)(1), added subpar. (E).
Subsec. (a)(5). , § 4062(d)(3)(C)–(E), added par. (5).
Subsec. (b)(3). , § 4055(a)(2), formerly § 4054(a)(2), as added and renumbered by , § 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,”.
, § 4085(i)(21)(D)(i), amended , § 9343(e)(2)(A), see 1986 Amendment note below.
Subsec. (b)(4). , § 4055(a)(2), formerly § 4054(a)(2), as added and renumbered by , § 411(f)(12)(A), (14), redesignated cl. (5) as (4). Former cl. (4) redesignated (3).
Subsec. (b)(4)(A). , § 4085(i)(1)(C), substituted “on an assignment-related basis” for “on the basis of an assignment described in section
of this title, under the procedure described in section
of this title”.
Subsec. (b)(5). , § 4055(a)(2), formerly § 4054(a)(2), as added and renumbered by , § 411(f)(12)(A), (14), redesignated cl. (5) as (4).
Subsec. (c). , § 4070(b)(4), inserted “or partial hospitalization services that are not directly provided by a physician” before period at end of last sentence.
, § 4070(a)(2), inserted sentence at end defining “treatment”.
Subsec. (c)(1). , § 4070(a)(1), substituted “$1375.00” for “$312.50”.
Subsec. (f). , § 4067(a), added subsec. (f).
Subsec. (h)(1)(C). , § 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). , § 4064(c)(1), formerly § 4064(c), as amended and redesignated by , § 411(g)(3)(E), (F), inserted “, in a sole community hospital (as defined in the last sentence of section
of this title),”.
Subsec. (h)(2). , § 4064(c), which had directed that “laboratory in a sole community hospital” be substituted for “hospital laboratory” in subsec. (h)(2), was redesignated § 4064(c)(1) by section 411(g)(3)(F) of and amended by section 411(g)(3)(E) of to provide for amendment of subsec. (h)(1)(D) instead of subsec. (h)(2).
Subsec. (h)(2)(A)(i). , § 4064(a)(1), as added by , § 411(g)(3)(A), inserted “(A)(i)” after “(2)”.
Subsec. (h)(2)(A)(ii). , § 4064(a)(3), as added by , § 411(g)(3)(A), added cl. (ii).
Subsec. (h)(2)(A)(iii). , § 4064(b)(1), as amended by , § 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). , § 4064(a)(2), as added by , § 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). , § 4064(b)(2)(A), substituted “April” for “January”.
Subsec. (h)(4)(B)(ii). , § 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). , § 4085(i)(22)(B), as added by , § 411(i)(4)(C)(vi), substituted “on an assignment-related basis” for “on the basis of an assignment described in section
of this title, under the procedure described in section
of this title,” in introductory provisions.
Subsec. (h)(5)(A)(iii). , § 4085(i)(3), added cl. (iii).
Subsec. (h)(5)(C). , § 4085(i)(22)(B), as added by , § 411(i)(4)(C)(vi), substituted “on an assignment-related basis” for “on the basis of an assignment described in section
of this title, in accordance with section
of this title, under the procedure described in section
of this title,”.
Subsec. (h)(5)(D). , § 4085(b)(1), added subpar. (D).
Subsec. (i)(2)(A)(iii). , § 4063(b), added cl. (iii).
Subsec. (i)(3)(B)(ii). , § 4068(a)(1), substituted “Subject to the last sentence of this clause, in” for “In”.
, § 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). , § 4055(a)(3), formerly § 4054(a)(3), as added and renumbered by , § 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
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
of this title with respect to payment for such services.”
Subsec. (i)(6). , § 4063(e)(1), as added by , § 411(g)(2)(E), added par. (6).
Subsec. (l)(2). , § 4084(a)(1), substituted “1985 and such other data as the Secretary determines necessary” for “1985”.
, § 4042(b)(2)(B), as added by , § 411(f)(2)(D), substituted “1395u(i)(3)” for “1395u(b)(4)(E)(ii)”.
