MISCELLANEOUS TECHNICAL CORRECTIONS TO MEDICARE CATASTROPHIC COVERAGE ACT OF 1988.

SEC. 608. MISCELLANEOUS TECHNICAL CORRECTIONS TO MEDICARE CATASTROPHIC COVERAGE ACT OF 1988. (a) Modification of Provisions Relating to Employment Maintenance of Effort.— Section 421 of the Medicare Catastrophic Coverage Act of 1988 is amended— (1) in subsection (a)(1)— (A) by striking “(c)(1)” and inserting “(c)(1)(A)”, and (B) by striking “during the period described in subsection (c)(1)(A)” and inserting “(determined as if they were provided in that period)”, (2) in subsection (a)(2)— (A) by striking “(c)(2)” and inserting “(c)(1)(B)”, and (B) by striking “during the period described in subsection (c)(1)(B)” and inserting “(determined as if they were provided in that period)”; (3) in subsections (a)(3)(A) and (a)(3)(B), by inserting “provided as of the date of the enactment of this Act” after “means benefits”; (4) in subsection (b)(1)— (A) by inserting “1989” after “50 percent of the”, and (B) by striking “of the duplicative part A benefits” and inserting “of the benefits under part A of title XVIII of the Social Security Act (as amended by this Act as of January 1, 1989) which were not covered under part A of title XVIII of the Social Security Act as such part was in effect on the day before the date of the enactment of this Act”; (5) in subsection (b)(2)— (A) by inserting “1990” after “50 percent of the”, and (B) by striking “of the duplicative part B benefits” and inserting “of the benefits under part B of title XVIII of the Social Security Act (as amended by this Act as of January 1, 1990, but excluding any such benefits with respect to covered outpatient drugs) which were not covered under part B of title XVIII of the Social Security Act as such part was in effect on the day before the date of the enactment of this Act.”; and (6) in subsection (b)(3)— (A) in subparagraph (A), by striking “the actuarial value of duplicative part A benefits and duplicative part B benefits” and inserting “the amount of the additional benefits or refunds to be provided under subsections (a)(1) and (a)(2)”; (B) in subparagraph (A)(i), by striking “on the basis of” and inserting “as being equal to the respective national”; (C) in subparagraph (B), by striking “Computation of actuarial value” and inserting “Publication of guidelines and national average actuarial values for minimum additional benefits and refunds”; and (D) by striking clause (i) of subparagraph (B) and all that follows through “shall include instructions” and inserting the following: “(i) calculate and publish— “(I) the national average actuarial value for the following year of the benefits under part A of title XVIII of the Social Security Act (as amended by102 STAT. 2412 this Act as of January 1, 1989) which were not covered under such part as such part was in effect before the date of the enactment of this Act, and “(II) the national average actuarial value for the following year of the benefits under part B of title XVIII of the Social Security Act (as amended by this Act as of January 1, 1990, but excluding any such benefits with respect to covered outpatient drugs) which were not covered under such part as such part was in effect before the date of the enactment of this Act, to be used by employers who exercise the option under subparagraph (A)(i) in determining the minimum amount of additional benefits or refunds to be provided under subsections (a)(1) and (a)(2), respectively; and “(ii) publish guidelines to be used by employers who exercise the option under subparagraph (A)(ii) in determining the minimum amount of additional benefits or refunds to be provided under subsections (a)(1) and (a)(2), respectively. The Secretary shall publish, before the beginning of 1989 with respect to part A benefits and before the beginning of 1990 with respect to part B benefits, guidelines”. (b) Inclusion of Provisions Repealing Authority to Administer Proficiency Examinations.— The Medicare Catastrophic Coverage Act of 1988 is amended by inserting after section 429 the following new section (and by inserting a corresponding item in the table of contents of such Act): “SEC. 430. REPEAL OF AUTHORITY TO ADMINISTER PROFICIENCY EXAMINATIONS. “(a) Repeal.— Section 1123 of the Social Security Act (42 U.S.C. 1320a–2) is repealed. “(b) Effect of Repeal.— Nothing in the amendment made by subsection (a) shall be construed as affecting the qualification of any individual, who has been determined under the program established under section 1123 of the Social Security Act to be qualified to perform the duties and functions of a health care specialty, to perform such duties and functions.”