MISCELLANEOUS AND TECHNICAL PROVISIONS RELATING TO PART A.

SEC. 4008. MISCELLANEOUS AND TECHNICAL PROVISIONS RELATING TO PART A. (a) Waiver of Liability for Skilled Nursing Facilities and Hospices.— (1) Skilled nursing facilities.—The second sentence of section 9126(c) of the Consolidated Omnibus Budget Reconciliation Act of 1985 is amended by striking “October 31, 1990” and inserting “December 31, 1995”. (2) Hospices.—Section 9305(f)(2) of the Omnibus Budget Reconciliation Act of 1986 is amended by striking “November 1, 1990” and inserting “December 31, 1995”. (3) Effective date.—The amendments made by paragraphs (1) and (2) shall take effect on the date of the enactment of this Act. (b) Hospital Obligations with Respect to Treatment of Emergency Medical Conditions.— (1) Civil monetary penalties—Section 1867(d)(2)(A) (42 U.S.C. 1395dd(d)(2)(A)) is amended by striking “knowingly” and inserting “negligently”. (2) Application of penalties to small hospitals.—Section 1867(d)(2)(A) (42 U.S.C. 139Sdd(d)(2)(A)) is amended by inserting “(or not more than $25,000 in the case of a hospital with less than 100 beds)” after “$50,000”. (3) Termination of hospital provider agreements.— (A) Section 1867 (42 U.S.C. 1395dd) is further amended— (i) by striking paragraph (1) of subsection (d), (ii) by redesignating paragraphs (2) and (3) of subsection (d) as paragraph (1) and (2), respectively, and (iii) in subsection (c)(2)(C), by striking “(d)(2)(C)” and inserting “(d)(1)(C)”. (B) Section 1866(a)(l)(1)(i) (42 U.S.C. 1395cc(a)(l)(1)(i)) is amended by inserting “and to meet the requirements of such section” before the comma at the end. (4) Effective date.—The amendments made by this subsection shall apply to actions occurring on or after the first day of the sixth month beginning after the date of the enactment of this Act. (c) Inspector General Study of Prohibition on Hospital Employment of Physicians.— (1) Study.—The Secretary of Health and Human Services (acting through the Inspector General of the Department of Health and Human Services) shall conduct a study of the effect of State laws prohibiting the employment of physicians by hospitals on the availability and accessibility of trauma and emergency care services, and shall include in such study an analysis of the effect of such laws on the ability of hospitals to meet the requirements of section 1867 of the Social Security Act relating to the examination and treatment of individuals with an emergency medical condition and women in labor. (2) Report.—By not later than 1 year after the date of the enactment of this Act, the Secretary shall submit a report to Congress on the study conducted under paragraph (1). (d) Designation of Rural Primary Care Hospitals.— (1) Priority designations of border state hospitals.—Section 1820G)(2)(C) (42 U.S.C. 1395i-4(i)(2)(C)) is amended by adding at the end the following new sentence: “In designating facilities 104 STAT. 1388–45as rural primary care hospitals under this subparagraph, the Secretary shall give preference to facilities not meeting the requirements of clause (i) of subparagraph (A) that have entered into an agreement described in subsection (g)(2) with a rural health network located in a State receiving a grant under subsection (a)(D.”. (2) Eligibility of certain closed hospitals.—Section 1820(f)(1)(B) (42 U.S.C. 1395i-4(f)(l)(B)) is amended by striking “is a hospital,” and inserting the following: “is a hospital (or, in the case of a facility that closed during the 12-month period that ends on the date the facility applies for such designation, at the time the facility closed),”. (3) Eligibility of urban hospitals.—Section 1820(f)(1)(A) (42 U.S.C. 1395i-4(f)(l)(A)) is amended by striking the semicolon and inserting the following: “, or is located in a county whose geographic area is substantially larger than the average geographic area for urban counties in the United States and whose hospital service area is characteristic of service areas of hospitals located in rural areas;”. (4) Effective date.—The amendments made by paragraphs (1), (2), and (3) shall take effect on the date of the enactment of this Act. (e) Skilled Nursing Facility Routine Cost Limits.— (1) In general.—Section 6024 of the Omnibus Budget Reconciliation Act of 1989 is amended by adding at the end the following new sentence: “The Secretary shall update such costs under such section for cost reporting periods beginning on or after October 1, 1989, by using cost reports submitted by skilled nursing facilities for cost reporting periods ending not earlier than January 31, 1988, and not later than December 31, 1988.”. (2) 2-year updates required.—Section 1888(a) (42 U.S.C. 1395yy(a)) is amended in the matter following paragraph (4) by striking the period and inserting the following: “, and shall, for cost reporting periods beginning on or after October 1, 1992 and every 2 years thereafter, provide for an update to the per diem cost limits described in this subsection”. (3) Effective date.