Subsec. (l)(5)(A). , § 4084(a)(2), substituted “group practice, or ambulatory surgical center” for “or group practice” in two places.
Subsec. (l)(5)(B)(ii). , § 4085(i)(23), as added by , § 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
of this title with respect to actions described in subsection (a) of that section.”
Subsec. (l)(6). , § 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
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.”
, § 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
of this title, on the development of the relative value scale under section
of this title.”
Subsec. (m). , § 4043(a), added subsec. (m).
Subsec. (n). , § 4066(a)(2), added subsec. (n).
Subsec. (o). , § 4072(b), as amended by , § 411(h)(3)(B), as amended by , § 608(d)(23)(A), added subsec. (o) [originally added as subsec. (f)].
Subsec. (p). , § 4077(b)(3), formerly § 4077(b)(4), as redesignated and amended by , § 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
of this title”.
, § 4073(b)(2), formerly § 4073(b)(3), as redesignated and amended by , § 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). , § 9401(b)(2)(B), substituted “, under the procedure described in section
of this title, or for tests furnished in connection with obtaining a second opinion required under section
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
of this title”.
Subsec. (a)(1)(D)(i). , § 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). , § 9343(e)(2)(A), as amended by , § 4085(i)(21)(D)(i), substituted “(i)(4)” for “(i)(3)”.
Subsec. (a)(1)(G). , § 9401(b)(2)(A), added cl. (G).
Subsec. (a)(1)(H). , § 9320(e)(1), added cl. (H).
Subsec. (a)(2)(A). , § 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
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). , § 9401(b)(2)(D), substituted “to a provider having an agreement under section
of this title, or for tests furnished in connection with obtaining a second opinion required under section
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
of this title”.
Subsec. (a)(2)(D)(i). , § 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). , § 9401(b)(2)(E), inserted “and for items and services furnished in connection with obtaining a second opinion required under section
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). , § 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
of this title, the applicable amount described in paragraph (2) of subsection (i) of this section.”
Subsec. (b)(3). , § 9343(e)(2)(A), as amended by , § 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 , § 9343(a)(2), see below.
, § 9343(a)(2), substituted “(i)(5)” for “(i)(4)”.
Subsec. (b)(5). , § 9401(b)(1), added cl. (5).
Subsec. (g). , § 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
of this title through the operation of section
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). , § 9339(b)(1), substituted “December 31, 1989” and “January 1, 1990” for “December 31, 1987” and “January 1, 1988”, respectively.
, § 9339(a)(1)(A), substituted “qualified hospital laboratory (as defined in subparagraph (D))” for “hospital laboratory”.
, § 9303(a)(1)(A), substituted “December 31, 1987” for “June 30, 1987” and “January 1, 1988” for “July 1, 1987”.
Subsec. (h)(1)(C). , § 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.
, § 9303(a)(1)(A), substituted “December 31, 1987” for “June 30, 1987” and “January 1, 1988” for “July 1, 1987”.
Subsec. (h)(1)(D). , § 9339(a)(1)(C), added subpar. (D).
Subsec. (h)(2). , § 9339(b)(2), struck out “(or, effective January 1, 1988, for the United States)” after “applicable region, State, or area”.
, § 9339(a)(1)(D), substituted “qualified hospital laboratory (as defined in paragraph (1)(D))” for “hospital laboratory”.
, § 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). , § 9339(c)(1), inserted cl. (A) designation after “provide for and establish”, and added cl. (B).
Subsec. (h)(4). , § 9303(b)(2), designated existing provisions as subpar. (A) and added subpar. (B).
Subsec. (h)(5)(C). , § 9303(b)(3), substituted “laboratory other than” for “laboratory which is independent of a physician’s office or”.
Subsec. (i)(1). , § 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). , § 9343(e)(2)(B), inserted “80 percent of” before “a standard overhead amount” in introductory provisions of subpars. (A) and (B).