. (c) Continuation of Cost Pass-Through for Certified Registered Nurse Anesthetists.— Section 9320 of the Omnibus Budget Reconciliation Act of 1986 is amended— (1) in subsection (i), by striking “The amendments” and inserting “Except as provided in subsection (k), the amendments”, and (2) by adding at the end the following new subsection: “(k) Authorization of Continuation of Pass-Through.— “(1) Subject to paragraph (2), the amendments made by this section shall not apply during 1989, 1990, and 1991 to a hospital located in a rural area (as defined for purposes of section 1886(d) of the Social Security Act) if the hospital establishes, before April 1, 1989, to the satisfaction of the Secretary of Health and Human Services that— “(A) as of January 1, 1988, the hospital employed or contracted with a certified registered nurse anesthetist (but not more than one full-time equivalent certified registered nurse anesthetist), 102 STAT. 2413 “(B) in 1987 the hospital had a volume of surgical procedures (including inpatient and outpatient procedures) requiring anesthesia services that did not exceed 250 (or such higher number as the Secretary determines to be appropriate), and “(C) each certified registered nurse anesthetist employed by, or under contract with, the hospital has agreed not to bill under part B of title XVIII of such Act for professional services furnished by the anesthetist at the hospital. “(2) Paragraph (1) shall not apply in 1990 or 1991 to a hospital unless the hospital establishes, before the beginning of each respective year, that the hospital has had a volume of surgical procedures (including inpatient and outpatient procedures) requiring anesthesia services in the previous year that did not exceed 250 (or such higher number as the Secretary determines to be appropriate). “(3) The Secretary shall implement this subsection in such a manner as to maintain budget neutrality consistent with section 1833(1)(3) of the Social Security Act.”. (d) Miscellaneous Technical Corrections to Various Provisions in the Medicare Catastrophic Coverage Act of 1988 (“MCCA”).— (1) Abbreviations used.— In this subsection: (A) The term “MCCA” refers to the Medicare Catastrophic Coverage Act of 1988 (Public Law 100–360). (B) The term “OBRA” refers to the Omnibus Budget Reconciliation Act of 1987 (Public Law 100–203). (2) Section 103.— The second sentence of section 1818(d)(1) of the Social Security Act, as amended by section 103 of MCCA, is amended by striking “entire”. (3) Section 104.— Section 104 of MCCA is amended— (A) in subsection (a)(1), by striking “paragraphs (2) and (3)” and inserting “paragraph (2) and subsection (b)”; (B) in subsection (b)(1)— (i) by striking “(1) the amendment made to section 1813(a)(1) of such Act” and inserting “(1)(A) section 1813(a)(1) of such Act (as amended by this subtitle)”, and (ii) by adding at the end the following new subparagraph: “(B) if that individual begins a period of hospitalization (as defined in such section) during 1989 or 1990 after the end of that spell of illness, the first period of hospitalization during 1989 or 1990 that begins after that spell of illness shall be considered to be (for purposes of such section) the first period of hospitalization that begins during that year; and”; (C) in subsections (c)(1) and (c)(2), by striking “by medicare beneficiaries” and inserting “by (or on behalf of) medicare beneficiaries”; (D) in subsection (c)(2), by striking “cost reporting periods beginning on or after October 1, 1988” and inserting “portions of cost reporting periods occurring on or after January 1, 1989”; (E) in subsection (c)(2), by inserting before the period at the end the following: “, without regard to whether such a hospital is paid on the basis described in subparagraph (A) or (B) of section 1886(b)(1) of such Act”; 102 STAT. 2414 (F) in subsection (d)(5), by striking “each place it appears”; and (G) by adding at the end of subsection (d) the following new paragraph: “(7) Section 1833(b) (42 U.S.C. 13951(b)) is amended by adding at the end the following new sentence: “The deductible under the previous sentence for blood or blood cells furnished an individual in a year shall be reduced to the extent that a deductible has been imposed under section 1813(a)(2) to blood or blood cells furnished the individual in the year.’.”. (4) Section 201.— Section 201(a)(1)(A) of MCCA is amended by striking “subsection” and inserting “subsections”. (5) Section 202.