TECHNICAL CORRECTIONS TO CERTAIN HEALTH CARE PROVISIONS IN THE OMNIBUS BUDGET RECONCILIATION ACT OF 1987.

SEC. 411. TECHNICAL CORRECTIONS TO CERTAIN HEALTH CARE PROVISIONS IN THE OMNIBUS BUDGET RECONCILIATION ACT OF 1987. (a) Reference to OBRA and Effective Dates.— (1) Reference.—In this section, the term “OBRA” refers to the Omnibus Budget Reconciliation Act of 1987 (Public Law 100–203). (2) Effective date.—Except as specifically provided in this section, the amendments made by this section, as they relate to a provision in OBRA, shall be effective as if they were included in the enactment of that provision in OBRA. (3) Ratification of enrollment corrections and printed enrollment.— (A) In general.—Except as provided in subparagraph (B), the enrollment corrections noted in footnotes numbered 9 through 72 of OBRA are hereby ratified and shall be considered to have been enacted as part of OBRA. The printed enrollment of title IV of OBRA, as prepared and printed under section 8004 of OBRA (including the footnote corrections described in subparagraph (B) and as incorporating the clarifications described in subparagraph (C)), shall be deemed to constitute title IV of OBRA as enacted. (B) Footnote corrections.— (i) With respect to the reference to which footnote 28 relates (101 Stat. 1330–81), the reference shall be deemed to have read “1320a–7b)”. (ii) With respect to the word to which footnote 30 relates (101 Stat. 1330–91), the word shall be deemed to have read “the”. (iii) With respect to the designation to which footnote 52 relates (101 Stat. 1330–151), the designation shall be deemed to have read “(F)”. (C) Clarifications of illegible matter.— (i) Section 1842(n)(1)(A) of the Social Security Act, as added by section 4051(a) of OBRA (101 Stat. 1330–93), is deemed to nave the phrase “the supplier’s reasonable charge to individuals enrolled under this part for the test” immediately after “or, if lower, the”. (ii) Section 1834(a)(7)(B)(i) of the Social Security Act, as inserted by section 4062(b) of OBRA (101 Stat. 1330–103), is deemed to have a reference to “1987” immediately after “December”. (b) Corrections Relating to Part 1 of Subtitle A of Title IV (Part A of the Medicare Program).— (1) Section 4002.— (A) Subclauses (III) and (IV) of section 1886(b)(3)(B)(i) of the Social Security Act, as amended by section 4002(a) of OBRA, are amended by striking “other hospitals” and inserting “for hospitals located in other urban areas”. (B) Section 1886(b)(3)(B)(i)(IV) of the Social Security Act, as amended by section 4002(a) of OBRA, is amended by striking 102 STAT. 769“percent” each place it appears and inserting “percentage points”. (C) Section 18860(b)(3)(B)(i)(V) of the Social Security Act, as amended by section 4002(a) of OBRA, is amended by inserting “increase” after “market basket percentage”. (D) The second sentence of section 1886(d)(2)(D) of the Social Security Act, as amended by section 4002(b) of OBRA, is amended by striking “the publication described in subsection (e)(5)(B)” and inserting “the publications described in subsection (e)(5)”. (E) Section 4002(c)(1)(B)(iii) of OBRA is amended, in the matter stricken, by striking the comma after “available”. (F) Section 1886(d)(3)(A)(ii) of the Social Security Act, as amended by section 4002(c)(1)(C) of OBRA, is amended by striking “in urban areas” and inserting “in other urban areas”. (G) Section 1886(d)(1)(A)(iii) of the Social Security Act, as amended by section 4002(d) of OBRA, is amended by striking “if greater” and inserting “if the average standardized amount (described in clause (i)(I) or clause (ii)(I) of paragraph (3)(D)) for hospitals within the region of, and in the same rural, large urban, or other urban area as, the hospital is greater than the average standardized amount (described in the respective clause) for hospitals within the United States in that type of area”. (H) (i) Section 1886(d)(2)(D) of the Social Security Act is amended by striking the last sentence (added by section 4002(f)(1)(A) of OBRA). (ii) Section 4002(f) of OBRA is amended by adding at the end the following new paragraph: “(3) The second sentence of section 1813(b)(1) of the Social Security Act (42 U.S.C. 1395e(b)(1)) is amended by striking ‘applicable percentage increase’ and all that follows through ‘is applied’ and inserting ‘Secretary’s best estimate of the payment-weighted average of the applicable percentage increases (as defined in section 1886(b)(3)(B)) which are applied.”. (iii) The amendment made by clause (ii) shall apply to the inpatient hospital deductible for years beginning with 1989. (I) Section 4002(g) of OBRA is amended— (i) in paragraph (1)(A), by striking “1886(a)(1)(A)(iii)” and inserting “1886(d)(1)(A)(iii)”. (ii) in paragraphs (1)(B) and (2)(B), by striking “1886(d)(3)(B)” and inserting “1886(b)(3)(B)”, and (iii) in paragraph (6), by striking “1886(d)(10)(B)” and inserting “1886(d)(1)(B)”. (2) Section 4003.— Section 4003(d) of OBRA is amended— (A) in paragraph (2)— (i) by inserting “(other than under section 1886(d)(5)(F) of such Act)” after “receives payments”, and (ii) by inserting “of such services” after “reasonable costs”; and (B) in the matter following paragraph (2), by inserting “the” after “facilities of”. (3) Section 4004.—Section 4004(a) of OBRA is amended by inserting “(1)” after “Survey.—” and by adding at the end the following new paragraph: “(2) Section 1886(d)(9)(C)(iv) of such Act is amended by adding at the end the following new sentence: “The second and third sentences 102 STAT. 770of paragraph (3)(E) shall apply to subsection (d) Puerto Rico hospitals under this clause in the same manner as they apply to subsection (d) hospitals under such paragraph and, for purposes of this clause, any reference in such paragraph to a subsection (d) hospital is deemed a reference to a subsection (d) Puerto Rico hospital.”. (4) Section 4005.— (A) Section 1886(d)(8)(B) of the Social Security Act, as added by section 4005(a)(1)(D) of OBRA, is amended— (i) by striking “The Secretary” and inserting “For purposes of this subsection, the Secretary”, and (ii) by striking all that follows “if’ and inserting the following: “the rural county would otherwise be considered part of an urban area, under the standards for designating Metropolitan Statistical Areas (and for designating New England County Metropolitan Areas) published in the Federal Register on January 3, 1980, if the commuting rates used in determining outlying counties (or, for New England, similar recognized areas) were determined on the basis of the aggregate number of resident workers who commute to (and, if applicable under the standards, from) the central county or counties of all contiguous Metropolitan Statistical Areas (or New England County Metropolitan Areas).”. (B) Section 1886(d)(8)(C) of the Social Security Act, as added by section 4005(a)(1)(D) of OBRA, is amended by striking “standardized amount” and inserting “standardized amounts”. (C) Section 4005(a) of OBRA is amended— (i) in paragraph (1)(D), by striking “subparagraph” and inserting “subparagraphs”, and (ii) in paragraph (3), by striking “This section, and the amendments made by paragraph (1),” and inserting “This subsection”. (D) Section 1883(d)(3) of the Social Security Act, as added by section 4005(b)(2)(B) of OBRA, is amended by inserting before the period at the end the following: “, except that such payment shall continue to be made in the period for those patients who are receiving extended care services at the time the hospital reaches the limit specified in this paragraph”. (5) Section 4006.— (A) Section 1886(g)(3)(A)(iv) of the Social Security Act, as amended by section 4006(a) of OBRA, is amended by inserting “for payments attributable” after “15 percent”. (B) Section 4006(a) of OBRA is amended— (i) by adding “and” at the end of subparagraph (A), and (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively. (6) Section 4007.— Section 4007 of OBRA is amended— (A) in the second sentence of subsection (a), by striking “updata” and inserting “updated”; (B) by amending subsection (b) to read as follows: “(b) Requiring Reporting of Standardized Cost Report Electronically.— “(1) In general.— Section 1886(f)(1) of the Social Security Act (42 U.S.C. 1395ww(f)(1)) is amended— “(A) by striking for a period ending not earlier than September 30, 1988,”, “(B) by inserting ‘(A)’ after ‘(f)(1)’, and 102 STAT. 771 “(C) by adding at the end the following new subparagraph: “(B) (i) Subject to clause (ii), the Secretary shall place into effect a standardized electronic cost reporting format for hospitals under this title. “(ii) The Secretary may delay or waive the implementation of such format in particular instances where such implementation would result in financial hardship (in particular with respect to hospitals with a small percentage of inpatients entitled to benefits under this title).”. “(2) Effective date.— The amendment made by paragraph (1)(0 shall apply to hospital cost reporting periods beginning on or after October 1, 1989”; and (C) in subsection (c)— (i) in paragraph (1)— (I) by striking “3-year”, and (II) by striking “contracting” and inserting “conducting”; (ii) in paragraph (2), by striking “by category of service and” in subparagraphs (A) and (B); (iii) in paragraph (2)(0, by striking “(by category of service)”; (iv) in paragraph (2), by striking subparagraph (D) and redesignating subparagraphs (E) through (L) as subparagraphs (D) through (K), respectively; (v) by amending subparagraph (1), as so redesignated, to read as follows: “(I) Bad debt and charity care.”; (vi) in paragraph (2), by adding at the end the following: “The Secretary shall develop a definition of ‘outpatient visit’ for purposes of reporting hospital information.”; (vii) in paragraph (5), by striking “paragraph (3)” and inserting “paragraph (2)”; (viii) in paragraph (5)(A), by striking “The terms” and all that follows through “as” and inserting “The term ‘bad debt and charity care’ has such meaning as”; (ix) in paragraph (5)(B)— (I) by inserting “at least” after “to payors”, (II) by striking “title VIII” and inserting “title XVIII”, and (III) by striking “self-paying individuals” and inserting “and other persons (including self-paying individuals)”; and (x) in paragraph (6)— (I) by striking “$1,000,000 for each of” and inserting “a total of $3,000,000 for”, (II) by inserting “or from operation funds” after “research funds”, (III) by striking “, and at least” and all that follows through “operations funds” and inserting “and”, and (IV) by striking “over 3 years”. (7) Section 4008.—Section 4008(d)(1)(B) of OBRA is amended by striking “1886” and inserting “1886(d)”. (8) Section 4009.— (A) Section 4009(a) of OBRA is amended— 102 STAT. 772 (i) by striking paragraphs (1) and (2) and inserting the following: “(1) Increase in civil monetary penalty and exclusion of responsible physician violators.— Section 1867(d)(2) of the Social Security Act (42 U.S.C. 1395dd(d)(2)) is amended— “(A) in the second sentence— “(i) by redesignating such sentence as subparagraph (C), “(ii) by striking ‘previous sentence’ and inserting ‘this paragraph’, and “(iii) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and “(B) by striking the first sentence and inserting the following: ‘(A) A participating hospital that knowingly violates a requirement of this section is subject to a civil money penalty of not more than $50,000 for each such violation. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this subparagraph in the same manner as such provisions apply with respect to a penalty or proceeding under section 1128A(a). “‘(B) The responsible physician in a participating hospital with respect to the hospital’s violation of a requirement of this subsection is subject to the sanctions described in section 1842(j)(2), except that, for purposes of this subparagraph, the civil money penalty with respect to each violation may not exceed $50,000, rather than $2,000.’”and (ii) by redesignating paragraph (3) as paragraph (2). (B) Section 4009(d)(1)(A) of OBRA is amended, in the matter inserted by such section, by striking the comma after “representatives”. (C) Section 4009(i) of OBRA is amended by striking “New England county metropolitan areas” and “4001(b)” and inserting “urban areas in New England” and “4002(b)”, respectively. (D) Section 4009j) of OBRA is amended by adding at the end the following new paragraphs: “(9) Section 1818(c) of the Social Security Act (42 U.S.C. 1395i–2(c)) is amended by striking paragraph (4) and redesignating paragraphs (5) through (7) as paragraphs (4) through (6), respectively. “(10) Section 9305(d) of the Omnibus Budget Reconciliation Act of 1986 is amended by striking ‘2 years after the date of the enactment of this Act’ and inserting ‘January 1, 1990’.”. (c) Corrections Relating to Subpart A of Part 2 of Subtitle A of Title IV (Health Maintenance Organization Reforms).— (1) Section 4011.—Subparagraph (F) of section 1876(c)(3) of the Social Security Act, as added by the amendment made by section 4011(a)(1) of OBRA, is amended by moving its indentation 4 ems to the left so its left margin is aligned with the left margin of subparagraph (G) of that section, as added by section 4011(b)(1) of OBRA. (2) Section 4012.— (A) (i) Section 1866(a)(1)(O) of the Social Security Act, as inserted by section 4012(a) of OBRA, is amended by striking “with a risk-sharing contract under section 1876” and inserting “(i) with a risk-sharing contract under section 1876, under section 1876(i)(2)(A) (as in effect before 102 STAT. 773February 1, 1985), under section 402(a) of the Social Security Amendments of 1967, or under section 222(a) of the Social Security Amendments of 1972, and (ii) which does not have a contract establishing payment amounts for services furnished to members of the organization”. (ii) The amendment made by clause (i) shall apply to admissions occurring on or after the first day of the fourth month beginning after the date of the enactment of this Act. (B) Section 4012(c) of OBRA is amended by striking “paragraph (2)” and inserting “subsection (a)”. (3) Section 4013.