—The amendments made by paragraphs (1) and (2) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989. (f) Clarification of Extension of Waiver for Finger Lakes Area Hospital Corporation.— (1) In general.—The second sentence of section 1886(c)(4) (42 U.S.C. 1395ww(c)(4)) is amended by striking “rate of increase from” and inserting “payments under the State system as compared to aggregate payments which would have been made under the national system since”. (2) Effective date.—The amendment made by paragraph (1) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989. (g) Enrollment in Part A for HMO Members.— (1) In general.— Section 1818(c) (42 U.S.C. 1395i-2(c)) is amended— (A) by striking “and” at the end of paragraph (5), (B) by striking the period at the end of paragraph (6) and inserting a semicolon, and (C) by adding at the end the following new paragraphs: 104 STAT. 1388–46 “(7) an individual who meets the conditions of subsection (a) may enroll under this part during a special enrollment period that includes any month during any part of which the individual is enrolled under section 1876 with an eligible organization and ending with the last day of the 5th consecutive month in which the individual is at no time so enrolled; “(8) in the case of an individual who enrolls during a special enrollment period under paragraph (7)— “(A) in any month of the special enrollment period in which the individual is at any time enrolled under section 1876 with an eligible organization or in the first month following such a month, the coverage period shall begin on the first day of the month in which the individual so enrolls (or, at the option of the individual, on the first day of any of the following three months), or “(B) in any other month of the special enrollment period, the coverage period shall begin on the first day of the month following the month in which the individual so enrolls; and “(9) in applying the provisions of section 1839(b), there shall not be taken into account months for which the individual can demonstrate that the individual was enrolled under section 1876 with an eligible organization.”. (2) Effective date.—The amendment made by paragraph (1) shall take effect on February 1, 1991. (h) Nursing Home Reform.— (1) Nurse aide training and competency evaluation.— (A) No compliance actions before effective date of guidelines.—The Secretary of Health and Human Services may not refuse to enter into an agreement or cancel an existing agreement with a State under section 1864 of the Social Security Act on the basis that the State failed to meet the requirement of section 1819(e)(1)(A) of such Act before the effective date of guidelines, issued by the Secretary, establishing requirements under section 1819(f)(2)(A) of such Act, if the State demonstrates to the satisfaction of the Secretary that it has made a good faith effort to meet such requirement before such effective date. (B) Part-time nurse aides not allowed delay in training.— Section 1819(b)(5)(A) (42 U.S.C. 1396r(b)(5)(A)) is amended— (i) by striking “A skilled nursing facility” and inserting “(i) Except as provided in clause (ii), a skilled nursing facility”; (ii) by striking “(on a full-time, temporary, per diem, or other basis)” and inserting “on a full-time basis”; (iii) by striking “(i)” and “(ii)” and inserting “(I)” and “(II)”; and (iv) by adding at the end the following: “(ii) A skilled nursing facility must not use on a temporary, per diem, leased, or on any basis other than as a permanent employee any individual as a nurse aide in the facility on or after January 1, 1991, unless the individual meets the requirements described in clause (i).”. (C) Requirement to obtain information from nurse aide registry.—Section 1819(b)(5)(C) (42 U.S.C. 1395i-104 STAT. 1388–473(b)(5)(O) is amended by striking “the State registry established under subsection (e)(2)(A) as to information in the registry” and inserting “any State registry established under subsection (e)(2)(A) that the facility believes will include information”. (D) Retraining of nurse aides.—Section 1819(b)(5)(D) (42 U.S.C. 1395i-3(b)(5)(D)) is amended by striking the period at the end and inserting “, or a new competency evaluation program.”. (E) Clarification of nurse aides not subject to charges.—Section 1819(f)(2)(A)(iv) (42 U.S.C. 1395i-3(f)(2)(A)(iv)) is amended— (i) in subclause (I), by striking “and” at the end; (ii) in subclause (II), by inserting after “nurse aide” the following: “who is employed by (or who has received an offer of employment from) a facility on the date on which the aide begins either such program”; (iii) in subclause (II), by striking the period at the end and inserting “, and”; and (iv) by adding at the end the following new subclause: “(III) in the case of a nurse aide not described in subclause (II) who is employed by (or who has received an offer of employment from) a facility not later than 12 months after completing either such program, the State shall provide for the reimbursement of costs incurred in completing such program on a prorate basis during the period in which the nurse aide is so employed.”