payments for emergency hospital services

payments for emergency hospital services Sec. 143. (a) The second sentence following paragraph (8) of section 1861(e) of the Social Security Act is amended by striking out “which meets the requirement of paragraphs (1), (2), (3), (4), (5) and (7) of this subsection” and inserting in lieu thereof “which (i) meets the requirements of paragraphs (5) and (7) of this subsection, (ii) is not primarily engaged in providing the services described in section 1861(j)(1)(A) and (iii) is primarily engaged in providing, by or under the supervision of individuals referred to in paragraph (1) of section 1861 (r), to inpatients diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons.” (b) That portion of section 1812(a) of such Act that precedes paragraph (1) thereof is amended by inserting “or, in the case of payments referred to in section 1814(d)(2) to him” after “on his behalf”. (c) Section 1814(d) of such Act is amended by— (1) striking out “Payments” and inserting in lieu thereof “(1) Payments”; (2) deleting “furnished” and inserting “furnished in a calendar year”; (3) deleting “and” at the end of clause (A) and inserting a comma in lieu thereof; (4) inserting before the period at the end of the first sentence the following: “, and (C) such hospital has elected to claim payments for all such inpatient emergency services and for the emergency outpatient services referred to in section 1835(b) furnished during such year”: and (5) adding at the end of such section 1814(d) the following new paragraphs: 81 Stat. 858 “(2) Payment may be made on the basis of an itemized bill to an individual entitled to hospital insurance benefits under section 226 for services described in paragraph (1) which are emergency services if (A) payment cannot be made under paragraph (1) solely because the hospital does not elect to claim such payment, and (B) such individual files application (submitted within such time and in such form and manner and by such person, and containing and supported by such information as the Secretary shall by regulations prescribe) for reimbursement. “(3) The amounts payable under the preceding paragraph with respect to services described therein shall, subject to the provisions of section 1813, be equal to 60 percent of the hospital’s reasonable charges for routine services furnished in the accommodations occupied by the individual or in semiprivate accommodations (as defined in section 1861(v)(4)), whichever is less, plus 80 percent of the hospital’s reasonable charges for ancillary services. If separate charges for routine and ancillary services are not made by the hospital, reimbursement may be based on two-thirds of the hospital’s reasonable charges for the services received but not to exceed the charges which would have been made if the patient had occupied semiprivate accommodations. For purposes of the preceding provisions of this paragraph, the term ‘routine services’ shall mean the regular room, dietary, and nursing services, minor medical and surgical supplies and the use of equipment and facilities for which a separate charge is not customarily made; the term ‘ancillary services’ shall mean those special services for which charges are customarily made in addition to routine services.” (d) The provisions made by subsection (a) of this section shall become effective as of July 1, 1966, and the provisions made by subsections (b) and (c) of this section shall apply to services furnished with respect to admissions occurring after December 31, 1967, and to out-patient hospital diagnostic services furnished after December 31, 1967, and before April 1, 1968.