—Section 4013 of OBRA is amended by striking “(a) In General” and all that follows through the end and inserting the following: “Section 2350(b)(3) of the Deficit Reduction Act of 1984 is amended by striking ‘four years after the date of the enactment of this Act’ and inserting ‘September 30, 1990’.”. (4) Section 4014.— Section 1876(i)(6) of the Social Security Act, as amended by section 4014 of OBRA, is amended— (A) in subparagraph (A), by inserting “, in addition to any other remedies authorized by law,” after “the Secretary may provide”, and (B) in the last sentence of subparagraph (B), by striking “under that section” and inserting “or proceeding under section 1128A(a)”. (5) Section 4018.—Section 1876(f)(3)(A) of the Social Security Act, as inserted by section 4018(a) of OBRA, is amended— (A) by inserting “enrollment and residency requirements under this section and for” after “for purposes of”, and (B) by striking “of the subdivision” and inserting “described in subparagraph (B)(iii) who receive services through the subdivision”. (d) Corrections Relating to Subpart B of Part 2 of Subtitle A of Title IV (Home Health Quality).— (1) Section 4021.— (A) Section 1891(a) of the Social Security Act, as added by section 4021(b) of OBRA, is amended— (i) in paragraph (3)(A), by striking “who is not a licensed health care professional (as defined in subparagraph (F))”, (ii) in paragraph (3)(F), by inserting “physical or occupational therapy assistant,” after “occupational therapist,”, and (iii) by striking paragraph (4) and by redesignating paragraphs (5) and (6) as paragraphs (4) and (5), respectively. (B) (i) Section 1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is amended by inserting before the period at the end the following: “; except that such term does not include such equipment furnished by a supplier who has used, for the demonstration and use of specific equipment, an individual who has not met such minimum training standards as the Secretary may establish with respect to the demonstration and use of such specific equipment”. (ii) The amendment made by clause (i) shall apply to equipment furnished on or after the effective date provided in section 4021(c) of OBRA. (2) Section 4022.— (A) The third sentence of section 1891(c)(1) of the Social Security Act, as added by section 4022(a) of OBRA, is amended by inserting “(other than subsections (a) and (b))” after “1128A”. 102 STAT. 774 (B) Section 1891(d)(2)(A) of the Social Security Act, as added by section 4022(a) of OBRA, is amended by striking “1991” and inserting “1992”. (3) Section 4023.— (A) Section 4023 of OBRA is amended by inserting “(a) In General.—” before “Section 1891”. (B) Section 1891(f)(2)(A) of the Social Security Act, as added by section 4023 of OBRA, is amended— (i) by moving the indentation of clauses (i) through (iii) (and the sentence following clause (iii)) 2 ems to the left, (ii) in clause (i), by striking “for each day of noncompliance” and inserting “in an amount not to exceed $10,000 for each day of noncompliance”, and (iii) by inserting after and below clause (iii), the following: “The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”. (C) Section 4023(b) of OBRA is amended by inserting before the period at the end the following: “, and no intermediate sanction described in section 1891(f)(2)(A) of such Act shall be imposed for violations occurring before such effective date”. (4) Section 4025.— (A) Section 1864(a) of the Social Security Act is amended— (i) in the first sentence added by section 4025(a) of OBRA, by striking “most recent accreditation survey conducted with respect to the agency,” and inserting “most recent accreditation survey conducted by a State agency or private accreditation agency under section 1865 with respect to the home health agency,”, and (ii) in the second sentence so added— (I) by inserting “such State or local” before “agency” the first place it appears, and (II) by striking “section 1864” and inserting “section 1865”. (B) Section 4025 of OBRA is amended— (i) in subsection (b), by striking “subsection (a)” and inserting “this section” and by redesignating such subsection as subsection (c), and (ii) by inserting after subsection (a) the following new subsection: “(b) Conforming Amendment.—The last sentence of section 1865(a) of such Act (42 U.S.C. 1395bb(a)) is amended by inserting ‘(other than a survey with respect to a home health agency’ after ‘any accreditation survey’.”. (5) Section 4026.— (A) Section 1861(v)(1)(L)(iii) of the Social Security Act, as added by section 4026(a)(1)of OBRA, is amended— (i) by striking “audited” each place it appears and inserting “verified”, and (ii)by adding at the end the following: “In the case of a home health agency that refuses to provide data, or deliberately provides false data, respecting wages for purposes of this clause upon the request of the Secretary, the Secretary may withhold up to 5 percent of the amount of the payments otherwise payable to the agency under this title until such date as the Secretary determines that such data has been satisfactorily provided.”. 102 STAT. 775 (B) Section 4026(a)(2) of OBRA is amended by striking “July 1, 1988” and inserting “July 1, 1989”. (C) Section 4026(b) of OBRA is amended by striking “June 1, 1988” and inserting “June 1, 1989”. (6) Section 4027.—Section 4027(a) of OBRA is amended by striking “July 1, 1988” and inserting “April 1, 1989”. (e) Corrections Relating to Subpart C of Part 2 of Subtitle A of Title IV (Other Medicare Part A and B Provisions).— (1) Section 4032.— (A) Section 4032 of OBRA is amended by striking “and Physician Review” in the heading of subsection (a) and by striking “and Carriers” in the heading of subsection (b). (B) Section 18166)(2) of the Social Security Act, as added by section 4032(a) of OBRA, is amended— (i) by inserting “in the case of a request for reconsideration of a denial,” after “(2)”, and (ii) by inserting “the” before “disposition”. (C) Section 4032(c)(1)(B) of OBRA is amended by striking “claims filed” and inserting “reconsiderations requested”. (2) Section 4033.— Section 4033 of OBRA is amended— (A) by striking “(a) In General.—” (B) by redesignating paragraphs (1) and (2) (and subparagraphs (A) and (B) of paragraph (2)) as subsections (a) and (b) (and paragraphs (1) and (2) of subsection (b)), respectively, and (C) by aligning the left margins of the matter in such section flush left. (3) Section 4039.—Section 4039 of OBRA is amended by adding at the end the following new subsection: “(h) Technical Corrections.— “(1) Section 1128A(b) of the Social Security Act (42 U.S.C. 1320a–7a(b)) is amended— “(A) in paragraph (1)(A), by striking ‘)(VII’ and inserting ‘XVII’, and “(B) in paragraph (2) by inserting ‘each’ after ‘$2,000 for’. “(2) Section 1138(a)(1)(B) of such Act (42 U.S.C. 1320b–8(a)(1)(B)) is amended by striking ‘In’ and inserting ‘in’. “(3) Section 1154(a)(4) of such Act (42 U.S.C. 1320c–3(a)(4)) is amended— “(A) by indenting subparagraphs (B) and (C) (and clauses (i) through (iii) of subparagraph (C) two additional ems; “(B) in subparagraph (B), by inserting ‘risk-sharing’ before ‘contract under section 1876’; and “(C) in subparagraph (C)(i), by adding before the comma at the end the following: ‘(other than the ability to perform review functions under this section that are not described in subparagraph (B))’. “(4) Section 1154(d) of such Act (42 U.S.C. 1320c–3(d)) is amended by striking “1164(b)(4)” and inserting ‘1164’. “(5) Section 1156(b) of such Act (42 U.S.C. 1320c–5(b)) is amended— “(A) in the second sentence of paragraph (1), by striking ‘such services on a reimbursable basis.’ and inserting ‘services under this Act on a reimbursable basis.’, and “(B) in paragraph (2), by striking ‘at such time’ and all that follows through ‘and shall remain’ and inserting ‘on the same date and in the same manner as an exclusion 102 STAT. 776 from participation under the programs under this Act becomes effective under section 1128(c), and shall remain’. “(6) Section 1160 of such Act (42 U.S.C. 1320c–9) is amended by adding at the end the following new subsection: “‘(e) For purposes of this section and section 1157, the term “organization with a contract with the Secretary under this part” includes an entity with a contract with the Secretary under section 1154(a)(4)(C).’. “(7) The heading of section 1870 of such Act (42 U.S.C. 1395gg) is amended to read as follows: ‘overpayment on behalf of individuals and settlement of claims for benefits on behalf of deceased individuals’. “(8) Section 1876(i)(7) of such Act (42 U.S.C. 1395mm(i)(7)) is amended— “(A) in subparagraph (A), by striking ‘Except as provided under section 1154(a)(4)(C), each’ and inserting ‘Each’; “(B) in subparagraph (A), by inserting ‘or with an entity selected by the Secretary under section 1154(a)(4)(C)’ after ‘located)’; and “(C) by striking ‘peer’ in subparagraph (B) and the second place it appears in subparagraph (A). “(9) Section 9353 of the Omnibus Budget Reconciliation Act of 1986 is amended— “(A) in subsection (a)(6)(A)(i), by striking ‘paragraphs (1) and (2)(D) shall apply to contracts as of and inserting ‘paragraph (1) shall apply to contracts entered into or renewed on or after’; “(B) in subsection (a)(6)(B), by striking ‘amendment made by paragraph (2)(B)’ and inserting ‘amendments made by paragraphs (2)(B) and (2)(D)’; and “(C) in subsection (e)(3)(B), by adding at the end the following: “The provisions of section 1876(1)(7) of the Social Security Act (added by such amendment) shall apply to health maintenance organizations with contracts in effect under section 1876 of such Act (as in effect before the date of the enactment of Public Law 97–248) in the same manner as it applies to eligible organizations with risk-sharing contracts in effect under section 1876 of such Act (as in effect on the date of the enactment of this Act).’.”. (f) Corrections Relating to Subpart A of Part 3 of Subtitle A of Title IV (Payments for Physicians’ Services).— (1) Section 4041.— (A) Section 4041(a)(1)(B) of OBRA is amended— (i) by inserting “as amended retroactively by section 4085(i)(7)(C),” after “(j)(1)(C),”, and (ii) by redesignating the clause added by such section as clause (viii). (B) The last sentence of section 1842(b)(2) of the Social Security Act, as added by section 4041(a)(3)(A) of OBRA, is amended by striking “and subsection (h)” and inserting “, subsection (h), and section 1845(f)(2)”. (C) Subclause (II) of section 4041(a)(3)(B)(iii) of OBRA is amended to read as follows: “(II) by striking ‘April 1’ and inserting ‘September 30’, and”. 102 STAT. 777 (2) Section 4042.— (A) Section 1842(b)(4)(F)(iii) of the Social Security Act, as added by section 4042(a) of OBRA, is amended— (i) in subclause (I), by striking the semicolon and inserting a comma, and (ii) in subclause (ID, by striking “physician’s” and inserting “physicians’ ”. (B) Section 1842(b)(4)(F)(ii)(1) of the Social Security Act, as added by section 4042(a) of OBRA, is amended by striking “subparagraph (E)(iii) ” and inserting “subsection (i)(4)”. (C) Section 4042(b) of OBRA is amended by striking “Section” and all that follows up to “The term” and inserting the following: “(1) Section 1842 of such Act (42 U.S.C. 1395u) is amended— “(A) in subsection (h)(7), by striking described in paragraph (8)’; “(B) in paragraph (8) of subsection (h)— “(i) by striking ‘(8) For purposes of this title, a’ and inserting ‘(1) A’, “(ii) by indenting such paragraph 2 ems, and “(iii) by inserting before such paragraph the following: “‘(i) For purposes of this title:’; (C) in subsection (b)(4)(E)— “(i) by striking ‘(E) In this section:’, “(ii) by redesignating clauses (i) and (ii), as paragraphs (2) and (3), respectively, and “(iii) by transferring and inserting such paragraphs, as redesignated, before subsection (j); “(D) in subsection (b)(4), by redesignating subparagraphs (F) and (G) of subsection (b)(4), as subparagraphs (E) and (F), respectively; and “(E) by inserting, after the paragraphs transferred and inserted by subparagraph (C)(iii), the following new paragraph: “‘4’” . (D) Section 4042(b) of OBRA is further amended by adding at the end the following: “(2) (A) Section 1842(b)(4)(A)(vii) of such Act, as redesignated by sections 4041(a)(1)(A)(i) and 4044(a), is amended by striking ‘subparagraph (E)(ii)’ and inserting ‘subsection (i)(3)’. “(B) Section 1833(1)(2) of such Act (42 U.S.C. 139510)(2)) is amended by striking ‘1842(b)(4)(E)(ii)’ and inserting ‘18420)(3)’.”. (E) The last sentence of section 1842(b)(4)(A)(iv)(II) of the Social Security Act, as added by section 4042(c)(2) of OBRA, is amended by striking “January 1, 1988” and inserting “January 1, 1989”. (F) Section 4042(c) of OBRA is amended— (i) by striking “Section” and all that follows up to “In the previous sentence” and inserting the following: “(1) The first sentence of clause (iv) of section 1842(b)(4)(A) of such Act (42 U.S.C. 139u(b)(4)(A)) is amended to read as follows: ‘The reasonable charge for physicians’ services furnished on or after January 1, 1987, by a nonparticipating physician shall be no greater than the applicable percent of the prevailing charge levels established under the third and fourth sentences of paragraph (3) (or under any other applicable provision of law affecting the prevailing charge level)?.”, and 102 STAT. 778 (ii) by adding at the end the following: “(2) Subclauses (I) and (II) of section 1842(j)(1)(C)(i) of such Act are amended by striking ‘prevailing charge for the year involved for such service furnished by nonparticipating physicians’ and inserting ‘applicable percent (as defined in subsection (b)(4)(A)(iv)) of the prevailing charge for the year and service involved’.”