, § 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). , § 9343(a)(1)(B), added par. (3) and redesignated former pars. (3) and (4) as (4) and (5), respectively.
Subsec. (l). , § 9320(e)(2), added subsec. (l).
1984—Subsec. (a)(1). , § 2354(b)(7), struck out “and” at the end.
Subsec. (a)(1)(B). , § 2323(b)(1), substituted “section
of this title” for “section
of this title”.
Subsec. (a)(1)(D). , § 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). , § 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). , § 2305(c), struck out “and in paragraph (5) of this subsection” after “of such section”.
Subsec. (a)(2)(A). , § 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),”.
, § 2354(b)(5), realigned margin of subpar. (A).
, § 2321(b)(1), inserted in provision preceding cl. (i) “(other than durable medical equipment)”.
, § 2323(b)(1), substituted “section
of this title” for “section
of this title”.
Subsec. (a)(2)(B). , § 2354(b)(5), realigned margin of subpar. (B).
, § 2321(b)(2), inserted in provision preceding cl. (i) “items and” after “to other”.
, § 2303(b)(1), inserted “or (D)” after “subparagraph (C)”.
Subsec. (a)(2)(B)(ii). , § 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). , § 2303(b)(2)–(4), added subpar. (D).
Subsec. (a)(3). , § 2323(b)(1), substituted “section
of this title” for “section
of this title”.
Subsec. (a)(5). , § 2305(b), struck out par. (5) which related to payment of reasonable costs for preadmission diagnostic services described in section
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). , § 2323(b)(2), substituted “section
of this title” for “section
of this title”.
Subsec. (b)(3). , § 2305(d), substituted “subsection (a)(1)(F)” for “subsection (a)(1)(G)”.
Subsec. (b)(4). , § 2303(c), added cl. (4).
Subsec. (f). , § 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
of this title.
Subsec. (h). , § 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). , § 3(b)(3), inserted a comma before “under the procedure described in section”.
Subsec. (i)(3). , § 2305(d), substituted “subsection (a)(1)(F)” for “subsection (a)(1)(G)”.
Subsec. (k). , § 2323(b)(4), added subsec. (k).
1982—Subsec. (a)(1)(B). , § 112(a)(1), substituted provisions that with respect to items and services described in section
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
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). , § 112(a)(2), (3), struck out cl. (H) which provided that, with respect to items and services described in section
of this title, the amount of benefits paid would be 100 percent of reasonable charges for such items and services.
Subsec. (a)(2)(B). , § 101(c)(2), inserted “and except as may be provided in section
of this title”.
Subsec. (b)(1). , § 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
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). , § 148(d), struck out requirement of consultation with National Professional Standards Review Council.
Subsec. (j). , § 117(a)(2), added subsec. (j).
1981—Subsec. (a)(2)(A). , § 2106(a), substituted provisions that with respect to home health services and to items and services described in section
of this title, the lesser of reasonable cost of such services as determined under section
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
of this title for provisions that with respect to home health services and to items and services described in section
of this title, the reasonable cost of such services, as determined under section
of this title.
Subsec. (a)(2)(B). , § 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
of this title and that in no case may payment for such other services exceed 80 percent of such costs.
Subsec. (b). , §§ 2133(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.
, § 2134(a), substituted “by a deductible of $75” for “by a deductible of $60”.
1980—Subsec. (a)(1)(B). , § 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
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). , § 918(a)(4), substituted “subsection (h)” for “subsection (g)”.
Subsec. (a)(1)(F). , § 932(a)(1)(B), added cl. (F).
Subsec. (a)(1)(G). , § 934(d)(1), added cl. (G).
Subsec. (a)(1)(H). , § 1(b)(1)(A), (B), added cl. (H).
Subsec. (a)(2). , § 1(b)(1)(C), inserted in subpar. (A) “and to items and services described in section
of this title”.