— (A) Section 1842(o)(1) of the Social Security Act, as added by section 202(c)(1)(C) of MCCA, is amended— (i) in subparagraph (A)(i), by striking “subparagraph (D)(i)” and inserting “paragraph (4)”, and (ii) in subparagraph (B)(ii), by inserting “an” before “eligible organization”. (B) Section 1842(f)(3) of the Social Security Act, as added by section 202(e)(1) of MCCA, is amended by inserting “, including claims processing functions” after “and related functions”. (C) Section 1842(b)(3)(K) of the Social Security Act, as inserted by section 202(e)(2)(B) of MCCA, is amended by inserting “, including claims processing functions,” after “and for related functions”. (D) Section 1842(c)(1)(A)(ii) of the Social Security Act, as added by section 202(e)(3)(A)(iii) of MCCA, is amended by inserting “, including claims processing functions” after “and related functions”. (E) Section 202(e)(3)(B) of MCCA is amended by inserting “, including claims processing functions” after “and related functions”. (F) Section 202(e)(3)(C) of MCCA is amended by striking “Section 1842(b)(2)” and inserting “Section 1842(b)(2)(A)”. (G) Section 1842(b)(2)(A) of the Social Security Act, as amended by section 202(e)(3)(C) of MCCA, as revised by the previous amendment, is amended by inserting “, including claims processing functions” after “and related functions”. (H) Section 202(e)(5)(A) of MCCA is amended by— (i) by striking “paragraph (3)” and inserting “paragraph (4)”, and (ii) by adding “and” after the semicolon at the end. (I) Section 1847(b)(3) of the Social Security Act, as added by section 202(j) of MCCA, is amended by striking “the contingency margin (established under section 1841A(d) for the following year)” and inserting “the contingency margin required for the following year”. (6) Section 203.— (A) Section 1861 of the Social Security Act is amended by adding immediately before subsection (jj), as added by section 203(b) of MCCA, the following new heading: “Home Intravenous Drug Therapy Services”. (B) Section 203(c)(3) of MCCA is amended by adding at the end the following new sentence: “Chapter 35 of title 44, United States Code, shall not apply to information required for purposes of carrying out this paragraph.”. 102 STAT. 2415 (7) Section 205.— Section 205(e)(1)(A) of MCCA is amended by redesignating clause (iv) as clause (iii). (8) Section 208.— The second sentence of section 208(b) of MCCA is amended by striking “shall include in the report” and inserting “shall report, not later than 2 years after the date of the enactment of this Act,”. (9) Section 211.— (A) Section 1839(g) of the Social Security Act, as added by section 211(a) of MCCA, is amended— (i) in paragraph (1)(B)(iii)(I), by striking “and” and inserting “over”, (ii) in paragraph (1)(B)(iii)(II), by inserting “premium” after “supplemental”, and (iii) in paragraph (7)(A)(ii), by inserting “each” before “such year,”. (B) Section 1839(f) of the Social Security Act, as amended by section 211(b) of MCCA, is amended by striking “for that January below the amount of benefits payable to that individual for that December” and inserting “for that December below the amount of benefits payable to that individual for that November”. (10) Section 212.— (A) Section 1841A(a)(1) of the Social Security Act, as inserted by section 212(a) of MCCA, is amended by striking “1841(j)” and inserting “1840(i)”. (B) Section 1840(i) of the Social Security Act, as added by section 212(b)(1) of MCCA, is amended by striking “Supplemental” and inserting “Supplementary”. (11) Section 213.— Section 213 of MCCA is amended by striking “(a) In General.—”. (12) Section 221.— Section 221(g)(2) of MCCA is amended by striking “subsection (c)” and inserting “subsection (d)”. (13) Section 222.— Section 222 of MCCA is amended— (A) in paragraph (1), by striking “sections 1833(a)(1)(A) and 1876” and inserting “section 1876”, and (B) in paragraph (2), by inserting “and organizations paid under section 1833(a)(1)(A) of such Act” after “organizations”. (14) Section 301.