. (3) Section 4044.— (A) Section 4044(a) of OBRA is amended by striking “Increase in Prevailing Charges” and inserting “Prevailing Charge Floor”. (B) Section 1842(b)(4)(A)(vi) of the Social Security Act, as inserted by section 4044(a) of OBRA, is amended— (i) by striking “subparagraph (E)(iii)” and inserting “subsection (i)(4)”. (ii) by striking “the average of the prevailing charge levels” and inserting “the estimated average prevailing charge levels based on the best available data”, and (iii) by striking “for participating physicians”. (4) Section 4045.— (A) Section 1842(b)(10) of the Social Security Act, as amended by section 4045(a) of OBRA, is amended— (i) in subparagraph (A)(i)— (I) by striking “under paragraph (3)”, (II) by striking “subparagraph (C)” and inserting “subparagraph (B)”, and (III) by striking “for participating and nonparticipating physicians”; (ii) in subparagraph (A)(iii), by striking “clause (i)(ID” and inserting “clause (i)(I)”; (iii) in subparagraph (B) by inserting “(including subsequent insertion of an intraocular lens)” after “cataract surgery”; and (iv) in subparagraph (D), by inserting “under” after “review”. (B) Section 4045(c)(2) of OBRA is amended— (i) in subparagraph (B), by inserting before the period at the end the following: “and by striking the second sentence”, and (ii) by adding at the end the following new subparagraph: “(D) The fourth sentence of section 1842(b)(3) of the Social Security Act (42 U.S.C. 1395u(b)(3)) is amended by inserting ‘(or under any other provision of law affecting the prevailing charge level)’ after ‘the level determined under this sentence’.”. (C) Section 1842(j)(1)(D)(iv) of the Social Security Act, as added by section 4045(c)(1)(B) of OBRA, is amended by striking “imposes a charge” and inserting “bills”. (D) (i) Section 1862(a)(15) of the Social Security Act (42 U.S.C. 1395y(a)(15)) is amended by inserting “(including subsequent insertion of an intraocular lens)” after “operation”. (ii) The amendment made by clause (i) shall apply to operations performed on or after 60 days after the date of the enactment of this Act. (5) Section 4048.— (A) Section 1842(b)(H)(C)(i) of the Social Security Act, as inserted by section 4046(a)(1)(C) of OBRA and as designated by section 4063(a)(1)(A), is amended by striking “implantation” and inserting “insertion”. 102 STAT. 779 (B) Section 1842(j)(1)(D)(ii)(IV) of the Social Security Act, as inserted by section 4046(a)(2)(A) of OBRA, is amended by striking “is”. (6) Section 4047.— (A) The heading of section 4047 of OBRA is amended by striking “PRIMARY CARE” and inserting “CERTAIN”. (B) Section 1842(b)(4)(G) of the Social Security Act, as added by section 4047(a) of OBRA, is amended— (i) by inserting “than” after “(other”, and (ii) by striking “(as determined under the third and fourth sentences of paragraph (3) and under paragraph (4))”. (C) Section 4047(b) of OBRA is amended by inserting “on or” after “medicare beneficiaries”. (D) The item in the table of contents of title IV of OBRA relating to section 4047 is amended to read as follows: “Sec. 4047. Customary charges for certain services of new physicians.”. (7) Section 4048.— (A) Paragraph (14) of section 1842(b) of the Social Security Act, as added by section 4048(a) of OBRA, is redesignated as paragraph (13). (B) Section 4048 of OBRA is amended by adding at the end the following new subsection: “(e) Conforming Amendment to Maxmimum Allowable Actual Charge.—Section 1842(1)(1)(C) of the Social Security Act (42 U.S.C. 1395u(j)(1)(C)), as amended by sections 4085(i)(7)(C) and 4041(a)(1)(B) of this title, is amended by adding at the end the following new clause: “(ix) If there is a reduction under subsection (b)(IS) in the reasonable charge for medical direction furnished by a nonparticipating physician, the maximum allowable actual charge otherwise permitted under this subsection for such services shall be reduced in the same manner and in the same percentage as the reduction in such reasonable charge.’.”. (8) Section 4049.— (A) Section 1834(b)(6) of the Social Security Act, as added by section 4049(a)(2) of OBRA, is amended by striking “radiologic” each place it appears and inserting “radiology”. (B) Section 4049(a) of OBRA is amended— (i) in paragraph (1), by striking “4062(c)(3)” and inserting “4062(d)(3)”, and (ii) in paragraph (2), by striking “4062(a)” and inserting “4062(b)’. (C) Section 1833(a)(1) of the Social Security Act, as amended by section 4049(a)(1)of OBRA, is amended in the clause added by that section by striking “1834(b)(5)” and inserting “1834(b)(6)”. (D) Section 1834(b) of the Social Security Act, as added by section 4049(a)(2) of OBRA, is amended— (i) “physicians”; (ii) in paragraph (5)(0, by striking “imposes a charge” and inserting “bills”; (iii) in paragraph (5)(0, by inserting “in the same manner as such sanctions may apply to a physician” after “18420)(2)”; 102 STAT. 780 (iv) in paragraph (6), by striking “, section 1833(a)(1)(I), and section 1842(h)(1)(B)” and inserting “and section 1833(a)(1)(J)”; and (v) in paragraph (6)(B), by striking “billings” and inserting “the total amount of charges”. (E) Section 4049(b) of OBRA is amended by striking “establish” and inserting “propose”. (9) Section 4051.—Section 1842(n) of the Social Security Act, as added by section 4051(a) of OBRA, is amended— (A) in paragraph (1) in the matter before subparagraph (A)— (i) by striking “to a patient”, (ii) by inserting “the bill or request for” after “for which”, (iii) by striking “his” and inserting “a”, and (iv) by striking “supervised the test” and inserting “supervised the performance of the test”; (B) in paragraph (1)(A), by striking “to individuals enrolled under this part”; (C) in paragraph (2)(A), by inserting “the payment amount specified in paragraph (1)(A) and” after “other than”; and (D) in paragraph (3), by striking “or supplier”. (10) First section 4052.— (A) Section 1892(a) of the Social Security Act, as added by the first section 4052(a) of OBRA, is amended— (i) in paragraphs (2)(C)(ii) and (3)(B), by striking “paragraph (3)” and inserting “paragraph (4)”, (ii) in paragraph (4), by striking “bar” and inserting “exclude”, and (iii) in paragraph (4), by inserting before the period at the end the following: “if a State requests that the physician not be excluded”. (B) The first section 4052(b) of OBRA (relating to conforming reference) is amended by striking “338E(b)(1)” and “254o(b)(1)K and inserting “338E)(b)(1)(B)(i)” and “254o(b)(1)(B)(i)”, respectively. (C) (i) Section 1892 of the Social Security Act, as added by the first section 4052(a) of OBRA, is amended— (I) in the heading, by striking “physicians” and “schoolarship” and inserting “individuals” and “scholarship” and inserting “individuals” and “scholarship and loan”, respectively; (II) by striking “physician” each place it appears (other than the third place it appears in subsection (a)(4)) and inserting “individual”; (III) by striking “physician” the third place it appears in subsection (a)(4) and inserting “practitioner”; (IV) in paragraph (1)(A), by inserting “, the Physician Shortage Area Scholarship Program, or the Health Education Assistance Loan Program,” after “Scholarship Program”; (V) in subsection (b), by striking “, and (2)” and all that follows through “Act” and inserting “or under subpart III of part F of title VII of such Act (as in effect before October 1, 1976) and which has not been paid by the deadline established by the Secretary pursuant to such respective section”; and 102 STAT. 781 (VI) in subsection (b), by striking the period at the end and inserting or” and by adding at the end the following: “(2) owed by an individual to the United States by reason of a loan covered by Federal loan insurance under subpart I of part C of title VII of the Public Health Service Act and payment for which has not been cancelled, waived, or suspended by the Secretary under such subpart.”. (ii) Section 733(0 of the Public Health Service Act (42 U.S.C. 294(f)) is amended by adding at the end the following: “Procedures for reduction of payments under the medicare program are provided under section 1892 of the Social Security Act.”. (iii) The amendments made by this subparagraph shall be effective 30 days after the date of the enactment of this Act. (11) Second section 4052.— (A) The second section 4052(a) of OBRA is amended by striking “is amended” and all that follows through the end and inserting the following: “is amended by inserting before the period at the end of the next-to-last sentence the following: ‘, and shall remain at such prevailing charge level until the prevailing charge for a year (as adjusted by economic index data) equals or exceeds such prevailing charge level’.”. (B) The second section 4052(b) of OBRA is amended by striking “January” and inserting “April”. (12) Section 4054.— (A) Section 4054 of OBRA is amended to read as follows: “SEC. 4054. APPLYING COPAYMENT AND DEDUCTIBLE TO CERTAIN OUT-PATIENT PHYSICIANS’ SERVICES. “(a) In General.— Section 1833 of the Social Security Act (42 U.S.C. 13951) is amended— “(1) in subsection (a)(1), by striking clause (F), “(2) in subsection (b), by striking paragraph (3) and by re-designating paragraphs (4) and (5) as paragraphs (3) and (4), respectively, and “(3) in subsection (i), by striking paragraph (4). “(b) Effective Date.—The amendments made by subsection (a) shall apply to services furnished on or after April 1, 1988.”. (B) The item relating to section 4054 in the table of contents of title IV of OBRA is amended to read as follows: “Sec. 4054. Applying copayment and deductible to certain outpatient physicians’ services.”. (13) Section 4055.— Section 4055 of OBRA is amended— (A) in subsection (a)(2), by striking “such list” and inserting “such definitions”, and (B) in subsection (b)(1), by striking “dermatology,”. (14) Redesignation.—The second section 4052 of OBRA and sections 4053, 4054, and 4055 of OBRA are redesignated as sections 4053 through 4056, respectively. (g) Corrections Relating to Subpart B of Part 3 of Subtitle A of Title IV (Payments for Other Part B Services).— (1) Section 4062.— (A) The heading of section 1834 of the Social Security Act, as inserted by section 4062(b) of OBRA, is amended by inserting “items and” after “particular”. (B) Subsection (a) of section 1834 of the Social Security Act, as so inserted, is amended— 102 STAT. 782 (i) in paragraph (1)(C), by inserting “or under part A to a home health agency” after “under this part”; (ii) in the second sentence of paragraph (2)(A), by striking “rental” before “payments”; (iii) in paragraph (2)(B)(i), by striking “allowed” and inserting ’‘reasonable”, and in paragraphs (3)(B)(i) and (8)(A)(i)(I), by striking “allowable” and inserting “reasonable”; (iv) in paragraph (3)(A), by striking the extra space after “ventilators”; (v) in paragraph (4), by inserting after “individual patient” the following: and for that reason cannot be grouped with similar items for purposes of payment under this title,”; (vi) in paragraph (4), by inserting “(A)” after “in a lump-sum amount” and by inserting “(B)” after “for that item, and”; (vii) in paragraph (4), by striking “maintenance and service” each place it appears and inserting “maintenance and servicing”, in paragraph (7)(A)(iii), by striking “service and maintenance” and inserting “maintenance and servicing”, and in paragraphs (7)(A)(ii) and (11)(A), by striking “servicing” and inserting “maintenance and servicing”; (viii) in paragraph (7)(A)(iii)(I), by striking “fee established by the carrier” and inserting “fee or fees established by the Secretary ”; (ix) in paragraph (9)(A)(ii)(I), by striking “12-month period” and inserting “6-month period”; (x) in paragraph (9)(A)(ii)(H), by striking “and to 1991” and inserting “, 1991, and 1992”; (xi) in paragraphs (9)(B)(i) and (10)(B)(i), by striking the comma after “1991”; (xii) in paragraph (9)(C)(i), by striking “subparagraph (A)(ii)(D” and inserting “subparagraph (A)(ii)”; (xiii) in paragraph (10)(B), by inserting before the period the following: ,rand payments under this subsection as such provisions apply to physicians’ services and physicians and a reasonable charge under section 1842(b)”; (xiv) in the last sentence of paragraph (11)(A), by striking “under subsection (j)(2)” and inserting “under section 1842q)(2)”; (xv) in paragraph (12), by striking “(as defined in section 1886(d)(2)(D))”; and (xvi) by striking paragraph (14). (C) Section 4062(c)(4) of OBRA is amended— (i) by inserting “and payment of a reasonable copying fee which the Secretary may establish” after “upon written request”, and (ii) by inserting before the period at the end the following: “, but only in a form which does not permit identification of individual suppliers”. (D) The last sentence of section 1866(a)(2)(A) of the Social Security Act, as added by section 4062(d)(4) of OBRA, is amended by striking “section 1834(a)(2)” and inserting “section 1834(a)(1)(B)”. (E) The matter added by section 4062(d)(3)(A)(ii) of OBRA is amended by striking “and” before “(I)”. 102 STAT. 783 (2) Section 4063.— (A) Section 1842(b)(H)(C)(ii) of the Social Security Act, as amended by section 4063(a)(1)(A) of OBRA, is amended— (i) by striking “implanted” and inserting “inserted”, and (ii) by inserting “or subsequent to” after “during”. (B) Subclause (IV) of section 1842(j)(1)(D)(ii) of the Social Security Act, as inserted by section 4063(a)(2)(A) of OBRA, is redesignated as subclause (V) and is amended by striking “is”. (C) Section 4063(a)(2)(B) of OBRA is amended by striking clause (ii) and by redesignating clauses (iii) and (iv) as clauses (ii) and (iii), respectively. (D) Section 1833(i)(2)(A)(iii) of the Social Security Act, as inserted by section 4063(b)(3) of OBRA is amended— (i) by striking “implantation” and inserting “insertion”, and (ii) by inserting “or subsequent to” after “during”. (E) Section 4063 of OBRA is amended by adding at the end the following new subsection: “(e) Prevention of Additional Billings for IOLs.