. (F) Modification of nursing facility deficiency standards.— (i) In general.— Section 1819(f)(2)(B)(iii)(D (42 U.S.C. 1395i-3(f)(2)(B)(iii)(D) is amended to read as follows: “(I) offered by or in a skilled nursing facility which, within the previous 2 years— “(a) has operated under a waiver under subsection (b)(4)(C)(ii)(ID; “(b) has been subject to an extended (or partial extended) survey under subsection (g)(2)(B)(i) or section 1919(g)(2)(B)(i); or “(c) has been assessed a civil money penalty described in subsection (h)(2)(B)(ii) or section 1919(h)(2)(A)(ii) of not less than $5,000, or has been subject to a remedy described in clauses (i) or (iii) of subsection (h)(2)(B), subsection (h)(4), section 1919(h)(l)(B)(i), or in clauses (i), (iii), or (iv) of section 1919(h)(2)(A), or”. (ii) Effective date.—The amendments made by clause (i) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1987, except that a State may not approve a training and competency evaluation program or a competency evaluation program offered by or in a nursing facility which, pursuant to any Federal or State law within the 2-year period beginning on October 1, 1988— (I) had its participation terminated under title XVIII of the Social Security Act or under the State plan under title XIX of such Act; 104 STAT. 1388–48 (II) was subject to a denial of payment under either such title; (III) was assessed a civil money penalty not less than $5,000 for deficiencies in nursing facility standards; (IV) operated under a temporary management appointed to oversee the operation of the facility and to ensure the health and safety of the facility’s residents; or (V) pursuant to State action, was closed or had its residents transferred. (G) Clarification of state responsibility to determine competency.—Section 1819(D(2)(B) (42 U.S.C. 1395i-3(f)(2)(B)) is amended in the second sentence by inserting “(through subcontract or otherwise)” after “may not delegate”. (H) Effective date.—Except as provided in subparagraph (F), the amendments made by this subsection shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987. (2) Other amendments.— (A) Assurance of appropriate payment amounts.— (i) Section 1861(v)(l)(E) (42 U.S.C. 1395x(v)(l)(E)) is amended in the second sentence by striking “the costs of such facilities” and inserting “the costs (including the costs of services required to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident eligible for benefits under this title) of such facilities”. (ii) Section 1888(d)(D (42 U.S.C. 1395xx(d)(D) is amended in the first sentence by striking “(and capital-related costs)” and inserting “(including the costs of services required to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident eligible for benefits under this title) and capital-related costs”. (B) Disclosure of information of quality assessment and assurance committees.—Section 1819(b)(1)(B) (42 U.S.C. 1395i-3(b)(l)(B)) is amended by adding at the end the following new sentence: “A State or the Secretary may not require disclosure of the records of such committee except insofar as such disclosure is related to the compliance of such committee with the requirements of this subparagraph.”. (C) Period for resident assessment.—Section 1819(b)(3)(C)(i)(I) (42 U.S.C. 1395i-3(b)(3)(C)(i)(D) is amended by striking “4 days” and inserting “not later than 14 days”. (D) Clarification of responsibility for services for mentally ill and mentally retarded residents.— Section 1819(b)(4)(A) (42 U.S.C. 1395i–3(b)(4)(A)) is amended— (i) by striking “and” at the end of clause (v), (ii) by striking the period at the end of clause (vi) and inserting “; and ”, and (iii) by inserting after clause (vi) the following new clause: “(vii) treatment and services required by mentally ill and mentally retarded residents not otherwise provided or arranged for (or required to be provided or arranged for) by the State.”. 104 STAT. 1388–49 (E) Notification of secretarial waiver.—Section 1819(b)(4)(C)(ii) (42 U.S.C. 1395i-3(b)(4)(C)(ii)) is amended— (i) by striking “and” at the end of subclause (II); (ii) by striking the period at the end of subclause (III) and inserting a comma; and (iii) by adding at the end the following new subclauses: “(IV) the Secretary provides notice of the waiver to the State long-term care ombudsman (established under section 307(a)(12) of the Older Americans Act of 1965) and the protection and advocacy system in the State for the mentally ill and the mentally retarded, and “(V) the facility that is granted such a waiver notifies residents of the facility (or, where appropriate, the guardians or legal representatives of such residents) and members of their immediate families of the waiver.”