, § 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). , § 1(b)(1)(D), inserted “(other than for items and services described in section
of this title)”.
, § 942, prescribed a formula for determining payment amounts for services described in subpars. (D) and (E) of section
of this title.
Subsec. (a)(4), (5). , § 942, added pars. (4) and (5).
Subsec. (b)(2). , § 1(b)(2), inserted “(A)” after “expenses incurred” and added cl. (B).
, § 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
of this title) for all physicians’ services furnished by him to hospital inpatients enrolled under this part”.
Subsec. (b)(3). , § 930(h)(2), added cl. (3).
Subsec. (b)(4). , § 934(d)(3), added cl. (4).
Subsec. (g). , § 935(a), substituted “$500” for “$100”.
Subsec. (h). redesignated subsec. (g) as added by section 279(b) of 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). , § 934(b), added subsec. (i).
1978—Subsec. (a)(1)(E). , § 4(b)(2), added cl. (E).
Subsec. (a)(2). , § 4(c), inserted “(unless otherwise specified in section
of this title)” after “and with respect to other services” in provisions preceding subpar. (A).
1977—Subsec. (a)(2). , § 1(b)(2), inserted parenthetical provisions preceding subpar. (A) excepting those services described in subparagraph (D) of section
of this title.
Subsec. (a)(3). , § 1(b)(1), (3), (4), added par. (3).
Subsec. (f)(1). 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). 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). added pars. (3) and (4).
1972—Subsec. (a). , § 226(c)(2), inserted reference to section
of this title in provisions preceding par. (1).
Subsec. (a)(1). , §§ 211(c)(4),
, added cls. (C) and (D).
Subsec. (a)(2). , §§ 233(b),
,
299K
(a), substituted subpars. (A) and (B) for provisions relating to the amount payable by reference to section
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). , § 204(a), substituted “$60” for “$50”.
Subsec. (f). , § 245(d), designated existing provisions as par. (1)(A) and added par. (1)(B) and (2).
Subsec. (g). , § 251(a)(2), added subsec. (g).
Subsec. (h). , § 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 .
1968—Subsec. (a)(1). , § 131(a)(1), (2), designated existing provisions as subpar. (A) and added subpar. (B).
Subsec. (b). , §§ 129(c)(7),
, 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
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).
, § 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). , § 129(c)(8), struck out reference to subsection (a)(2)(A) of section
of this title.
Subsec. (f). , § 132(b), added subsec. (f).
Effective Date of 2000 Amendment
, § 1(a)(6) [title I, § 105(e)], Dec. 21, 2000, , 2763A–472, provided that: “The amendments made by this section [amending this section and sections
and
of this title] shall apply to services furnished on or after January 1, 2002.”
, § 1(a)(6) [title I, § 111(a)(2)], Dec. 21, 2000, , 2763A–473, provided that: “The amendment made by paragraph (1) [amending this section] shall apply with respect to services furnished on or after April 1, 2001.”
, § 1(a)(6) [title II, § 201(c)], Dec. 21, 2000, , 2763A–481, provided that: “The amendment made—
“(1) by subsection (a) [amending section
of this title] shall apply to services furnished on or after the date of the enactment of BBRA [, § 1000(a)(6), approved Nov. 29, 1999];
“(2) by subsection (b)(1) [amending this section] shall apply as if included in the enactment of section 403(e)(1) of BBRA (A–371) [, § 1000(a)(6) [title IV, § 403(e)(1)]]; and
“(3) by subsection (b)(2) [amending provisions set out as a note under section
of this title] shall apply as if included in the enactment of section 403(d)(2) of BBRA (A–371) [, § 1000(a)(6) [title IV, § 403(d)(2)], set out as a note under section
of this title].”
, § 1(a)(6) [title II, § 205(c)], Dec. 21, 2000, , 2763A–483, provided that: “The amendments made by this section [amending this section and section
of this title] shall apply to services furnished on or after the date of the enactment of this Act [Dec. 21, 2000].”