— “(1) Section 1833(i) of the Social Security Act (42 U.S.C. 13951(i)) is amended by adding at the end the following new paragraph: “(6) Any person, other than a facility having an agreement under section 1832(a)(2)(F)(i), who knowingly and willfully presents, or causes to be presented, a bill or request for payment, for an intraocular lens inserted during or subsequent to cataract surgery for which payment may be made under paragraph (2)(A)(iii), is subject to a civil money penalty of not to exceed $2,000. The provisions of section 1128A (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 1128A(a).’. “(2) Section 1832(a)(2)(F)(i) of such Act (42 U.S.C. 1395k(a)(2)(F)(D) is amended by inserting ‘(including intraocular lens in cases described in section 1833(i)(2)(A)(iiD)Y after ‘services’ each place it appears.”. (3) Section 4064.— (A) Section 4064(a) of OBRA is amended by striking all that follows the first dash and inserting the following: “Paragraph (2) of section 1833(h) of the Social Security Act (42 U.S.C. 13951(h)) is amended— “(1) by inserting ‘(A)(i)’ after ‘(2)’; “(2) in the second sentence— “(A) by redesignating clauses (A) and (B) as clauses (i) and (ii), respectively, and “(B) by designating such sentence as subparagraph (B); and “(3) by adding at the end of subparagraph (A)(i), as designated under paragraph (1), the following new clause: “‘(ii) Notwithstanding any other provision of this subsection— “‘(I) any change in the fee schedules which would have become effective under this subsection for tests furnished on or after January 1, 1988, shall not be effective for tests furnished during the 3-month period beginning on January 1, 1988, and ‘“(II) the Secretary shall not adjust the fee schedules under clause (i) to take into account any increase in the consumer price index for 1988.’.”. (B) Section 4064(b)(1)of OBRA is amended— 102 STAT. 784 (i) by striking “1833(h)(2) of the Social Security Act (42 U.S.C. 13951(h)(2))” and inserting “1833(h)(2)(A) of the Social Security Act (42 U.S.C. 13951(h)(2)(A)), as amended by subsection (a),”; (ii) by striking “the following: ‘In establishing fee schedules under the first sentence of this paragraph with respect to” and inserting “the following new clause: “‘(iii) In establishing fee schedules under clause (i) with respect to”; and (iii) by moving the indentation of all the matter added following “with respect to” 2 ems to the left. (C) The clause added by section 4064(b)(1) of OBRA, as amended by subparagraph (A), is amended by inserting before the period at the end the following: and such reduced fee schedules shall serve as the base tor 1989 and subsequent years”. (D) Section 1833(h)(4)(B)(ii) of the Social Security Act, as amended by section 4064(b)(2)(B) of OBRA, is amended by inserting “after” before “March”. (E) Section 4064(c) of OBRA is amended by striking all that follows the dash and inserting the following: “Section 1833(h)(1)(D) of such Act is amended by inserting “, in a sole community hospital (as defined in the last sentence of section 1886(d)(5)(C)(ii))? after ‘a hospital laboratory’.”. (F) Section 4064(c) of OBRA is amended by inserting “(1)” after the dash and by adding at the end the following new paragraph: “(2) The amendment made by paragraph (1) shall apply with respect to diagnostic laboratory tests furnished on or after April 1, 1988.”. (G) Section 1846 of the Social Security Act, as added by section 4064(d)(1)of OBRA, is amended— (i) in subsection (a)— (I) by striking “certified” and “certification” and inserting “approved” and “approval”, respectively, (II) by inserting “or for coverage” after “conditions of participation”, and (III) by striking “cancelling immediately the certification of the provider or clinical laboratory” and inserting “terminating immediately the provider agreement or cancelling immediately approval of the clinical laboratory”; (ii) in subsections (b)(1)(A) and (b)(2)(A)(iv), by striking “certified”; (iii) in subsection (b)(2)(A)(ii), by striking “civil fines and penalties” and inserting “civil money penalties in an amount not to exceed $10,000 for each day of substantial noncompliance”; (iv) in subsection (b)(2)(A), by adding at the end the following new sentence: “The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (ii) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). (v) in subsection (b)(2)(A)(iii), by striking “certification”; (vi) in subsection (b)(2)(A)(iv), by striking “provided on or after the date in” and inserting “furnished on or after the date on”; and 102 STAT. 785 (vi) in subsection (b)(3), by striking “fines” and inserting “penalties” each place it appears. (H) The matter inserted in section 1861(s) of the Social Security Act by section 4064(e)(1) of OBRA is amended by inserting a comma after “year”. (4) Section 4066.— (A) The heading of section 4066 of OBRA is amended by inserting “AND OTHER DIAGNOSTIC TESTS” after “RADIOLOGY” (B) The item relating to section 4066 in the table of contents of title IV of OBRA is amended to read as follows: “Sec. 4066. Payments to hospital outpatient departments for radiology and other diagnostic tests.”. (C) Section 1833(n) of the Social Security Act, as added by section 4066(a)(2) of OBRA, is amended— (i) in paragraph (1)(A), by striking “beginning on or after October 1, 1988, under this part for services described in subsection (a)(2)(E)” and inserting “for services described in subsection (a)(2)(E)(i) furnished under this part on or after October 1, 1988, and for services described in subsection (a)(2)(E)(ii) furnished under this part on or after October 1, 1989,”; (ii) in paragraph (1)(B)(i)(II), by inserting “or (for services described in subsection (a)(2)(E)(i) furnished on or after January 1, 1989) the fee schedule amount established” after “the prevailing charge”; and (iii) by amending subclauses (I) and (II) of paragraph (1)(B)(ii) to read as follows: “(I) The term ‘cost proportion’ means 50 percent, except that such term means 65 percent in the case of outpatient radiology services for portions of cost reporting periods which occur in fiscal year 1989 and in the case of diagnostic procedures described in subsection (a)(2)(E)(ii) for portions of cost reporting periods which occur in fiscal year 1990. “(II) The term ‘charge proportion’ means 100 percent minus the cost proportion.”. (5) Section 4067.—Section 1833(f) of the Social Security Act, as inserted by section 4067(a) of OBRA, is amended by striking “medicare economic index (referred to in the fourth sentence of section 1842(b)(3)) applicable to physicians’ services” and inserting “MEI (as defined in section 1842(i)(3)) applicable to primary care services (as defined in section 1842(i)(4))”. (6) Section 4068.—The last sentence of section 1135(d)(3) of the Social Security Act, as added by section 4068(b)(1)of OBRA, is amended by striking “speciality” and inserting “specialty”. (h) Corrections Relating to Subpart B of Part 3 of Subtitle A of Title IV (Part B Eligibility and Benefits Changes).— (1) Section 4070.— (A) The last sentence of section 1833(c) of the Social Security Act, as added by section 407()(a)(2) of OBRA, is amended by striking “prescribing or monitoring prescription drugs” and inserting “monitoring or changing drug prescriptions”. (B) Section 1861(ff) of the Social Security Act, as added by section 4070(b)(2) of OBRA, is amended— (i) by inserting before such subsection the following heading: 102 STAT. 786 “Partial Hospitalization Services”, and (ii) in paragraph (3), by striking “hospital-based or hospital-affiliated (as defined by the Secretary)” and inserting “furnished by a hospital to its outpatients”. (2) Section 4071.—Section 1861(s)(10)(A) of the Social Security Act, as amended by section 4071(a) of OBRA, is amended by inserting “, subject to section 4071(b) of the Omnibus Budget Reconciliation Act of 1987,” before “influenza vaccine”. (3) Section 4072.— (A) Section 1861(s)(12) of the Social Security Act, as amended by section 4072(a) of OBRA, is amended by inserting “subject to section 4072(e) of the Omnibus Budget Reconciliation Act of 1987,” after “(12)”. (B) Section 4072(b) of OBRA is amended— (i) by striking “by inserting after subsection (e)” and inserting “by adding at the end, as previously amended,”, and (ii) by redesignating the subsection added by such section as subsection (o). (4) Section 4073.— Section 4073 of OBRA is amended— (A) by striking paragraph (1) of subsection (b); (B) in paragraph (2) of subsection (b)— (i) by redesignating such paragraph as paragraph (1); (ii) by inserting “and” at the end of subparagraph (A); (iii) by striking subparagraph (B); (iv) in the matter added by subparagraph (C)— (I) by striking “and (I)” and inserting “(K)”, (II) by inserting “80 percent of the lesser of the actual charge for the services or” after “amounts paid shall be”, (III) by striking “but in no event more than” and inserting “but in no event shall such fee schedule exceed”, and (IV) by striking the semicolon and inserting a comma; and (v) by redesignating subparagraph (C) as subparagraph (B); (C) in paragraph (3) of subsection (b)— (i) by inserting “, as previously amended,” after “at the end”, (ii) by redesignating such paragraph as paragraph (2), (iii) by redesignating the subsection added by such paragraph as subsection (p), and (iv) by adding at the end of the subsection added by such paragraph the following: “Except for deductible and coinsurance amounts applicable under section 1833, 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 1128A (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 1128A(a).; 102 STAT. 787 (D) in the subsection added by subsection (c)— (i) by redesignating such subsection as subsection (gg), and (ii) in paragraph (1), by striking “his” and inserting “the nurse-midwife’s” and by striking “physician’s” and inserting “physicians” and (E) in the matter inserted by subsection (d)(1), by striking “section 1861(ff)” and inserting “section 1861(gg)”. (5) Section 4074.— Section 4074 of OBRA is amended— (A) in the matter inserted by subsection (a)(1), by striking “(ff)” and inserting “(hh)”, and (B) by redesignating the subsection added by subsection (b) as subsection (hh). (6) Section 4076.—Subsection (a) of section 4076 of OBRA is amended to read as follows: “(a) Services Covered.—Section 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)) is amended by inserting “(D’ before ‘in a hospital’ and by striking ‘or as an assistant at surgery’ and inserting (II) as an assistant at surgery. or (III) in a rural area (as defined in section 1886(d)(2)(D)) that is designated, under section 332(a)(1)(A) of the Public Health Service Act, as a health manpower shortage area,’.”. (7) Section 4077.— Section 4077(b) of OBRA is amended— (A) in paragraph (1), by inserting “by section 4073(a) of this title” after “as amended”; (B) by striking paragraph (2); (C) in paragraph (3)— (i) by striking “1395k(a)(1))” and inserting “13951(a)(1)),” (ii) by striking subparagraphs (A) and (B), (iii) in subparagraph (C), by striking “(I)” and inserting “(K)” and by redesignating such subparagraph as subparagraph (A), (iv) in subparagraph (D), by striking “subparagraph:” and inserting “clause.” and by redesignating such subparagraph as subparagraph (B), and (v) in the matter added by subparagraph (B), as so redesignated— (I) by striking “(J)” and inserting “(L)”, and (II) by inserting “80 percent of the lesser of the actual charge for the services or” after “amounts paid shall be”; (D) in paragraph (4), by striking “section 4073(b)(3)” and inserting “4073(b)(2)”; (E) in paragraph (5), by redesignating the subsection (gg) added by such paragraph as subsection (ii); and (F) by redesignating paragraphs (3) through (6) as paragraphs (2) through (5), respectively. (8) Section 4079.—Section 4079(c)(1) of OBRA is amended by striking “subsection (d)” and inserting “subsection (e)”. (i) Provisions Relating to Subpart D of Part 3 of Subtitle A of Title IV (Other Part B Provisions).— (1) Section 4081.— (A) Section 1842(h)(3)(B) of the Social Security Act, as added by section 4081(a) of OBRA, is amended— (i) in the second sentence— (I) by striking “claims” and inserting “payment”, and 102 STAT. 788 (II) by striking “including such information as the Secretary determines is generally provided” and inserting “shall include an explanation of benefits and any additional information that the Secretary may determine to be appropriate in order”; (ii) in the third sentence, by striking “arrangements” and inserting “agreements”; and (iii) in the fourth sentence— (I) by inserting “by a carrier” after “under this subparagraph”, and (II) by inserting before the period at the end the following: “, and such user fees shall be collected and retained by the carrier” (B) Section 4081(b)(2) of OBRA is amended by redesignating subparagraphs (A) through (C) as subparagraphs (B) through (D), respectively, and by inserting before subparagraph (B), as so redesignated, the following: “(A) in the matter before paragraph (1), by inserting ‘(or, with respect to paragraph (3), the issuer of the policy)’ after ‘he finds that such policy’,”. (C) Section 1882(c)(3) of the Social Security Act, as inserted by section 4081(b)(2)(C) of OBRA, is amended— (i) in subparagraph (A), by striking “claims form” each place it appears and inserting “claim form” in the first 2 places and “notice” in the third place, (ii) in subparagraph (B)(i), by inserting “under the policy” after “payment determination”, and (iii) in subparagraph (B)(ii), by striking “appropriate payment” and inserting “payment covered by such policy’. (D) Section 4081(c)(2)(B)(i) of OBRA is amended by striking “medical” and inserting “medicare”. (E) Section 4081(c)(2)(B)(ii) of OBRA is amended by inserting “or which has not enacted such legislation before July 1, 1988,” after “in which such legislation may be considered”. (2) Section 4082.