. (F) Clarification of definition of nurse aide.—Section 1819(b)(5)(F)(i) (42 U.S.C. 1395i-3(b)(5)(F)(i)) is amended by striking “(G)),” and inserting “(G)) or a registered dietician,”. (G) Residents’ rights to refuse intrafacility transfers for NGNmedical reasons.—Section 1819(c)(l)(A) (42 U.S.C. 1395i–3(c)(1)(A)) is amended— (i) by redesignating clause (x) as clause (xi) and by inserting after clause (ix) the following new clause: “(x) Refusal of certain transfers.—The right to refuse a transfer to another room within the facility, if a purpose of the transfer is to relocate the resident from a portion of the facility that is a skilled nursing facility (for purposes of this title) to a portion of the facility that is not such a skilled nursing facility.”; and (B) by adding at the end the following: “A resident’s exercise of a right to refuse transfer under clause (x) shall not affect the resident’s eligibility or entitlement to benefits under this title or to medical assistance under title XIX of this Act.”. (H) Resident access to clinical records.—Section 1819(c)(l)(A)(iv) (42 U.S.C. 1395i–3(c)(l)(A)(iv)) is amended by inserting before the period at the end the following: “and to access to current clinical records of the resident upon re-quest by the resident or the resident’s legal representative, within 24 hours (excluding hours occurring during a week-end or holiday) after making such a request”. (I) Inclusion of state notice of rights in facility notice of rights.—Section 1819(c)(l)(B)(ii) (42 U.S.C. 1395i–3(c)(l)(B)(ii)) is amended by inserting “including the notice (if any) of the State developed under section 1919(e)(6)” after “in such rights)”. (J) Specification of required programs.—Section 1819(e)(i)(A) (42 U.S.C. 1395i-3(e)(l)(A)) is amended by striking “clause (i) or (ii) of subsection (f)(2)(A)” and inserting “subsection (f)(2)”. (K) Clarification of nurse aide registry requirements.— Section 1819(e)(2) (42 U.S.C. 1395i–3(e)(2)) is amended— 104 STAT. 1388–50 (i) in subparagraph (A), by striking the period and inserting the following: “, or any individual described in subsection (f)(2)(B)(ii) or in subparagraph (B), (C), or (D) of section 6901(b)(4) of the Omnibus Budget Reconciliation Act of 1989.”; and (ii) by adding at the end the following new subparagraph: “(C) Prohibition against charges.—A State may not impose any charges on a nurse aide relating to the registry established and maintained under subparagraph (A).”. (L) Clarification on findings of neglect.—Section 1819(g)(l)(C) (42 U.S.C. 1395i–3(g)(l)(O) is amended by adding at the end the following: “A State shall not make a finding that an individual has neglected a resident if the individual demonstrates that such neglect was caused by factors beyond the control of the individual.”. (M) Timing of public disclosure of survey results.—Section 1819(g)(5)(A)(i) (42 U.S.C. 1395i-3(g)(5)(A)(i)) is amended by striking “deficiencies and plans” and inserting “deficiencies, within 14 calendar days after such information is made available to those facilities, and approved plans”. (N) Ombudsman program coordination with state survey and certification agencies.—Section 1819(g)(5)(B) (42 U.S.C. 1395i-3(g)(5)(B)) is amended by striking “with respect” and inserting “or of any adverse action taken against a skilled nursing facility under paragraphs (1), (2), or (4) of subsection (h), with respect”. (O) Maintaining regulatory standards for certain services.—Any regulations promulgated and applied by the Secretary of Health and Human Services after the date of the enactment of the Omnibus Budget Reconciliation Act of 1987 with respect to services described in clauses (fi), (iv), and (v) of section 1819(b)(4)(A) of the Social Security Act shall include requirements for providers of such services that are at least as strict as the requirements applicable to providers of such services prior to the enactment of the Omnibus Budget Reconciliation Act of 1987. (P) Effective dates.— The amendments made by this paragraph shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987. (i) Clarification of Secretarial Waiver Authority.— (1) Rural hospital demonstration.—The Secretary of Health and Human Services is authorized to waive such provisions of title XVIII of the Social Security Act as are necessary to conduct any demonstration project for limited-service rural hospitals with respect to which the Secretary has entered into an agreement before the date of the enactment of the Omnibus Budget Reconciliation Act of 1989. (2) Nursing home demonstrations.— Section 6901(d)(3)(B) of the Omnibus Budget Reconciliation Act of 1989 is amended— (A) by striking “Wisconsin” and inserting “Wisconsin and nursing home case-mix demonstration projects in other States”; and (B) by striking the second sentence. 104 STAT. 1388–51 (3) State waiver authority.