, § 1(a)(6) [title II, § 223(e)], Dec. 21, 2000, , 2763A–490, provided that: “The amendments made by subsections (b) and (c) [amending this section and section
of this title] shall be effective for services furnished on or after October 1, 2001.”
, § 1(a)(6) [title II, § 224(b)], Dec. 21, 2000, , 2763A–490, provided that: “The amendment made by subsection (a) [amending this section] shall apply to services furnished on or after July 1, 2001.”
, § 1(a)(6) [title IV, § 401(b)(2)], Dec. 21, 2000, , 2763A–503, provided that: “The amendments made by paragraph (1) [amending this section] shall take effect as if included in the enactment of BBA [].”
, § 1(a)(6) [title IV, § 402(c)], Dec. 21, 2000, , 2763A–505, provided that: “The amendments made by this section [amending this section] take effect on the date of the enactment of this Act [Dec. 21, 2000].”
, § 1(a)(6) [title IV, § 403(b)], Dec. 21, 2000, , 2763A–506, provided that: “The amendment made by subsection (a) [amending this section] shall take effect as if included in the enactment of BBRA [, § 1000(a)(6)].”
, § 1(a)(6) [title IV, § 405(b)], Dec. 21, 2000, , 2763A–507, provided that: “The amendments made by subsection (a) [amending this section] shall apply as if included in the enactment of section 202 of BBRA [, § 1000(a)(6) [title II, § 202]] (A–342).”
, § 1(a)(6) [title IV, § 406(b)], Dec. 21, 2000, , 2763A–508, provided that: “The amendment made by subsection (a) [amending this section] shall apply to devices furnished on or after April 1, 2001.”
, § 1(a)(6) [title IV, § 430(c)], Dec. 21, 2000, , 2763A–525, provided that: “The amendments made by this section [amending this section and section
of this title] apply to items and services furnished on or after July 1, 2001.”
Effective Date of 1999 Amendment
, div. B, § 1000(a)(6) [title II, § 201(h)(2)], Nov. 29, 1999, , 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].”
, div. B, § 1000(a)(6) [title II, § 201(m)], Nov. 29, 1999, , 1501A–341, provided that: “Except as provided in this section, the amendments made by this section [amending this section and sections
and
of this title] shall be effective as if included in the enactment of BBA [the Balanced Budget Act of 1997, ].”
, div. B, § 1000(a)(6) [title II, § 202(b)], Nov. 29, 1999, , 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, ].”
, div. B, § 1000(a)(6) [title II, § 204(c)], Nov. 29, 1999, , 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, ] 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, § 321(g)(2), (k)(2)] of effective as if included in the enactment of the Balanced Budget Act of 1997, , except as otherwise provided, see section
1000
(a)(6) [title III, § 321(m)] of , set out as a note under section
of this title.
Amendment by section
1000
(a)(6) [title IV, § 401(b)(1)] of effective Jan. 1, 2000, see section
1000
(a)(6) [title IV, § 401(c)] of , set out as a note under section
of this title.
, div. B, § 1000(a)(6) [title IV, § 403(e)(2)], Nov. 29, 1999, , 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 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 provided that: “The amendments made by this section [amending this section and section
of this title] shall apply to items and services furnished on or after January 1, 1998.”
Section 4102(e) of provided that: “The amendments made by this section [amending this section and sections
,
, and
of this title] shall apply to items and services furnished on or after January 1, 1998.”
Section 4103(e) of provided that: “The amendments made by this section [amending this section and sections
,
, and
of this title] shall apply to items and services furnished on or after January 1, 2000.”
Section 4104(e) of provided that: “The amendments made by this section [amending this section and sections
,
,
, and
of this title] shall apply to items and services furnished on or after January 1, 1998.”
Amendment by section 4201(c)(1) of applicable to services furnished on or after Oct. 1, 1997, see section 4201(d) of , set out as a note under section
of this title.
