RURAL HEALTH CLINIC SERVICES.

SEC. 4205. RURAL HEALTH CLINIC SERVICES. (a) Per-Visit Payment Limits for Provider-Based Clinics.— (1) Extension of limit.— (A) In general.—The matter in section 1833(f) (42 U.S.C. 13951(f)) preceding paragraph (1) is amended by striking “independent rural health clinics” and inserting “rural health clinics (other than such clinics in rural hospitals with less than 50 beds)”. (B) Effective date.—The amendment made by subparagraph (A) applies to services furnished on or after January 1, 1998. (2) Technical clarification.—Section 1833(f)(1) (42 U.S.C. 13951(f)(1)) is amended by inserting “per visit” after “$46”. (b) Assurance of Quality Services.— (1) In general.—Subparagraph (I) of the first sentence of section 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) is amended to read as follows: “(I) has a quality assessment and performance improvement program, and appropriate procedures for review of utilization of clinic services, as the Secretary may specify,”. (2) Effective date.—The amendment made by paragraph (1) shall take effect on January 1, 1998. (c) Waiver of Certain Staffing Requirements Limited to Clinics in Program.— (1) In general.—Section 1861(aa)(7)(B) (42 U.S.C. 1395x(aa)(7)(B)) is amended by inserting before the period “, or if the facility has not yet been determined to meet the requirements (including subparagraph (J) of the first sentence of paragraph (2)) of a rural health clinic”. (2) Effective date.—The amendment made by paragraph (1) applies to waiver requests made on or after January 1, 1998. (d) Refinement of Shortage Area Requirements.— (1) Designation reviewed triennially.—Section 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) is amended in the second sentence, in the matter in clause (i) preceding subclause (I)— (A) by striking “and that is designated” and inserting “and that, within the previous 3-year period, has been designated”; and (B) by striking “or that is designated” and inserting “or designated”.111 STAT. 377 (2) Area must have shortage of health care practitioners.—Section 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) as amended by paragraph (1), is further amended in the second sentence, in the matter in clause (i) preceding subclause (I)— (A) by striking the comma after “personal health services”; and (B) by inserting “and in which there are insufficient numbers of needed health care practitioners (as determined by the Secretary),” after “Bureau of the Census)”. (3) Previously qualifying clinics grandfathered only to prevent shortage.— (A) In general.—Section 1861(aa)(2) of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended in the third sentence by inserting before the period “if it is determined, in accordance with criteria established by the Secretary in regulations, to be essential to the delivery of primary care services that would otherwise be unavailable in the geographic area served by the clinic”. (B) Payment for certain physician assistant services.—Section 1842(b)(6)(C) (42 U.S.C. 1395u(b)(6)(C)) is amended to read as follows: “(C) in the case of services described in clause (i) of section 1861(s)(2)(K), payment shall be made to either (i) the employer of the physician assistant involved, or (ii) with respect to a physician assistant who was the owner of a rural health clinic (as described in section 1861(aa)(2)) for a continuous period beginning prior to the date of the enactment of the Balanced Budget Act of 1997 and ending on the date that the Secretary determines such rural health clinic no longer meets the requirements of section 1861(aa)(2), for such services provided before January 1, 2003, payment may be made directly to the physician assistant; and”. (4) Effective dates; implementing regulations.— (A) In general.—Except as otherwise provided, the amendments made by the preceding paragraphs take effect on the date of the enactment of this Act. (B) Current rural health clinics.—The amendments made by the preceding paragraphs take effect, with respect to entities that are rural health clinics under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) on the date of enactment of this Act, on the date of the enactment of this Act. (C) Grandfathered clinics.— (i) In general.—The amendment made by paragraph (3)(A) shall take effect on the effective date of regulations issued by the Secretary under clause (ii). (ii) Regulations.—The Secretary shall issue final regulations implementing paragraph (3)(A) that shall take effect no later than January 1, 1999.