EFFECTIVE DATES, TRANSITION. AND CONFORMING AMENDMENTS.

SEC 104. EFFECTIVE DATES, TRANSITION. AND CONFORMING AMENDMENTS. (a) Effective Date — (1) In general.— Except as provided in paragraphs (2) and (3), the amendments made by this subtitle shall take effect on January 1, 1989, and shall apply— (A) to the inpatient hospital deductible for 1989 and succeeding years, 102 STAT. 688 (B) to care and services furnished on or after January 1, 1989, (C) to premiums for January 1989 and succeeding months, and (D) to blood or blood cells furnished on or after January 1, 1989. (2) Elimination of post-hospital requirement for extended care services.—The amendments made by this subtitle, insofar as they eliminate the requirement (under section 1812(a)(2) of the Social Security Act) that extended care services are only covered under title) XVIII of such Act if they are post-hospital extended care services, shall only apply to extended care services furnished pursuant to an admission to a skilled nursing facility occurring on or after January 1, 1989. (b) Hold Harmless Provisions.—In the case of an individual for whom a spell of illness (as defined in section 1861(a) of the Social Security Act, as in effect on December 31, 1988) began before January 1, 1989, and had not yet ended as of such date— (1) the amendment made to section 1813(a)(1) of such Act shall not apply to services furnished during that spell of illness during 1989 or 1990, and (2) the amount of any deductible under section 1813(a)(2) of such Act (as amended by this subtitle) shall be reduced during that spell of illness during 1989 or 1990 to the extent the deductible under such section was applied during the spell of illness. (c) Adjustments in Payments for Inpatient Hospital Services.— (1) PPS hospitals.—In adjusting DRG prospective payment rates under section 1886(d) of the Social Security Act, outlier cutoff points under section 1886(d)(5)(A) of such Act, and weighting factors under section 1886(d)(4) of such Act for discharges occurring on or after October 1, 1988, the Secretary of Health and Human Services shall, to the extent appropriate, take into consideration the reductions in payments to hospitals by medicare beneficiaries resulting from the elimination of a day limitation on medicare inpatient hospital services (under the amendments made by section 101). (2) PPS-exempt hospitals.—In adjusting target amounts under section 1886(b)(3) of the Social Security Act for cost reporting periods beginning on or after October 1, 1988, the Secretary shall, on a hospital-specific basis, take into consideration the reductions in payments to hospitals by medicare beneficiaries resulting from the elimination of a day limitation on medicare inpatient hospital services (under the amendments made by section 101). (d) Miscellaneous Conforming Amendments.— (1) Section 1811 (42 U.S.C. 1395c) is amended by striking “hospital, related post-hospital” and inserting “inpatient hospital services, extended care services”. (2) Section 1814 (42 U.S.C. 1395f) is amended— (A) in paragraphs (2)(B) and (6) of subsection (a), by striking “post-hospital” each place it appears; (B) in subsection (a)(2)(B), by striking “, for any of the conditions” and all that follows up to the semicolon; (C) in subsection (a)(1)(A)— (i) by striking “and” at the end of clause (i), 102 STAT. 689 (ii) by striking the semicolon at the end of clause (ii) and inserting and”, and (iii) by adding at the end the following new clause: “(iii) in a subsequent extension period, the medical director or physician described in clause (i)(II) recertifies at the beginning of the period that the individual is terminally ill;”; and (D) in subsection (d)(3)— (i) by striking “60 percent” and “80 percent” and inserting ‘TOO percent” both places, and (ii) by striking “two-thirds of”. (3) Section 1832(b) (42 U.S.C. 1395k(b)) is amended by striking “ ‘spell of illness’,” and the comma before “and”. (4) Section 1861 (42 U.S.C. 1395x) is amended— (A) by striking subsection (a); (B) in subsection (e)— (i) in the matter before paragraph (1), by striking “paragraph (7) of this subsection, and subsection (i) of this section” and inserting “and paragraph (7) of this subsection”, (ii) in the third sentence, by striking “section 1814(f)(2), and subsection (i) of this section” and inserting “and section 1814(f)(2)”, (iii) in the fifth sentence, by striking except for purposes of subsection (a)(2),”, and (iv) by striking the second sentence; (C) by striking subsection (i); (D) in subsections (v)(1)(G)(i), (v)(2)(A), and (v)(3), by striking “post-hospital” each place it appears; and (E) in subsection (y)— (i) by striking “Post-Hospital” in the heading and by striking “post-hospital” each place it appears, (ii) in paragraph (1), by striking “(except for purposes of subsection (a)(2))”, (iii) in paragraphs (2) and (3), by striking “spell of illness” and “spell” each place either appears and inserting “year”, (iv) in paragraph (2)(A)(i), by striking “30 days” and inserting “45 days”, (v) in paragraph (3), by striking “one-eighth” and all that follows through “31st day” and inserting “the coinsurance amount established under section 1813(a)(3)(C) for each day before the 46th day”, and (vi) by striking paragraph (4). (5) Section 1866(d) (42 U.S.C. 1395cc(d)) is amended by striking “post-hospital” each place it appears. (6) Subsections (d)(1) and (f) of section 1883 (42 U.S.C. 1395tt) are amended by striking “post-hospital” each place it appears.