Section 4205(a)(1)(B) of 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 provided that: “The amendments made by this section [amending this section and section
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 applicable to items and services furnished on or after July 1, 1998, see section 4432(d) of , set out as a note under section
of this title.
Amendment by section 4511(b) of applicable with respect to services furnished and supplies provided on and after Jan. 1, 1998, see section 4511(e) of , set out as a note under section
of this title.
Section 4512(d) of provided that: “The amendments made by this section [amending this section and sections
and
of this title] shall apply with respect to services furnished and supplies provided on and after January 1, 1998.”
Section 4521(c) of 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 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 provided that: “The amendments made by this subsection [amending this section and section
of this title] shall apply to services furnished on or after January 1, 2000.”
Section 4541(e) of provided that:
“(1) The amendments made by subsections (a)(1), (a)(2), and (b) [amending this section and sections
and
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
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
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 provided that: “The amendments made by subsections (a) and (b) [amending this section and section
of this title] shall apply to drugs and biologicals furnished on or after January 1, 1998.”
Amendment by section 4603(c)(2)(A) of applicable to cost reporting periods beginning on or after Oct. 1, 1999, except as otherwise provided, see section 4603(d) of , set out as an Effective Date note under section
of this title.
Effective Date of 1994 Amendment
Section 123(f)(1), (2) of provided that:
“(1) Enforcement; miscellaneous and technical amendments.—The amendments made by subsections (a) and (e) [amending this section and section
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
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
of this title] shall apply to services furnished on or after January 1, 1995.”
Section 141(c)(2) of provided that: “The amendments made by paragraph (1) [amending this section] shall take effect as if included in the enactment of OBRA–1990 [].”
Amendment by section 147(a), (e)(2), (3), (f)(6)(C), (D) of effective as if included in the enactment of , see section 147(g) of , set out as a note under section
of this title.
Section 147(d)(1), (2) of provided that the amendment made by that section is effective as if included in the enactment of .
Amendment by section 156(a)(2)(B) of applicable to services provided on or after Oct. 31, 1994, see section 156(a)(3) of , set out as a note under section
of this title.
Effective Date of 1993 Amendment
Section 13532(b) of 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 provided that: “The amendments made by this subsection [amending this section and section
of this title] shall apply to items furnished on or after January 1, 1994.”
Section 13555(b) of 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 provided that: “The amendments made by this section [amending this section and sections
and
of this title] shall apply to services furnished on or after January 1, 1991.”
Amendment by section 4153(a)(2)(B), (C) of applicable to items furnished on or after Jan. 1, 1991, see section 4153(a)(3) of , set out as a note under section
of this title.
Section 4154(b)(2) of 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 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 [], 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 [].”
Section 4154(e)(5) of , as amended by , title I, § 147(f)(2), Oct. 31, 1994, , provided that: “The amendments made by paragraphs (1)(A), (1)(B), (2), and (4) [amending this section, section
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 [], 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 applicable to services furnished on or after Jan. 1, 1991, see section 4155(e) of , set out as a note under section
of this title.
Amendment by section 4161(a)(3)(B) of applicable to services furnished on or after Oct. 1, 1991, see section 4161(a)(8) of , set out as a note under section
of this title.
Section 4163(e) of , as amended by , title I, § 147(f)(5)(B), Oct. 31, 1994, , provided that: “Except as provided in subsection (d)(3) [enacting provisions set out as a note under section
of this title], the amendments made by this section [amending this section and sections
,
,
,
,
, and
of this title] shall apply to screening mammography performed on or after January 1, 1991.”
Section 4206(e)(2) of provided that: “The amendments made by subsection (b) [amending this section and section
of this title] shall apply to contracts under section 1876 of the Social Security Act [section
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 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 provided that: “The amendments made by this subsection [amending this section and section
of this title] shall apply to services furnished on or after January 1, 1991.”