— Section 4082(c) of OBRA is amended— (A) by striking “1842(b)(5) of such Act (42 U.S.C. 1395u(b)(5)” and inserting “1842(b)(2) of such Act (42 U.S.C. 1395u(b)(2))”, and (B) in paragraph (1), by striking “(5)” and inserting “(2)”. (3) Section 4084.—Section 4084 of OBRA is amended by adding at the end the following new subsection: “(c) Additional Technical Corrections.— “(1) Section 1861(bb)(2) of the Social Security Act (42 U.S.C. 1395x(bb)(2)) is amended by adding at the end the following: ‘Such term also includes, as prescribed by the Secretary, an anesthesiologist assistant.’. “(2) Section 1833(a)(1)(H) of such Act (42 U.S.C. 13951(a)(1)(H)) is amended by striking ‘lesser of the actual charge’ and inserting ‘least of the actual charge, the prevailing charge that would be recognized if the services had been performed by an anesthesiologist,’. “(3) The amendments made by this subsection shall apply to services furnished after December 31, 1988.”. (4) Section 4085.— (A) Section 1845(f) of the Social Security Act, as added by section 4085(a) of OBRA, is amended— (i) in paragraph (1), by striking “October 1st” and inserting “December 31st”, and 102 STAT. 789 (ii) in paragraph (2), by striking “July 1st of the following year” and inserting “the later of (A) July 1st of the following year, or (B) 45 days after the date of a reasonable charge update”. (B) Subparagraph (D) of section 1833(h)(5) of the Social Security Act, as added by section 4085(b)(1) of OBRA, is amended— (i) by striking “If a person” and all that follows through “under subparagraph (C)” and inserting the following: “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”, and (ii) by striking “section 1842(j)(2)” and inserting “paragraphs (2) and (3) of section 1842Q) in the same manner such paragraphs apply with respect to a physician”. (C) Section 4085(i) of OBRA is amended— (i) in the matter inserted by paragraph (1)(A), by inserting a comma after “assignment-related basis”; (ii) in paragraph (1), by striking subparagraph (B); (iii) in paragraph (11), by striking “9367(a)” and inserting “4072(a)’, (iv) in paragraph (21)(D)(1), by inserting “by” after “(i)”; (v) in paragraph (21)(D)(ii), by striking “and by” and all that follows up to the semicolon; and (vi) by adding at the end the following: “(22) (A) Section 1832(a)(2)(F)(ii) of the Social Security Act (42 U.S.C. 1395k(a)(2)(F)(ii)) is amended by striking ‘an assignment described in section 1842(b)(3)(B)(ii)’ and inserting ‘payment on an assignment-related basis’. “(B) Section 1833(h)(5) of such Act (42 U.S.C. 1395101)(5)) is amended, in each of subparagraphs (A) and (C), by striking ‘on the basis of an assignment’ and all that follows through ‘1870(f)(1),’ and inserting ‘on an assignment-related basis’. “(C) Section 1842(b)(7)(B)(iii) of such Act (42 U.S.C. 1395u(b)(7)(B)(ii)) is amended by striking ‘the basis of’ and all that follows through ‘1870(f)(1)’ and inserting ‘an assignment-related basis’. “(23) Section 1833(1)(5)(B)(ii) of such Act (42 U.S.C. 1395k(l)(5)(B)(ii)) is amended— “(A) in the first sentence by striking ‘monetary’ and inserting ‘money’, and “(B) by amending the second sentence to read as follows: ‘The provisions of section 1128A (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 1128A(a).’. “(24) The fourth sentence of section 1842(b)(3) of such Act (42 U.S.C. 1395u(b)(3)) is amended by striking ‘physician services’ and ‘physicians services’ and inserting ‘physicians’ services’ in both places. “(25) Section 1842(b)(12)(C) of such Act (42 U.S.C. 1395u(b)(12)(C)) is amended— “(A) in the first sentence by striking ‘monetary’ and inserting ‘money’, and 102 STAT. 790 “(B) by amending the second sentence to read as follows: ‘The provisions of section 1128A (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 1128A(a).’. “(26) Section 1842(j)(2) of such Act (42 U.S.C. 1395u(j)(2)(B)) is amended— “(A) by striking ‘title’ each place it appears and inserting ‘Act’, and “(B) in subparagraph (B)— “(i) by striking ‘the imposition of, “(ii) by inserting ‘and assessments’ after ‘such penalties’, and “(iii) by amending the second sentence to read as follows: ‘The provisions of section 1128A (other than the first 2 sentences of subsection (a) and other than subsection (b)) shall apply to a civil money penalty and assessment under subparagraph (B) in the same manner as such provisions apply to a penalty, assessment, or proceeding under section 1128A(a), except to the extent such provisions are inconsistent with subparagraph (A) or paragraph (3).’. “(27) Section 1842(l)(1)(C)(i) of such Act (42 U.S.C. 1395u(l)(1)(C)(i)) is amended by inserting ‘the physician establishes that’ after ‘(i)’. “(28) Section 1866(g) of such Act (42 U.S.C. 1395cc(g)) is amended— “(A) in the first sentence by striking ‘monetary’ and inserting ‘money’, and “(B) by amending the second sentence to read as follows: ‘The provisions of section 1128A (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 1128A(a).’.”. (D) (i) Section 1862(e) of the Social Security Act (42 U.S.C. 1395y(e)) is amended— (I) by striking “or section 1128A” and inserting “, 1128A, 1156, 1842(j)(2), or 1867(d)”, (II) by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), and (III) by inserting “(1)” after “(e)”. (ii) Section 1890 of the Social Security Act, as added by section 10 of Public Law 100–93, is amended— (I) by striking its heading, (II) by striking “Sec. 1890” and inserting “(2)”; (III) by inserting “1842(j)(2),” before “1862(d),”; (IV) by striking “or 1866” and inserting “1866, or 1867(d)”; and (V) by transferring and adding such provision at the end of section 1862(e) of such Act. (j) Corrections to Part 4 of Subtitle A of Title IV (Relating to Peer Review Organizations).— (1) Section 4091.—Section 4091(a)(1)(B) of OBRA is amended by striking “renewals occurring” and inserting “contracts expiring”. 102 STAT. 791 (2) Section 4093.—Section 1154(a)(3) of the Social Security Act, as amended by section 4093(a) of OBRA, is amended by amending the last sentence to read as follows: “(C) The discussion and review conducted under subparagraph (B)(H) shall not affect the rights of a practitioner or provider to a formal reconsideration of a determination under this part (as provided under section 1155).”. (3) Section 4094.— (A) Section 4094(a) of OBRA is amended by striking “subparagraph (B)” and inserting “subparagraph (A)”. (B) Section 1154(a)(15) of the Social Security Act, as added by section 4094(b) of OBRA, is amended by striking “at at” and inserting “in at”. (4) Section 4096.— (A) Section 4096(a)(1)(A) of OBRA is amended by striking “(b)(3)(ii)” and inserting “(b)(3)(B)(ii)”. (B) Section 1870(f) of the Social Security Act, as amended by section 4096(a)(2) of OBRA, is amended by striking “specified in subclauses (I) and (II) of ” and inserting “of assignment specified in”. (C) Sections 1154(e)(3)(A)(i) and 1154(e)(3)(B) (42 U.S.C. 1320c–3(e)(3)(A)(i), 1320c–3(e)(2)(B)), as amended by section 4096(c) of OBRA, are each amended by striking “or (2)” before “paragraph (2)”. (5) Section 4097.—Section 4097(b) of OBRA is amended by striking “1866(a)(4)(C)(ii) of such Act (42 U.S.C. 1395cc(a)(4)(C)(ii)) ” and inserting “1866(a)(3)(C)(ii) of such Act (42 U.S.C. 1395cc(a)(3)(C)(ii))”. (k) Corrections to Subtitle B of Title IV (Relating to Medic-aid).— (1) Table of contents.—The table of contents of title IV of OBRA is amended by striking the item relating to section 4105 and by redesignating the items relating to sections 4106 and 4107 as relating to sections 4105 and 4106, respectively. (2) Section 4101.—Section 1916(c)(1)of the Social Security Act, as inserted by section 4101(d)(1)(C) of OBRA, is amended by striking “nonfarm”. (3) Section 4102.— (A) Section 1915(d)(5)(B) of the Social Security Act, as amended by section 4102(a)(1)(B) of OBRA, is amended— (i) in clause (iii)(TII), by striking “75” and inserting “65”, and (ii) by inserting before “Effective on” the following: “The Secretary shall develop (by not later than October 1, 1989) a method for projecting, on a State-specific basis, the percentage increase in the number of residents in each State who are over 75 years of age for any period.”. (B) Section 1915(d)(5)(C)(i) of the Social Security Act, as amended by section 4102(a)(1)(B) of OBRA, is amended— (i) by striking “(4)(B),” and inserting “(4), and”, and (ii) by striking “, and services furnished” and all that follows through “subsection (c)”. (4) Section 4103.—Section 1905(a)(5)(B) of the Social Security Act, as inserted by section 4103(a) of OBRA, is amended by striking “subparagraph” and inserting “clause”. (5) Section 4104.— (A) Paragraph (1) of section 4104(1) of OBRA is amended to read as follows: 102 STAT. 792 “(1) by striking ‘, or’ at the end of subclause (I)() and inserting a semicolon and by inserting ‘or’ at the end of subclause ()(); and”. (B) Section 1902(a)(10)(A)(ii)()(I) of the Social Security Act, as added by section 4104(2) of OBRA, is amended— (i) by striking “are more restrictive” and inserting “may be more restrictive”, and (ii) by striking the period at the end and inserting a semicolon. (6) Section 4112.— (A) Section 4112 of OBRA is amended— (i) in subsection (a)(2)(A)— (I) by striking “such date” and inserting “April 1, 1989”, and (II) by inserting “, effective for inpatient hospital services provided on or after July 1, 1989” before the period; (ii) in subsection (a)(2)(B)— (I) by striking “such date” and inserting “April 1, 1990”, and (II) by inserting “, effective for inpatient hospital services provided on or after July 1, 1990” before the period; (iii) the undesignated paragraph at the end of subsection (a) is amended— (I) by striking “June 30 of each year in which the State is required to submit” and inserting “90 days after the date a State submits”, (II) by indenting all of such paragraph 2 ems, and (III) by designating the first two sentences thereof as paragraph (3) and the last sentence thereof as paragraph (4); (iv) in subsection (b)(2), by striking “the State plan” and inserting “a State plan”; (v) in subsection (b)(3)(B)(i), by inserting “, less the portion of any cash subsidies described in clause (i)(II) in the period reasonably attributable to inpatient hospital services” after “charity care in a period”; (vi) in subsection (c)— (I) by striking “paragraphs (2)(A) and (2)(B)” and inserting “paragraphs (1)(B) and (2)(A) of subsection (a)”, (II) by striking “paragraph (2)(A)” and “paragraph (2)(B)” and inserting “such paragraph (1)(B)” and “such paragraph (2)(A)”, respectively, (III) in paragraph (1), by inserting “at least” after “equal to”, (IV) in paragraph (2), by inserting “(without regard to the election made by a State under subsection (b)(1))” after “payment) and”, (V) in the matter after paragraph (2), by inserting “at least” before “one-third” and before “two-thirds”, and (VI) by adding at the end the following new sentences: “In the case of a hospital described in subsection (d)(2)(A)(i) (relating to children’s hospitals), in computing the hospital’s disproportionate share adjustment percentage for purposes of paragraph (1)(B) of this subsection, the disproportionate patient percent-102 STAT. 793age (defined in section 1886(d)(5)(F)(vi)) shall be computed by substituting for the fraction described in subclause (I) of such section the fraction described in subclause (ID of that section. If a State elects in a State plan amendment under subsection (a) to provide the payment adjustment described in paragraph (2), the State must include in the amendment a detailed description of the specific methodology to be used in determining the specified additional payment amount (or increased percentage payment) to be made to each hospital qualifying for such a payment adjustment and must publish at least annually the name of each hospital qualifying for such a payment adjustment and the amount of such payment adjustment made for each such hospital.”; and (vii) in subsection (e)— (I) by inserting “(1)” after “Special Rule.—”, (II) by inserting “based on a pooling arrangement involving a majority of the hospitals participating under the plan” after “payment adjustments”, and (III) by adding at the end the following new paragraph: “(2) In the case of a State that used a health insuring organization before January 1, 1986, to administer a portion of its plan on a State-wide basis, during the 3-year period beginning on July 1, 1988— “(A) the requirements of subsections (b) and (c) shall not apply if the aggregate amount of the payment adjustments under the plan for disproportionate share hospitals (as defined under the State plan) is not less than the aggregate amount of payment adjustments otherwise required to be made if such subsections applied, and “(B) subsection (d)(2)(B) shall apply to hospitals located in urban areas, as well as in rural areas.”;. (B) Section 4112 of OBRA is further amended— (i) by striking “(a) Implementation of Requirement.—” and inserting the following: “(a) In General.— Title )(I)( of the Social Security Act is amended— “(1) by redesignating section 1923 as section 1924, and “(2) by inserting after section 1922 the following new section: “ ‘adjustment in payment for inpatient hospital services furnished by disproportionate share hospitals “Sec. 1923. (a) Implementation of Requirement.