— Section 1814(b) (42 U.S.C. 1395f(b)) is amended— (A) in paragraph (3)(B), by striking “October 1, 1983” and inserting “January 1, 1981”; (B) in the second sentence, by striking “seventh month” and inserting “37th month”; and (C) by adding at the end the following: “If, by the end of such 36-month period, the Secretary determines, based on evidence submitted by the Governor of the State, that neither of the conditions described in subparagraph (A) or (B) of paragraph (3) continues to apply, the Secretary shall continue without interruption payment to hospitals in the State under the State’s system. If, by the end of such 36-month period, the Secretary determines, based on such evidence, that either of the conditions described in subparagraph (A) or (B) of such paragraph continues to apply, the Secretary shall (i) collect any net excess reimbursement to hospitals in the State during such 36-month period (basing such net excess reimbursement on the net difference, if any, in the rate of increase in costs per hospital inpatient admission under the State system compared to the rate of in-crease in such costs with respect to all hospitals in the United States over the 36-month period, as measured by including the cumulative savings under the State system based on the difference in the rate of increase in costs per hospital inpatient admission under the State system as compared to the rate of increase in such costs with respect to all hospitals in the United States between January 1, 1981, and the date of the Secretary’s initial notice), and (ii) provide a reasonable period, not to exceed 2 years, for transition from the State system to the national payment system.”. (4) Effective date.—The amendment made by paragraphs (1) and (2) shall be effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989. (j) Determination of Reasonable Costs Relating to Swing Beds.— “(1) In general.—Section 1883(a)(2)(B)(ii)(II) (42 U.S.C. 1395tt(a)(2)(B)(ii)(Il)) is amended by striking “the previous calendar year” and all that follows through the period and inserting “the most recent year for which cost reporting data are available with respect to such services (increased in a compounded manner by the applicable increase for payments for routine service costs of skilled nursing facilities under section 1888 for subsequent cost reporting periods and up to and including such calendar year) under this title to freestanding skilled nursing facilities in the region (as defined in section 1886(d)(2)(D)) in which the facility is located.”. (2) Hold harmless.—If, as a result of the amendment made by paragraph (1), the reasonable cost of routine services furnished by a hospital during a calendar year (as determined under section 1883 of the Social Security Act) is less than the reasonable cost of such services determined under such section for the previous calendar year, the reasonable cost of such services furnished by the hospital during the calendar year under such section shall be equal to the reasonable cost determined under such section for the previous calendar year. 104 STAT. 1388–52 (3) Swing beds certified prior to may 1, 1987.—Notwithstanding the requirement of section 1883(b)(1) of the Social Security Act that the Secretary may not enter into an agreement under such section with a hospital that is not located in a rural area, any agreement entered into under such section on or before May 1, 1987, between the Secretary of Health and Human Services and a hospital located in an urban area shall remain in effect. (4) Effective date.—The amendment made by paragraph (1) shall apply to services furnished on or after October 1, 1990. (k) Prospective Payment System for Skilled Nursing Facility Services.— (1) Development of proposal.— The Secretary of Health and Human Services shall develop a proposal to modify the current system under which skilled nursing facilities receive payment for extended care services under part A of the medicare program or a proposal to replace such system with a system under which such payments would be made on the basis of prospectively determined rates. In developing any proposal under this paragraph to replace the current system with a prospective payment system, the Secretary shall— (A) take into consideration the need to provide for appropriate limits on increases in expenditures under the medicare program without jeopardizing access to extended care services for individuals unable to care for themselves; (B) provide for adjustments to prospectively determined rates to account for changes in a facility’s case mix, volume of cases, and the development of new technologies and standards of medical practice; (C) take into consideration the need to increase the payment otherwise made under such system in the case of services provided to patients whose length of stay or costs of treatment greatly exceed the length of stay or cost of treatment provided for under the applicable prospectively determined payment rate; (D) take into consideration the need to adjust payments under the system to take into account factors such as a disproportionate share of low-income patients, differences in wages and wage-related costs among facilities located in various geographic areas, and other factors the Secretary considers appropriate; and (E) take into consideration the appropriateness of classifying patients and payments upon functional disability, cognitive impairment, and other patient characteristics. (2) Reports.