— Section 301 of MCCA is amended— (A) in subsection (b)(1), by striking “clause (ii)” and inserting “subparagraph (B)” and by adding “and” at the end; (B) by striking paragraph (2) of subsection (b) and by redesignating paragraph (3) of such subsection as paragraph (2); (C) in subsection (b)(2), as so redesignated, by striking “by adding at the end the following new clause” and inserting “by striking subparagraph (B) and inserting the following”; (D) in the matter inserted by subsection (b)(2), as so redesignated and amended— (i) by redesignating subclauses (I) through (IV) of clause (ii) and subclauses (I) through (V) of clause (iii) as clauses (i) through (iv) of subparagraph (B) and clauses (i) through (v) of subparagraph (C), respectively; (ii) in subparagraph (B), as so redesignated, by striking “in clause (iii)” and inserting “in subparagraph (C)”; and (iii) in subparagraph (C), as so redesignated, by striking “under clause (ii)” and inserting “under subparagraph (B)”; 102 STAT. 2416 (E) in subsection (c)— (i) by adding “and” at the end of paragraph (1), (ii) by striking “; and” at the end of paragraph (2), and inserting a period, and (iii) by striking paragraph (3); (F) in subsection (d)(2), in the subparagraph (C) amended by such paragraph, by inserting “section” before “1833(b)”; (G) in subsection (d)— (i) by redesignating paragraphs (1) through (3) as paragraphs (2) through (4), respectively, and (ii) by inserting before paragraph (2), as so redesignated, the following new paragraph: “(1) in paragraph (3), by inserting ‘, without regard to whether the costs incurred were for items and services for which medical assistance is otherwise available under the plan’ after ‘qualified medicare beneficiary’ the first place it appears;”; (H) in subsection (e)(i)— (i) by inserting “(A)” before “Section”, and (ii) by adding at the end the following new subparagraphs: “(B) Subsection (h)(1) of such section is further amended by inserting ‘(A)’ after ‘include’ and by inserting before the period at the end the following: ‘, or (B) qualified medicare beneficiaries (as defined in section 1905(p)(1))’. “(C) The second sentence of subsection (h)(2) of such section is amended by inserting ‘(except in the case of qualified medicare beneficiaries, as defined in section 1905(p)(1))’ after ‘shall be applied’ the second place it appears.”; (I) in subsection (e)(2)— (i) in subparagraph (C), by striking “and” at the end and by redesignating such subparagraph as subparagraph (D); (ii) in subparagraph (D), by striking the period at the end and inserting “, and” and by redesignating such subparagraph as subparagraph (E); and (iii) by inserting after subparagraph (B) the following new subparagraph: “(C) in subsection (a), by striking paragraph (15);”; (J) in paragraph (5)(B) of the matter added by subsection (g)(2)— (i) by striking “paragraph (2)(A)” and inserting “paragraph (2)”, and (ii) by striking “clause (ii)” and inserting “subparagraph (B)”; and (K) in subsection (h)(2), by inserting “first calendar quarter beginning after the close of the” after “additional requirements before the first day of the”. (15) Section 302.— (A) Section 302(a)(2)(B) of MCCA is amended— (i) in clause (i), by striking “not more” the first place it appears and inserting “(not more”, and (ii) in clause (iii), by striking “clause” and inserting “clauses”. (B) Section 1902(1)(2)(A) of the Social Security Act, as amended by section 302(a)(2)(B)(iii) of MCCA, is amended— (i) in clause (ii)— 102 STAT. 2417 (I) by striking “Subject to clause (iii), the” and inserting “The”, (II) in subclause (I), by inserting “or, if greater, the percentage provided under clause (iii),” after “75 percent,”; and (ii) in clause (iii), by striking “(ii)” each place it appears and inserting “(ii)®”. (C) Section 1923(a)(2) of the Social Security Act is amended by indenting the subparagraph (C) added by section 302(b)(2) of MCCA 2 ems. (16) Section 303.— (A) Section 1924 of the Social Security Act, as inserted by section 303(a)(1)(B) of MCCA, is amended— (i) in the last sentence of subsection (c)(1)(B), by striking “has right to a fair hearing” and all that follows through “needs allowance” and inserting “will have a right to a fair hearing under subsection (e)(2)”; (ii) in subsection (c)(2)(B), by striking “resources shall not” and all that follows through “does not exceed” and inserting “resources shall be considered to be available to an institutionalized spouse, but only to the extent that the amount of such resources exceeds”; (iii) in subsection (d)(3)(A)(i), by striking “nonfarm”; (iv) in subsection (d)(4), by striking “subparagraph (C)” and inserting “subparagraph (B)”; (v) in the first sentence of subsection (e)(2)(A), by inserting before the period at the end the following: “if an application for benefits under this title has been made on behalf of the institutionalized spouse”; (vi) in subsection (f)(1)— (I) by striking “to the community spouse (or to another for the sole benefit of the community spouse)”, and (II) by striking “pacticable” and inserting “practicable”; and (vii) in subsection (f)(3), by striking “spouse of