transfer of all outpatient hospital services to supplementary medical insurance program

transfer of all outpatient hospital services to supplementary medical insurance program Sec. 129. (a) Section 1861 (s)(2) of the Social Security Act is amended— (1) by inserting “(A)” after “(2)”: (2) by striking out “physicians’ bills” and all that follows and inserting in lieu thereof the following: “physicians’ bills; “(B) hospital services (including drugs and biologicals which cannot, as determined in accordance with regulations, be self-administered) incident to physicians’ services rendered to out-patients; and “(C) diagnostic services which are— “(i) furnished to an individual as an outpatient by a hospital or by others under arrangements with them made by a hospital, and “(ii) ordinarily furnished by such hospital (or by others under such arrangements) to its outpatients for the purpose of diagnostic study;”. (b) Section 1861 (s) of such Act is further amended by adding at the end thereof (after and below paragraph (11)) the following new sentence: “There shall be excluded from the diagnostic services specified in paragraph (2)(C) any item or service (except services referred to in paragraph (1)) which— “(12) would not be included under subsection (b) if it were furnished to an inpatient of a hospital; or “(13) is furnished under arrangements referred to in such para graph (2)(C) unless furnished in the hospital or in other facilities operated by or under the supervision of the hospital or its organized medical staff.” (c) (1) Section 226(b)(1) of such Act is amended by striking out “post-hospital home health services, and outpatient hospital diagnostic services” and inserting in lieu thereof “and post-hospital home health services”. (2) Section 1812(a) of such Act is amended— (A) by adding “and” at the end of paragraph (2); (B) by striking out and” at the end of paragraph (3) and inserting in lieu thereof a period; and (C) by striking out paragraph (4). (3) Section 1813(a) of such Act is amended by striking out paragraph (2), and by redesignating paragraphs (3) and (4) as paragraphs (2) and (3), respectively. 81 Stat. 848 (4) (A) Section 1813(b)(1) of such Act is amended by striking out “or diagnostic study”. (B) The first sentence of section 1813(b)(2) of such Act is amended by striking out “or diagnostic study”. (5) (A) Section 1814(a)(2) of such Act is amended— (i) by adding “or” at the end of subparagraph (D); (ii) by striking out “or” at the end of subparagraph (E); and (iii) by striking out subparagraph (F). (B) The last sentence of section 1814(a) of such Act is amended by striking out “(E), or (F)” and inserting in lieu thereof “or (E)”. (6) (A) Section 1814(d) of such Act is amended by striking out “or outpatient hospital diagnostic services”. (B) Section 1832(a)(2)(B) of such Act is amended by striking out “hospital” and inserting in lieu thereof “hospital and the services for which payment may be made pursuant to section 1835(b)(2)”. (7) Section 1833(b) of such Act is amended— (A) by striking out “(or regarded under clause (2) as incurred in such preceding year with respect to services furnished in such last three months)”; and (B) by striking out “, and (2)” and all that follows and inserting in lieu thereof a period. (8) Section 1833(d) of such Act is amended by striking out “other than subsection (a)(2)(A) thereof”. (9) (A) Section 1835(a) of such Act is amended by striking out “Payment” and inserting in lieu thereof “Except as provided in subsection (b), payment”. (B) Section 1835 of such Act is further amended by redesignating subsection (b) as subsection (c), and by inserting after subsection (a) the following new subsection: “(b) (1) Payment may also be made to any hospital for services described in section 1861 (s) furnished as an outpatient service by a hospital or by others under arrangements made by it to an individual entitled to benefits under this part even though such hospital does not have an agreement in effect under this title if (A) such services were emergency services, (B) the Secretary would be required to make such payment if the hospital had such an agreement in effect and otherwise met the conditions of payment hereunder, and (C) such hospital has made an election pursuant to section 1814(d)(1)(C) with respect to the calendar year in which such emergency services are provided. Such payments shall be made only in the amounts provided under section 1833(a)(2) and then only if such hospital agrees to comply, with respect to the emergency services provided, with the provisions of section 1866(a). “(2) Payment may also be made on the basis of an itemized bill to an individual for services described in paragraph (1) of this subsection if (A) payment cannot be made under such paragraph (1) solely because the hospital does not elect, in accordance with section 1814(d)(1)(C), to claim such payments and (B) such individual files application (submitted within such time, and in such form and manner, and containing and supported by such information as the Secretary shall by regulations prescribe) for reimbursement. The amounts payable under this paragraph shall, subject to the provisions of section 1833, be equal to 80 percent of the hospital’s reasonable charges for such services.” (C) Section 1861(e) of such Act is amended— (i) by striking out “except for purposes of section 1814(d),” and inserting in lieu thereof “except for purposes of sections 1814(d) and 1835(b),”; and 81 Stat. 849 (ii) by striking out “(including determination of whether an individual received inpatient hospital services for purposes of such section)” and inserting in lieu thereof “and 1835(b)(including determination of whether an individual received inpatient hospital services or diagnostic services for purposes of such sections)”. (10) Sect ion 1861 (p) of such Act is repealed. (11) Section 1861(y)(3) of such Act is amended by striking out “1813(a)(4)”and inserting in lieu thereof “1813(a)(3)”. (12) (A) Section 1866(a)(2)(A) of such Act is amended— (i) by striking out “, (a)(2), or (a)(4)” and inserting in lieu thereof “or (a)(3)”; and (ii) by striking out “or, in the case of outpatient hospital diagnostic services, for which payment is made under part A”. (B) Section 1866(a)(2)(C) of such Act is amended by striking out “1813(a)(3)” and inserting in lieu thereof “1813(a)(2)”. (13) Section 21(a) of the Railroad Retirement Act of 1937 is amended by striking out “post-hospital home health services, and out-patient hospital diagnostic services” and inserting in lieu thereof “and post-hospital home health services”. (d) The amendments made by this section shall apply with respect to services furnished after March 31, 1968, except that subsection (c)(5) of such section shall become effective with respect to services furnished after the date of enactment of this Act.