— (ii) in subsection (a)(1), by striking “A State’s plan under title )(I)( of the Social Security Act” and inserting “A State plan under this title”; (iii) in subsection (a)(1), by striking “of such Act”; (iv) in subsection (a), by striking “of Health and Human Services” each place it appears; (v) in the matter following paragraph (2)(B) of subsection (a), by striking “of the Social Security Act”; (vi) in subsections (b) and (c), by striking “under title )(I)( of the Social Security Act” each place it appears and inserting “under this title”, 102 STAT. 794 (vii) in subsection (d)(2)(B), by striking “of the Social Security Act”; (viii) in subsections (b)(2), (b)(3), and (d)(2)(B), by striking double quotation marks enclosing terms and inserting single quotation marks; (ix) by placing opening double quotation marks at the beginning of any matter with an initial paragraph indentation (beginning with subsection (a)(1)) and closing double quotation marks at the end of subsection (e); and (x) by adding at the end the following: “(b) Conforming Amendment.— Section 1903(i)(3) of such Act (42 U.S.C. 1396b(i)(3)) is amended by inserting ‘(other than amounts attributable to the special situation of a hospital which serves a disproportionate number of low income patients with special needs)’ before ‘to the extent’.”. (7) Section 4113.— Section 4113 of OBRA is amended— (A) in the matter inserted by subsection (a)(1)(B)— (i) by moving the left margin of the matter 2 ems to the left, and (ii) by striking “subparagraph (G)” and inserting “subparagraph (E) or (G)”; (B) in the matter inserted by subsection (a)(2), by striking “paragraph (2)(G) or (6)” and inserting “paragraph (2)(B)(iii), (2)(E), (2)(G), or (6)”; (C) in subsection (b)(2)(ii), by striking “such”; and (D) by striking subsection (d) and redesignating subsection (e) as subsection (d). (8) Section 4114.— (A) Section 4114 of OBRA is amended in paragraph (1), by striking “ ‘(1)’ ” and inserting “ ‘(o)(1)’ ”. (B) Section 1905(o)(1)(B) of the Social Security Act, as added by section 4114(3) of OBRA, is amended— (i) by striking “only”, and (ii) by striking “immunodeficiency syndrome” and inserting “immune deficiency syndrome (AIDS)”. (9) Section 4115.— (A) Section 4115 of OBRA is amended— (A) in subsection (b)(4)(B), by striking “program” and inserting “Program”, (B) in subsection (c)— (i) by inserting “under section 9121 of this Act” after “Upon approval”, and (ii) by striking “1916, and 1924” and inserting “1902(e)(1), and 1916”, and (C) by adding at the end the following: “(d) Extension of Texas State Waiver.—Section 9523(a) of the Consolidated Omnibus Budget Reconciliation Act of 1985 is amended by striking ‘January 1, 1989’ and inserting ‘January 1, 1990’.”. (10) Section 4118.— (A) Section 1915(c)(10) of the Social Security Act, as added by section 4118(b) of OBRA, is amended— (i) by striking “No waiver under this subsection shall limit by an amount less than 200” and inserting “The Secretary shall not limit to fewer than 200”, and (ii) by striking “under such waiver” and inserting “under a waiver under this subsection”. (B) Section 4118(e) of OBRA is amended— (i) in paragraph (3), by striking “amendment” and inserting “amendments”, and (ii) in paragraph (1)— 102 STAT. 795 (I) by inserting “(A)” after “(1)”, (II) by striking “1128A(a)(D” and “1320a–7(a)(1)” and inserting “1128(a)” and “1320a–7(a))”, respectively, and (III) by adding at the end the following: “(B) Section 1128A of such Act is amended by adding at the end the following new subsection: “(l) ‘A principal is liable under this section for the actions of the principal’s agent acting within the scope of the agency.’” (C) Section 1128(d)(3)(B)(u) of the Social Security Act, as added by section 4118(e)(2)(B) of OBRA, is amended by striking “under a program”. (D) Section 4118(e) of OBRA is amended by redesignating paragraph (3) as paragraph (14) and by inserting after paragraph (2) the following new paragraphs: “(3) Section 1128(b)(8)(A)(i) of such Act is amended by inserting after ‘(A)(i)’ the following: ‘who has a direct or indirect ownership or control interest of 5 percent or more in the entity or’. “(4) Section 1128(d) of such Act is amended— “(A) in paragraph (1), by striking ‘subsection (b)’ and inserting ‘this section and section 1128A’, and “(B) in paragraph (3)(A), by striking ‘under a program’. “(5) Section 1128(i) of such Act is amended— “(A) in the matter before paragraph (1), by striking ‘a physician or other individual and inserting “an individual or entity”, “(B) in paragraphs (1) through (4), by striking ‘physician or other individual’ each place it appears and inserting ‘individual or entity’, and “(C) in paragraph (4), by striking ‘first offender or other program’ and inserting ‘first offender, deferred adjudication, or other arrangement or program’. “(6) Section U28A(a)(D(D) of such Act is amended— “(A) by striking ‘excluded under’ and inserting ‘excluded from’, and “(B) by inserting ‘or as a result of the application of the provisions of section 1842(j)(2) or section 1867(d)(2)’ after ‘or 1866(b)’. “(7) The second sentence of section 1128A(c)(1) of such Act is amended— “(A) by inserting “, request for payment, or other occurrence described in this section’ after ‘any claim’, and “(B) by inserting “, the request for payment was made, or the occurrence took place’ after ‘claim was presented’. “(8) Section 1128A(i) of such Act is amended, in the matter before paragraph (1), by striking ‘subsection’ and inserting ‘section’. “(9) Section 1128A(i)(1) of such Act is amended by inserting ‘or title )()(’ after ‘title V’. “(10) Section 1128A of such Act is further amended— “(A) in the matter in subsection (a) before paragraph (1), by inserting but excluding a beneficiary, as defined in subsection (1)(5)’ after ‘other entity’, “(B) in subsection (i)(2), by striking ‘submitted by’ and all that follows through the end and inserting ‘for payments for items and services under title V, )(VIII, )(I)(, or )()( of this Act.’, and 102 STAT. 796 “(C) by adding at the end the following new paragraph: “’(5) The term “beneficiary” means an individual who is eligible to receive items or services for which payment may be made under title V, XVIII, XIX, or XX but does not include a provider, supplier, or practitioner.’. “(11) Section 1903(i)(2) of such Act (42 U.S.C. 1396b(i)(2)) is amended— “(A) in subparagraph (A), by striking ‘in the State plan under this title pursuant to section 1128 or section 1128A’ and inserting ‘under title V, XVIII, or XX or under this title pursuant to section 1128, 1128A, 1156, 1842(j)(2), or 1867(d)(2)’, and “(B) in subparagraph (B), by striking ‘pursuant to section 1128 or section U28A from participation in the program under this title’ and inserting ‘from participation under title V, XVIII, or XX or under this title pursuant to section 1128, 1128A, 1156, 1842(j)(2), or 1867(d)(2)’. “(12) Section 504(b)(6) of such Act (42 U.S.C. 704(b)(6)) is amended by striking ‘pursuant to section 1128 or section 1128A from participation in the program under this title’ each place it appears and inserting ‘under this title or title XVIII, XIX, or XX pursuant to section 1128, U28A, 1156, 1842(j)(2), or 1867(d)(2)’. “(13) Section 2005(a)(9) of such Act (42 U.S.C. 1397d(a)(9)) is amended by striking ‘pursuant to section 1128 or section 1128A from participation in the program under this title’ each place it appears and inserting ‘under this title or title V, XVIII, or XIX pursuant to section 1128, 1128A, 1156, 1842(j)(2), or 1867(d)(2)’.”. (E) Section 4118(f)(1) of OBRA is amended by striking “4111(g)(8)” and inserting “4211(h)(8)”. (F) Section 4118(g)(D(B) of OBRA is amended by striking “insert” and inserting “inserting”. (G) Section 4118(h) of OBRA is amended— (i) by inserting a dash after “Expenses.”; (ii) in paragraph (1), by striking “Section 1902(a)(17) of the Social Security Act (42 U.S.C. 1396a(a)(17)) is amended” and inserting “Sections 1902(a)(17) and 1903(f)(2) of the Social Security Act (42 U.S.C. 1396a(a)(17), 1396b(f)(2)) are each amended”; (iii) in paragraph (2), by striking “(2) The amendment made by paragraph (1)” and inserting “(3) The amendments made by this subsection”, and (iv) by inserting after paragraph (1) the following new paragraph: “(2) The first sentence of section 1902(f) of such Act (42 U.S.C. 1396a(f)) is amended by inserting after ‘as recognized under State law’ the following: ‘regardless of whether such expenses are reimbursed under another public program of the State or political subdivision thereof’.”. (H) Section 1915(c)(7)(B) of the Social Security Act, as added by section 4118(k) of OBRA, is amended by inserting before the period at the end the following: “, without regard to the availability of beds for such inpatients”. (I) Section 4118(1)(1) of OBRA is amended by inserting “, as redesignated by section 4102(a),” after “1396n(h))”. 102 STAT. 797 (J) Section 9414(b)(3) of the Omnibus Budget Reconciliation Act of 1986, as amended by section 4U8(o)(1)(C) of OBRA, is amended by striking “nonfarm”. (K) Section 4118(o)(2)(A) of OBRA is amended by inserting “each place it appears” before “and inserting”. (L) Section 4118(p)(9) of OBRA is amended by striking “1925(a)” and “(4111(a))” and inserting “1923(a)” and “4211(a)”, respectively. (M) Section 4118(p) of OBRA is amended by adding at the end the following new paragraph: “(11) Paragraph (5) of section 9432(c) of the Omnibus Budget Reconciliation Act of 1986 is amended to read as follows: “‘(5) The Secretary shall submit an interim report on the results of the study, including an analysis of the geographic variations under paragraph (2), to the Congress not later than January 1, 1990, and shall report the final results of the study to the Congress not later than January 1, 1992.’.”. (11) Omitted section.— (A) Part 2 of subtitle B of title IV of OBRA is amended by adding at the end the following new section: “SEC. 4119. STUDY OF MEANS OF RECOVERING COSTS OF NURSING FACILITY SERVICES FROM ESTATES OF BENEFICIARIES.“The Secretary of Health and Human Services shall study the means of recovering amounts from estates of deceased medicare beneficiaries (or the estates of the spouses of such deceased beneficiaries) to pay for the medical assistance for skilled nursing facility or intermediate care facility services furnished, under title XIX of the Social Security Act, to such medicare beneficiaries. The Secretary shall report to Congress, not later than December 31, 1988, on such means, and include appropriate recommendations for changes in legislation.”. (B) The table of contents of title IV of OBRA is amended by inserting after the item relating to section 4118 the following new item: “Sec. 4119. Study of means of recovering costs of nursing facility services from estates of beneficiaries.”. (12) Medicare conforming amendment to section 4014 of obra.— (A) Paragraph (5) of section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) is amended to read as follows: (5) (A) If the Secretary determines that an entity with a contract under this subsection— (i) fails substantially to provide medically necessary items and services that are required (under law or under the contract) to be provided to an individual covered under the contract, if the failure has adversely affected (or has substantial likelihood of adversely affecting) the individual; (ii) imposes premiums on individuals enrolled under this subsection in excess of the premiums permitted under this title; “(iii) acts to discriminate among individuals in violation of the provision of paragraph (2)(A)(v), including expulsion or refusal to re-enroll an individual or engaging in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment (except as permitted by this subsection) by eligible individuals with the organization whose medical condi-102 STAT. 798 tion or history indicates a need for substantial future medical services; or “(iv) misrepresents or falsifies information that is furnished— “(I) to the Secretary or the State under this subsection, or “(II) to an individual or to any other entity under this subsection, the Secretary may provide, in addition to any other remedies available under law, for any of the remedies described in subparagraph (B). “(B) The remedies described in this subparagraph are— “(i) civil money penalties of not more than $25,000 for each determination under subparagraph (A), or, with respect to a determination under clause (iii) or (iv)(I) of such subparagraph, of not more than $100,000 for each such determination, plus, with respect to a determination under subparagraph (A)(ii), double the excess amount charged in violation of such subparagraph (and the excess amount charged shall be deducted from the penalty and returned to the individual concerned), and plus, with respect to a determination under subparagraph (A)(iii), $15,000 for each individual not enrolled as a result of a practice described in such subparagraph, or “(ii) denial of payment to the State for medical assistance furnished under the contract under this subsection for individuals enrolled after the date the Secretary notifies the organization of a determination under subparagraph (A) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).’. (B) The amendment made by subparagraph (A) shall apply to actions occurring on or after the date of the enactment of this Act. (13) Treatment of educationally-related services.— (A) Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by inserting after subsection (b) the following new subsection: “(c) Nothing in this title shall be construed as prohibiting or restricting, or authorizing the Secretary to prohibit or restrict, payment under subsection (a) for medical assistance for covered services furnished to a handicapped child because such services are included in the child’s individualized education program established pursuant to part B of the Education of the Handicapped Act or furnished to a handicapped infant or toddler because such services are included in the child’s individualized family service plan adopted pursuant to part H of such Act.”