a family member” and inserting “spouse or a family member”. (B) Section 1917(c) of the Social Security Act, as amended by section 303(b) of MCCA, is amended— (i) in paragraph (1)— (I) by inserting “for nursing facility services and for a level of care in a medical institution equivalent to that of nursing facility services and for services under section 1915(c)” after “period of ineligibility” the first place it appears, (II) by inserting “or after” after “during”, and (III) by striking “the individual’s application for medical assistance under the State plan” and inserting “the date the individual becomes an institutionalized individual (if the individual is entitled to medical assistance under the State plan on such date) or, if the individual is not so entitled, the date the individual applies for such assistance while an institutionalized individual”; (ii) in paragraph (2)(A)(ii), by inserting “®” after “who” and by inserting “(II)” after “or” the first place it appears; (iii) in paragraph (2)(A)(iii), by striking “of the individual’s admission to the medical institution or nursing102 STAT. 2418 facility” and inserting “the individual becomes an institutionalized individual”; (iv) in paragraph (2)(A)(iv), by striking “of such individual’s admission to the medical institution or nursing facility” and inserting “the individual becomes an institutionalized individual”; (v) in paragraph (2)(B)— (I) by inserting “(i)” after “transferred”, and (II) by striking “or the individual’s child who is blind or permanently and totally disabled” and inserting “, (ii) to the individual’s child described in subparagraph (A)(ii)(II), or (iii) to (or to another for the sole benefit of) the individual’s spouse if such spouse does not transfer such resources to another person other than the spouse for less than fair market value”; (vi) in paragraph (3), by striking “in a medical institution or nursing facility” and inserting “in a nursing facility, who is an inpatient in a medical institution and with respect to whom payment is made based on a level of care provided in a nursing facility, or who is described in section 1902(a)(10)(A)(ii)(VI)”; and (vii) by adding at the end the following new paragraph: “(5) In this subsection, the term ‘resources’ has the meaning given such term in section 1613, without regard to the exclusion described in subsection (a)(1) thereof.”. (C) Section 1902(r)(2)(A) of the Social Security Act, as added by section 303(e)(5)(C) of MCCA, is amended by striking “or under subsection (f)” and inserting “or (f) or under section 1905(p)”. (D) Section 303(g) of MCCA is amended— (i) in paragraph (2)(B), by inserting before the period at the end the following: “, except that such section shall not apply with respect to inter-spousal transfers occurring before October 1, 1989”; (ii) in paragraph (2)(C), by inserting before the period at the end the following: “, and the laws and policies established by the State as of June 30, 1988, or provided for before July 1, 1988, shall continue to apply through September 30, 1989, (and may, at a State’s option continue after such date) to inter-spousal transfers occurring before October 1, 1989”; and (iii) in paragraph (5), by striking “other than subsection (e)” and inserting “other than paragraphs (1) and (5) of subsection (e)”. (17) Section 411(a).— Section 1842(n)(1)(A) of the Social Security Act, as clarified by section 411(a)(3)(C) of MCCA, is amended by striking “the the supplier’s” and inserting “the supplier’s”. (18) Section 411(b).— (A) Subclauses (III) and (IV) of section 1886(b)(3)(B)(i) of the Social Security Act, as amended by section 411(b)(1)(A) of MCCA, are amended by striking “for for hospitals” and inserting “for hospitals”. (B) Section 411(b)(1)(E) of MCCA is amended by designating subparagraph (E) as clause (ii) and by inserting immediately before such subparagraph the following: “(E) (i) Section 1886(d)(3)(A)(i) of the Social Security Act, as amended by section 4002(c)(1)(B)(i) of OBRA, is amended by striking ‘occuring’ and inserting ‘occurring’.”. 102 STAT. 2419 (C) Section 411(b)(4) of MCCA is amended by adding at the end the following new subparagraph: “(E) Section 4005(b)(3)(B) of OBRA is amended by striking ‘on’ after ‘(B)’.”. (D) Section 411(b)(6)(C) of MCCA is amended— (i) in clause (ix)(I), by striking “payors” and inserting “payers”, (ii) in clause (ix)(III), by striking “and” before “other persons”, and (iii) in clause (x)(II), by striking “operation” and inserting “operations”. (E) Section 411(b)(8)(A)(i) of MCCA is amended, in paragraph (I)(A)(ii) of the amendment inserted by such section, by inserting “the” immediately before “previous”. (19) Section 411(c).