— (A) By not later than April 1, 1991, the Secretary (acting through the Administrator of the Health Care Financing Administration) shall submit any research studies to be used in developing the proposal under paragraph (1) to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. (B) By not later than September I, 1991, the Secretary shall submit the proposal developed under paragraph (1) to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. (C) By not later than March 1, 1992, the Prospective Payment Assessment Commission shall submit an analysis of and comments on the proposal developed under paragraph (1) to the 104 STAT. 1388–53 Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. (l) Review of Hospital Regulations With Respect to Rural Hospitals.— (1) In general.—The Secretary of Health and Human Services shall review the requirements applicable under title XVIII of the Social Security Act to determine which requirements could be made less administratively and economically burden-some (without diminishing the quality of care) for hospitals defined in section 1886(d)(D(B) of such Act that are located in a rural area (as defined in section 1886(d)(2)(D) of such Act). Such review shall specifically include standards related to staffing requirements. (2) Report.—The Secretary of Health and Human Services shall report to Congress by April 1, 1992, on the results of the review conducted under subsection (a), and include conclusions on which regulations, if any, should be modified with respect to hospitals described in subsection (a). (m) Miscellaneous Technical Corrections.— (1) Application of preentitlement psychiatric hospital services to limit on inpatient hospital services.—Effective as if included in the enactment of the Medicare Catastrophic Coverage Repeal Act of 1989, section 101(b)(D(B) is amended by inserting “(other than the limitation under section 1812(c) of such Act)” after “limitation”. (2) Provisions relating to hospitals.— (A) Section 1886(d)(5)(D)(iii) (42 U.S.C. l395ww(dK5)(D)(iii)), as amended by section 6003(e)(l)(A)(iv) of Omnibus Budget Reconciliation Act of 1989 (in this subsection referred to as “OBRA-1989”), is amended by striking “The term” and inserting “For purposes of this title the term”. (B) Section 1820 of such Act (42 U.S.C. 1395i–4), as added by section 6003(g)(l)(A) of the Omnibus Budget Reconciliation Act of 1989, is amended— (i) in subsection (d)(D, by striking “demonstration”; (ii) in subsection (g)(1)(A)(ii), by striking “rural referral center” and inserting “regional referral center”; and (iii) in subsection (j), by inserting “and part C” after “this part”. (C) Section 6003(g)(3)(C)(vii)(I) of the Omnibus Budget Reconciliation Act of 1989 is amended by striking “each place it appears”. (D) Section 1835(c) of the Social Security Act (42 U.S.C. 1395n(c)) is amended— (i) in the first sentence, by striking “a hospital” and inserting “a hospital or a rural primary care hospital”; (ii) in the second sentence, by striking “1833(a)(2)” and inserting “1833(a)(2) (or, in the case of a rural primary care hospital, in accordance with section 1833(a)(6))”; and (iii) by striking the third sentence. (3) Technical corrections relating to other providers of services— (A) Section 1814(i)(l)(C)(i) (42 U.S.C. 1395fli)(l)(C)(i), as amended by section 6005(a)(2) of the Omnibus Budget Rec-104 STAT. 1388–54conciliation Act of 1989, is amended by striking “during fiscal year 1990” and inserting “on or after January 1, 1990, and on or before September 30, 1990,”. (B) Section 6005(c) of the Omnibus Budget Reconciliation Act of 1989 is amended by striking “subsection (a)” and inserting “subsections (a) and (b)”. (C) Section 1818A(d)(D (42 U.S.C. 1395i-2a(d)(1)), as inserted by section 6012(a)(2) of the Omnibus Budget Reconciliation Act of 1989, is amended— (i) in subparagraph (A), by inserting “for enrollment under this section” after “Premiums”, and (ii) by striking subparagraph (C). (D) Section 1818(g)(2)(B) (42 U.S.C. 1395i-2(g)(2)(B)), as added by section 6013(a) of the Omnibus Budget Reconciliation Act of 1989, is amended by striking “subsection (c)” and inserting “subsection (c)(6)”. (F) Section 1819(f)(2)(A)(ii) (42 U.S.C. 1395i-3(f)(2)(A)(ii)) is amended by striking “and” at the end. (G) Section 1866(a)(l)(F) (42 U.S.C. 1395cc(a)(D(F) is amended— (i) in clause (i), by striking the comma at the end and inserting “),”, and (ii) in clause (ii), by striking “(4)(A)” and inserting “(3)(A)” and by striking the semicolon at the end and inserting a comma.