. (B) The amendment made by subparagraph (A) shall take effect on the date of the enactment of this Act. (14) Clarification of term “institution for mental diseases”.— (A) Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by inserting after subsection (h) the following new subsection: “(i) The term ‘institution for mental diseases’ means a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of 102 STAT. 799persons with mental diseases, including medical attention, nursing care, and related services.”. (B) The amendment made by subparagraph (A) shall take effect on the date of the enactment of this Act. (15) Eligibility verification technical correction.— (A) Section 1137 of the Social Security Act (42 U.S.C. 1320b–7) is amended by adding at the end the following new subsection: “(f) Subsections (a)(1) and (d) shall not apply with respect to aliens seeking medical assistance for the treatment of an emergency medical condition under section 1903(v)(2).”. (B) The amendment made by subparagraph (A) shall apply as if it were included in the enactment of section 9406 of the Omnibus Budget Reconciliation Act of 1986. (16) Technical corrections relating to presumptive eligibility.— (A) Section 1920(d)(1)(B) of the Social Security Act (42 U.S.C. 1396r–1(d)(D(B)) is amended by striking “by a qualified provider” and inserting “by a provider that is eligible for payments under the State plan”. (B) Section 192()(b)(2)(D) of such Act (42 U.S.C. 1396r–1(b)(2)(D)) is amended— (i) in clause (i)— (I) in subclause (I), by striking “or section 330” and inserting 330, or 340” and by striking “or” at the end, (II) in subclause (II), by striking the semicolon at the end and inserting “, or”, and (III) by adding after subclause (II) the following new subclause: “(III) title V of the Indian Health Care Improvement Act;”; (ii) in clause (ii), by striking “or” at the end; and (iii) by adding at the end the following new clause: “(iv) is the Indian Health Service or is a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act (Public Law 93–638).”. (C) The amendments made by this paragraph shall be effective as if they were included in section 9407(b) of the Omnibus Budget Reconciliation Act of 1986. (17) Waiver for children infected with aids or drug dependent at birth.— (A) Section 1915 of the Social Security Act (42 U.S.C. 1396n) is amended— (i) by redesignating subsection (f) as paragraph (2); (ii) in subsection (e), by striking paragraph (2) and by redesignating such subsection as subsection (f); (iii) by inserting after subsection (d) the following new subsection: “(e) (1) (A) Subject to paragraph (2), the Secretary shall grant a waiver to provide that a State plan approved under this title shall include as ‘medical assistance’ under such plan payment for part or all of the cost of nursing care, respite care, physicians’ services, prescribed drugs, medical devices and supplies, transportation services, and such other services requested by the State as the Secretary may approve which are provided pursuant to a written plan of care to a child described in subparagraph (B) with respect to whom there has been a determination that but for the provision of such services the infants would be likely to require the level of care provided in a 102 STAT. 800hospital or nursing facility the cost of which could be reimbursed under the State plan. “(B) Children described in this subparagraph are individuals under 5 years of age who— “(i) at the time of birth were infected with (or tested positively for) the etiologic agent for acquired immune deficiency syndrome (AIDS), “(ii) have such syndrome, or “(iii) at the time of birth were dependent on heroin, cocaine, or phencyclidine, and with respect to whom adoption or foster care assistance is (or will be) made available under part E of title IV. “(2) A waiver shall not be granted under this subsection unless the State provides assurances satisfactory to the Secretary that— “(A) necessary safeguards (including adequate standards for provider participation) have been taken to protect the health and welfare of individuals provided services under the waiver and to assure financial accountability for funds expended with respect to such services; ”(B) under such waiver the average per capita expenditure estimated by the State in any fiscal year for medical assistance provided with respect to such individuals does not exceed 100 percent of the average per capita expenditure that the State reasonably estimates would have been made in that fiscal year for expenditures under the State plan for such individuals if the waiver had not been granted; and “(C) the State will provide to the Secretary annually, consistent with a data collection plan designed by the Secretary, information on the impact of the waiver granted under this subsection on the type and amount of medical assistance provided under the State plan and on the health and welfare of recipients. “(3) A waiver granted under this subsection may include a waiver of the requirements of section 1902(a)(1)(relating to statewideness) and section 1902(a)(10)(B) (relating to comparability). A waiver under this subsection shall be for an initial term of 3 years and, upon the request of a State, shall be extended for additional five-year periods unless the Secretary determines that for the previous waiver period the assurances provided under paragraph (2) nave not been met. “(4) The provisions of paragraph (6) of subsection (d) shall apply to this subsection in the same manner as it applies to subsection (a).”; and (iv) in subsection (h), by striking “or (d)” and inserting“(d), or (e)”. (B) Section 1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C. 1396a(a)(10)(A)(ii)(VI)) is amended by striking “(c) or (d)” each place it appears and inserting “(c), (d), or(e)”. (l) Corrections Relating to Subtitle C of Title IV (Nursing Home Reform).— (1) Section 4201.— (A) Section 1819 of the Social Security Act, as added by section 4201(a)(3) of OBRA, is amended— (i) in subsection (b)(3)(C)(i)(1), by striking “October 1, 1990” the second place it appears and inserting “January 1, 1991”; (ii) in subsection (b)(4)(C)(i)— (I) by inserting “licensed” after “24-hour”, 102 STAT. 801 (II) by striking “employ” and inserting “use”, and (III) by striking “during the day tour of duty (of at least 8 hours a day)” and inserting “at least 8 consecutive hours a day,”; (III) in subsection (b)(5)(A), by striking “October 1, 1989” and all that follows through “July 1, 1989” and inserting “January 1, 1990”; (iv) in subsection (e)(1)(A), by striking “March 1, 1989” and inserting “January 1, 1989”, (v) in subsection (e)(1)(B), by striking “March 1, 1990” and inserting “January 1, 1990”; (vi) in subsection (e)(2)(A), by striking “March 1, 1989” and inserting “January 1, 1989’”; (vii) in subsection (e)(3), by striking “October 1, 1990” and inserting “October 1, 1989”; (viii) in subsection (e)(5), by striking “July 1, 1989” and inserting “July 1, 1990”; (ix) in subsection (f)(3), by striking “October 1, 1989” and inserting “October 1, 1988”; (x) in subsection (f)(6)(A), by striking “July 1, 1989” and inserting “January 1, 1989”; and (xi) in subsection (f)(6)(B), by striking “October 1, 1990” and inserting “April 1, 1990”. (B) Section 4201(d) of OBRA is amended— (i) by striking “Amendment.—” (ii) by striking “1919(a)(2)” and inserting “1819(a)(1)”, and (iii) by adding at the end the following new paragraph: “(2) Section 1861(n) of such Act (42 U.S.C. 1395x(n)) is amended by striking ‘or (j)(1) of this section’ and inserting ‘or of section 1819(a)(D’.”. (2) Sections 4201 and 4211.— (A) Sections 1819(b)(3)(A)(iv) and 1919(b)(3)(A)(iv) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively, are amended by striking “in the case of a resident eligible for benefits under part A of this title” and by striking “in the case of a resident eligible for benefits under part A of title XVIII respectively”. (B) Sections 1819(b)(3)(A)(iii) and 1919(b)(3)(A)(iii) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively, are amended by striking “in the case of a resident eligible for benefits under title )(I)(,” and “in the case of a resident eligible for benefits under this title,”, respectively. (C) Subclause (III) of each of sections 1819(b)(3)(B)(ii) and 1919Cb)(3)(B)(ii) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively, is amended to read as follows: “(III) The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”. (D) Sections 1819(b)(5) and 1919(b)(5) of the Social Security Act, as added by section 4201(a)(3) of OBRA and as inserted by section 4211(a)(3) of OBRA, respectively, are each amended— 102 STAT. 802 (i) in subparagraph (A), by striking “, who is not a licensed health care professional (as defined in subparagraph (E)),”, (ii) in subparagraph (A)(ii), by striking “such services” and inserting “nursing or nursing-related services”, and (iii) in subparagraph (G), by inserting “physical or occupational therapy assistant,” after “occupational therapist,”. (E) Effective as of the date of the enactment of this Act and until the effective date of section 1819(c) of such Act, section 1861(j) of the Social Security Act is deemed to include the requirement described in section 1819(c)(3)(A) of such Act (as added by section 4201(a)(3) of OBRA). (F) Sections 1819(c)(2)(A)(v) and 1919(c)(2)(A)(v) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively, are each amended by striking “an allowable charge” and all that follows through the semicolon and inserting “for a stay at the facility;”. (G) Sections 1819(c)(6) and 1919(c)(6) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively, are each amended— (i) in subparagraph (A)(ii), by striking “once the facility accepts” and inserting “upon”, and (ii) in subparagraph (B), by striking “a facility’s acceptance of”. (H) Sections 1819(e)(2)(B) and 1919(e)(2)(B) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively are each amended by inserting after the first sentence the following sentence: “The State shall make available to the public information in the registry.”. (I) Sections 1819(e)(3), 1819(f)(3), 1919(e)(3), and 1919(f)(3) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 42U(a)(3) of OBRA, are each amended— (i) by inserting “and discharges” after “transfers” (ii) by inserting “and discharges” after “transfers”. (J) Sections 1819(f)(2)(A)(i)(I) and 1919tf)(2)(A)(i)(I) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively, are each amended by striking “cognitive, behavioral and social care” and inserting “recognition of mental health and social service needs”. (K) Sections 1819(f)(7) and 1919(f)(7) of the Social Security Act, as added by section 4201(a)(3) and as inserted by section 4211(a)(3) of OBRA, respectively, are each amended by striking “patients” and inserting “residents”. (L) (i) Section 1819(1)(7)(8) of the Social Security Act, as added by section 4201(a)(3), is amended by striking “shall not” and inserting “shall”. (ii) Section 1919(f)(7)(B) of the Social Security Act, as inserted by section 4211(a)(3) of OBRA, is amended by striking “do not”. (3) Section 4211.— (A) Section 1919(b)(4)(C) of the Social Security Act, as inserted by section 4211(a) of OBRA, is amended— (i) by striking “registered nurse” each place it appears and inserting “registered professional nurse”; (ii) by striking “employ” and inserting “use”; (iii) by striking “(u) Facility waivers.—” and all that follows through “(i) Waiver” and inserting “(ii) Waiver”; 102 STAT. 803 (iv) by striking “and subject to clause (ii)” and inserting “and subject to clause (iii)”; (v) by striking “(ii) Assumption” and inserting “(iii) Assumption”; and (vi) in clause (iii), as so redesignated, by striking “excercise” and inserting “exercise”. (B) Section 1919(b)(5)(A) of the Social Security Act, as added by section 4211(a)(3) of OBRA, is amended by striking “subparagraph (E)” and inserting “subparagraph (F)”. (C) Effective as of the date of the enactment of this Act and until the effective date of section 1919(c) of such Act, section 1905(c) of the Social Security Act is deemed to include the requirement described in section 1919(c)(3)(A) of such Act (as inserted by section 4211(a)(3) of OBRA). (D) Section 1919 of the Social Security Act, as inserted by section 4211(a)(3) of OBRA, is amended— (i) in subsection (e)(1)(A), by striking “September 1, 1988” and inserting “January 1, 1989”; (ii) in subsection (e)(1)(B), by striking “September 1, 1990” and inserting “January 1, 1990”; (iii) in subsection (e)(7)(E), by striking “October 1, 1988” and inserting “April 1, 1989”; and (iv) in subsection (f)(2), by striking “July 1, 1988” and inserting “September 1, 1988”. (E) Section 1902(a)(28)(D)(i) of the Social Security Act, as amended by section 4211(b)(1)(B) of OBRA, is amended by striking “1919(f)” and all that follows through “instrument)” and inserting “1919(e)”. (F) Section 4211(d)(2) of OBRA is amended by striking “For calendar quarters during fiscal years 1988 and 1989” and inserting “For the 8 calendar quarters (beginning with the calendar quarter that begins on July 1, 1988)”. (G) Section 4211(h)(10)(G) of OBRA is amended by adding before the period at the end the following: “, and by striking ‘skilled nursing facility or intermediate care facility’ in subparagraph (B) and inserting ‘nursing facility’”. (H) Section 4211(h)(2) of OBRA is amended— (i) in subparagraph (C), by striking “inserting ‘nursing facilities’” each place it appears and inserting “inserting ‘nursing facilities and for intermediate care facilities for the mentally retarded’ ”, (ii) in subparagraph (D)(i), by striking “inserting ‘nursing facility’ ” and inserting “inserting ‘nursing facility or intermediate care facility for the mentally retarded’ ”, and (iii) in subparagraph (D)(ii), by striking “inserting ‘nursing facility’ ” and inserting “inserting ‘nursing facility services or services in an intermediate care facility for the mentally retarded”. (I) Subparagraph (B) of section 4211(h)(12) of OBRA is amended to read as follows: “(B) in subsection (c)(2)(B)(ii), by striking ‘skilled’ each place it appears.”