Section 6102(g) of provided that: “Except as otherwise provided in this section, this section, and the amendments made by this section [enacting section
of this title, amending this section and sections
,
, and
of this title, and enacting provisions set out as notes under this section and sections
,
, and
of this title], shall take effect on the date of the enactment of this Act [Dec. 19, 1989].”
Section 6111(b)(2) of , as amended by , title IV, § 4154(e)(4), Nov. 5, 1990, , 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 provided that: “The amendments made by this section [amending this section and section
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 provided that:
“(1) The amendments made by this section [amending this section and section
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 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 effective with respect to referrals made on or after Jan. 1, 1992, see section 6204(c) of , set out as a note under section
of this title.
Amendment by section 201(a) of effective Jan. 1, 1990, see section 201(c) of , set out as a note under section
of this title.
Amendment by section 202(a) of effective Jan. 1, 1990, see section 202(b) of , set out as a note under section
of this title.
Effective Date of 1988 Amendments
Section 8422(b) of 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 [].”
Amendment by effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, , see section 608(g) of , set out as a note under section
of this title.
Amendment by section
–(3) of applicable to items dispensed on or after Jan. 1, 1990, see section 202(m)(1) of , set out as a note under section
of this title.
Amendment by section
–(E) of applicable to items and services furnished on or after Jan. 1, 1990, see section 203(g) of , set out as a note under section
of this title.
Amendment by section 204(d)(1) of applicable to screening mammography performed on or after Jan. 1, 1990, see section 204(e) of , set out as a note under section
of this title.
Amendment by section 205(c) of applicable to items and services furnished on or after Jan. 1, 1990, see section 205(f) of , set out as a note under section
of this title.
Except as specifically provided in section 411 of , amendment by section
, (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 , as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, , effective as if included in the enactment of that provision in , see section 411(a) of , set out as a Reference to OBRA; Effective Date note under section
of Title
, General Provisions.
Effective Date of 1987 Amendment
Section 4043(c) of 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
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 applicable to items and services furnished on or after Apr. 1, 1988, see section 4045(d) of , set out as a note under section
of this title.
Amendment by section 4049(a)(1) of applicable to services performed on or after Apr. 1, 1989, see section 4049(b)(2) of , as amended, set out as a note under section
of this title.
Section
, formerly § 4054(b), of , as added and renumbered by , title IV, § 411(f)(12)(A), (14), July 1, 1988, , 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 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 , as amended, set out as a note under section
of this title.
Section 4063(c) of provided that: “The amendments made by this section [amending this section and section
of this title] shall apply to items furnished on or after July 1, 1988.”
Section 4064(b)(3) of 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 , as added by , title IV, § 411(g)(3)(F), July 1, 1988, , 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 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 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 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 [].”
Section 4070(c)(1) of 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 , see section 4072(e) of , set out as a note under section
of this title.
Amendment by section 4073(b) of effective with respect to services performed on or after July 1, 1988, see section 4073(e) of , set out as a note under section
of this title.
Amendment by section 4077(b)(2), (3) of effective with respect to services performed on or after July 1, 1988, see section 4077(b)(5) of , set out as a note under section
of this title.
Section 4084(b) of 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 [].”
Section 4084(c)(3) of , as added by , title IV, § 411(i)(3), July 1, 1988, , provided that: “The amendments made by this subsection [amending this section and section
of this title] shall apply to services furnished after December 31, 1988.”
Section 4085(b)(2) of 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 provided that the amendment to section 9343 of by section 4085(i)(21)(D) of , 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 .
Effective Date of 1986 Amendments
Amendment by section 9320(e)(1), (2) of 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 , as amended, set out as notes under section
of this title.
Amendment by section 9337(b) of applicable to expenses incurred for outpatient occupational therapy services furnished on or after July 1, 1987, see section 9337(e) of , set out as a note under section
of this title.
Section 9339(a)(2) of 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 provided that: “The amendment made by paragraph (1) [amending this section] shall apply to samples collected on or after January 1, 1987.”
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