. (4) Section 4202.—Section 1819(g)(2)(C)(i) of the Social Security Act, as added by section 4202(a) of OBRA, is amended by striking “October 1, 1990” and inserting “January 1, 1990”. 102 STAT. 804 (5) Sections 4202 and 4212.—Sections 1819(g) and 1919(g) of the Social Security Act, as added by sections 4202(a)(2) and 4212(a) of OBRA, respectively, are amended— (A) in paragraph (1)(C), by striking “, review,” and inserting “and timely review”; (B) in the first sentence of paragraph (1)(C), by inserting “or by another individual used by the facility in providing services to such a resident” after “a nursing facility”; (C) by striking the second sentence of paragraph (1)(C) and inserting the following: “The State shall, after notice to the individual involved and a reasonable opportunity for a hearing for the individual to rebut allegations, make a finding as to the accuracy of the allegations. If the State finds that a nurse aide has neglected or abused a resident or misappropriated resident property in a facility, the State shall notify the nurse aide and the registry of such finding. If the State finds that any other individual used by the facility has neglected or abused a resident or misappropriated resident property in a facility, the State shall notify the appropriate licensure authority.”; (D) in paragraph (1)(D), by striking “to establish standards under subsection (f)” and inserting “to issue regulations to carry out this subsection”; (E) in paragraph (2)(A)(i), by amending the third sentence to read as follows: “The provisions of section 1128A (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 1128A(a).”; (F) in paragraph (3)(D) (relating to special surveys of compliance, as redesignated by paragraph (6)(A) in the case of section 1919(g)), by striking “on that basis” and inserting “on the basis of that survey”; and (G) in paragraph (4), by striking “chronically”. (6) Section 4212.— (A) Section 1919(g)(3) of the Social Security Act, as added by section 4212(a) of OBRA, is amended by redesignating the second subparagraph (C) (relating to special surveys of compliance) as subparagraph (D). (B) Section 4212(b) of OBRA is amended to read as follows: “(b) Posting Survey Results.— Section 1919(c) of such Act is amended by adding at the end the following new paragraph: “(7) Posting or survey results.— A nursing facility must post in a place readily accessible to residents, and family members and legal representatives of residents, the results of the most recent survey of the facility conducted under subsection (g).’”. (C) Section 1902(a)(33)(B) of the Social Security Act, as amended by section 4212(d)(3) of OBRA, is amended by striking “1919(d)” and inserting “1919(g)”. (D) Section 4212(e)(1)(B) of OBRA is amended by inserting “provided” after “services” each place it appears. (E) Section 4212(e) of OBRA is amended by adding at the end the following new paragraph: “(5) Section 1922(e) of such Act, as redesignated and transferred by section 4211(a)(2) of this Act, is amended by striking ‘1910(c)’ in paragraphs (1) and (2)(A) and inserting ‘1910(b)’.”. 102 STAT. 805 (7) Sections 4203 and 4213.— (A) Sections 1819(h)(2)(B)(ii) and 1919(h)(3)(C)(ii) of the Social Security Act, as added by sections 4203(a)(2) and 4213(a) of OBRA, respectively, are each amended by striking “and the Secretary” and all that follows through “1128A.” and inserting the following: “. The provisions of section 1128A (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 1128A(a).”. (B) Sections 1819(h)(6) and 1919(h)(9) of the Social Security Act, as added by sections 4203(a)(2) and 4213(a) of OBRA, respectively, are each amended by inserting “by such facilities” after “shall be made available”. (8) Section 4213.— (A) Section 4213(a) of OBRA is amended by striking “as inserted by section 4201 and amended by section 4202” and inserting “as inserted by section 4211 and amended by section 4212”. (B) Section 1919(h) of the Social Security Act, as added by section 4213(a) of OBRA, is amended— (i) in the last sentence of paragraph (1), by striking “(2)(A)(i)” and inserting “(2)(A)(ii)”, (ii) in the second sentence of paragraph (2)(B)(i), by striking “or otherwise”, and (iii) in paragraph (5), by striking “State and the Secretary” and inserting “State or the Secretary, respectively”. (C) Paragraph (1) of section 4213(b) of OBRA is amended by striking “1902” and all that follows through the end and inserting the following: “1902(i) of such Act (42 U.S.C. 1396a(i)) is amended— “(A) in paragraph (1), by striking ‘skilled nursing facility or intermediate care facility’ and inserting ‘intermediate care facility for the mentally retarded’; “(B) in paragraph (1), by striking ‘the provisions of section 18610) or section 1905(c), respectively,’ and inserting ‘the requirements for such a facility under this title’; and “(C) in paragraphs (2) and (3), by striking ‘the provisions of section 18610) or section 1905(c) (as the case may be)’ and inserting ‘the requirements for such a facility under this title’.”. (9) Section 4204.— (A) Section 4204(a) of OBRA is amended by striking “extended care”. (B) Section 4204 of OBRA is amended— (i) in subsection (a), by striking “made by this part” and inserting “made by sections 4201 and 4202 (relating to skilled nursing facility requirements and survey and certification requirements)”, (ii) by redesignating subsection (c) as subsection (d), and (iii) by inserting after subsection (a) the following new subsection: “(b) Enforcement.— (1) Except as otherwise specifically provided n section 1819 of the Social Security Act, the amendments made by section 4203 of this Act apply January 1, 1988, without regard to whether regulations to implement such amendments are promulgated by such date. “(2) In applying the amendments made by section 4203 of this Act or services furnished by a skilled nursing facility before October 1, 1990, any reference to a requirement of subsection (b), (c), or (d), of 102 STAT. 806 section 1819 of the Social Security Act is deemed a reference to the provisions of section 1861(j) of such Act.”. (10) Section 4214.— Section 4214 of OBRA is amended— (A) by striking “(c) Transitional Rule.—”and inserting “(2)”, (B) by inserting “of section 1919 of the Social Security Act” after “(b), (c), or (d)”, and (C) by redesignating subsection (d) as subsection (c). (m) Corrections to Subtitle E of Title IV (Relating to Rural Health).— (1) Section 4401.—Section 711(b)(1) of the Social Security Act, as added by section 4401 of OBRA, is amended by striking “section 4083 of the Omnibus Budget Reconciliation Act of 1987” and inserting “section 4403 of the Omnibus Budget Reconciliation Act of 1987 (as such section pertains to rural health issues)”. (2) Section 4403.— (A) Section 4403 of OBRA is amended— (i) in the heading, by striking “EXPERIMENTS AND DEMONSTRATION PROJECTS RELATING TO RURAL HEALTH CARE ISSUES” and inserting “RESEARCH AND DEMONSTRATION PROJECTS ON RURAL AND INNER-CITY HEALTH ISSUES”; (ii) in subsection (a)— (I) by striking “Set Aside.—” and inserting “Set Asides for Issues of Health Care in Rural Areas and In Inner-City Areas.—(1)”, (II) by striking “expended in each fiscal year” and all that follows through “1972” and inserting “annually appropriated to, and expended by, the Health Care Financing Administration for the conduct of research and demonstration projects in fiscal years 1988, 1989, and 1990”, (III) by striking “experiments” and inserting “research”; (iii) by adding at the end the following new paragraph: “(2) Not less than ten percent of the total amounts annually appropriated to, and expended by, the Health Care Financing Administration for the conduct of research and demonstration projects in fiscal years 1988, 1989, and 1990 shall be expended for research and demonstration projects relating exclusively or substantially to issues of providing health care in inner-city areas, including (but not limited to) the impact of the payment methodology under section 1886(d) of the Social Security Act on the financial viability of inner-city hospitals and the impact of medicare policies on access to (and the quality of) health care in inner-city areas.”; and (iv) in subsection (b)— (I) by striking “of experiments” and inserting “of research”, (II) by inserting “or to inner-city health issues” after “rural health issues”, and (III) by striking “experiments and”. (B) The item in the table of contents of OBRA relating to section 4403 is amended to read as follows: “Sec. 4403. Set aside for research and demonstration projects on rural and inner-city health issues.”. 102 STAT. 807 (n) Corrections to Certain Health-Related Provisions in Title I)(.— (1) Section 9010.—The last sentence of section 226(b) of the Social Security Act, as added by section 9010(e)(3) of OBRA, is amended to read as follows: “In determining when an individual’s entitlement or status terminates for purposes of the preceding sentence, the term ‘36 months’ in the second sentence of section 223(a)(1), in section 202(d)(1)(G)(i), in the last sentence of section 202(e)(1), and in the last sentence of section 202(f)(1) shall be applied as though it read ‘15 months’.”. (2) Section 9115.—Section 9115(b) of OBRA is amended by striking “1902(1)” and inserting “1902(o)”. (3) Section 9119.—Section 9119 of OBRA is amended by adding at the end the following new subsection: “(d) Conforming Amendments to Medicare Program for the Medically Needy.— (1) Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended— “(A) in subsection (a)— “(i) by striking ‘and’ at the end of paragraph (48), “(ii) by striking the period at the end of paragraph (49) and inserting “; and’, and “(iii) by inserting after paragraph (49) the following new paragraph: “‘(50) provide, in accordance with subsection (q), for a monthly personal needs allowance for certain institutionalized individuals and couples.’; and “(B) by adding at the end the following new subsection: “‘(q) (1) (A) In order to meet the requirement of subsection (a)(50), the State plan must provide that, in the case of an institutionalized individual or couple described in subparagraph (B), in determining the amount of the individual’s or couple’s income to be applied monthly to payment for the cost of care in an institution, there shall be deducted from the monthly income (in addition to other allowances otherwise provided under the State plan) a monthly personal needs allowance— “‘(i) which is reasonable in amount for clothing and other personal needs of the individual (or couple) while in an institution, and “‘(ii) which is not less (and may be greater) than the minimum monthly personal needs allowance described in paragraph (2). “(B) In this subsection, the term “institutionalized individual or couple” means an individual or married couple— “‘(i) who is an inpatient (or who are inpatients) in a medical institution or nursing facility for which payments are made under this title throughout a month, and “‘(ii) who is or are determined to be eligible for medical assistance under the State plan. “‘(2) The minimum monthly personal needs allowance described in this paragraph is $30 for an institutionalized individual and $60 for an institutionalized couple (if both are aged, blind, or disabled, and their incomes are considered available to each other in determining eligibility).’. “(2) The amendments made by paragraph (1) apply to payments under title XIX of the Social Security Act for calendar quarters beginning on or after July 1, 1988, without regard to whether or not 102 STAT. 808 final regulations to carry out such amendments have been promulgated by such date.”. (o) Subtitle D of Title IV.— (1) Section 4303.— Section 2115 of the Public Health Service Act is amended— (A) in subsection (i)(1), as added by section 4303(a) of OBRA, by striking “from appropriations under subsection (i)” and inserting “by the Secretary from appropriations under subsection (j)”, and (B) in subsection (j), as added by section 4303(b) of OBRA, by inserting “to the Department of Health and Human Services” after “to be appropriated”. (2) Section 4307.—Section 4307(3)(0 of OBRA is amended by striking “subsection (g)” and inserting “subsection (e), as redesignated by section 4303(d)(2)(A),”. (3) Section 4308.— (A) Subtitle D of title IV of OBRA is amended by adding at the end the following new section: “SEC. 4308. TECHNICAL AMENDMENTS RELATING TO COURT OF CLAIMS PROCEDURES. “(a) Duties of Special Masters.—Section 2112(c)(2) of the Public Health Service Act (42 U.S.C. 300aa–12(a)) is amended— “(1) by inserting shall prepare and submit to the court proposed findings of fact and conclusions of law,’ after ‘adjunct to the court’, “(2) by inserting ‘and’ at the end of subparagraph (C), “(3) by striking ‘, and’ at the end of subparagraph (D) and inserting a period, and “(4) by striking subparagraph (E). “(b) Requiring Filing of Appeals Within 60 Days.—Section 2112(e) of such Act (42 U.S.C. 300aa–12(e)), as redesignated by section 4303(d)(2)(A), is amended by inserting ‘within 60 days of the date of the judgment’ after ‘petition filed’. “(c) Clarification on Timing of Bringing Additional Actions.—The second sentence of section 2121(a) of such Act (42 U.S.C. 300aa–21(a)) is amended by striking ‘the entry of the court’s judgment’ and inserting ‘the court’s final judgment’.”. (B) The table of contents relating to title IV of OBRA is amended by inserting after the item relating to section 4307 the following new item: “Sec. 4308. Technical amendments relating to Court of Claims procedures.”.