— Section 411(c) of MCCA is amended— (A) in paragraph (2), by adding at the end the following new subparagrapn: “(C) Section 1866(a)(1) of the Social Security Act, as amended by section 4012(a) of OBRA, is amended— “(i) by striking ‘and’ at the end of subparagraph (M), and “(ii) by striking the period at the end of subparagraph (N) and inserting ‘, and’.”; (B) in paragraph (4)— (i) by striking “and” at the end of subparagraph (A), (ii) by redesignating subparagraph (B) as subparagraph (C), and (iii) by inserting after subparagraph (A) the following new subparagraph: “(B) in subparagraph (B)(i), by inserting ‘of such subparagraph’ after ‘(v)(I), and”; and (C) by redesignating paragraph (5) as paragraph (6) and by inserting after paragraph (4) the following new paragraph: “(5) Section 4015.— Section 4015(a) of OBRA is amended— “(A) in the first sentence of paragraph (7) by striking ‘the the’ and inserting ‘the’, and “(B) in paragraph (10), by striking ‘affect’ and inserting (20) Section 4ii(d).— (A) Section 411(d)(2)(A) of MCCA is amended by striking “by inserting” and all that follows and inserting the following: “to read as follows: ‘The provisions of section 1128A (other them subsections (a) and (b)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A.’.”. (B) Section 411(d)(4)(A) of MCCA is amended— (i) in clause (i)— (I) by striking “accreditation” the first place it appears and inserting “certification”, and (II) by striking “accreditation survey conducted by a State agency or” and inserting “certification survey conducted by a State agency or accreditation survey conducted by a”; and (ii) in clause (ii), amend subclause (II) to read as follows: “(II) by striking ‘pursuant to an agreement with the Secretary under section 1864’ and inserting ‘utilized by the Secretary under section 1865’.”. 102 STAT. 2420 (C) Section 411(d)(4)(A)(ii)(I) of MCCA is amended by striking “such”. (D) The subsection inserted by section 411(d)(4)(B)(ii) of MCCA is amended by striking “agency” and inserting “agency)”. (21) Section 411(f).— (A) Section 1842(i)(3) of the Social Security Act, as redesignated by section 4042(b)(1)(C)(iii) of OBRA as amended by section 411(f)(2)(C) of MCCA, is amended by striking “paragraph (3)” and inserting “subsection (b)(3)”. (B) Section 411(f)(2)(F)(i) of MCCA is amended, in the matter inserted by such section— (i) by striking “139u(b)(4)(A)” and inserting “1395u(b)(4)(A)”, and (ii) by striking the closing single quotation mark and the period that follows it. (C) Section 411(f)(8)(D) of MCCA is amended by redesignating clauses (ii) through (v) as clauses (iii) through (vi), respectively, and by inserting after clause (i) the following new clause: “(ii) in paragraph (4)(C), by striking ‘Radiologist’ and inserting ‘For radiologist’, and by striking ‘1842(b)(4)(E)(ii)’ and inserting ‘1842(i)(3)’;”. (D) Section 411(f)(9)(B) of MCCA is amended by inserting “and inserting ‘(or other applicable limit)’ ” before the semicolon at the end. (E) Section 4U(f)(10)(A)(iii) of MCCA is amended by striking “physician” and inserting “individual”. (F) Section 4U(f)(10)(C)(i) of MCCA is amended— (i) by striking “and” at the end of subclause (V), (ii) by striking the period at the end of subclause (VI) and inserting “, and”, and (iii) by adding at the end the following new subclause: “(VII) in subsection (d)(2), by striking ‘continued’ and inserting ‘continues’.”. (G) Subclause (II) of section 411(f)(10)(C)(i) of MCCA is amended to read as follows: “(II) by striking ‘physician’ and ‘a physician’ each place either appears (other than the third place either appears in subsection (a)(4)) and inserting ‘individual’ and ‘an individual’, respectively;”. (H) Section 411(f)(10)(C)(i)(IV) of MCCA is amended— (i) by striking “paragraph (1)(A)” and inserting “subsection (a)(1)(A)”, and (ii) by striking the comma after “Loan Program”. (22) Section 411(g).— (A) Section 411(g)(1)(B) of MCCA is amended— (i) by amending clause (xi) to read as follows: “(xi) in paragraphs (8)(B) and (9)(B), by striking ‘(as defined in section 1886(d)(2)(D))’ and inserting ‘(as defined by the Secretary)’ and, in clause (i) of such paragraphs, by striking the comma after ‘1991’;” and (ii) by amending clause (xv) to read as follows: “(xv) in paragraph (12), by striking ‘for each region (as defined in section 1886(d)(2)(D))’ and inserting ‘for one or more entire regions defined for purposes of paragraphs (8)(B) and (9)(B)’; and”. (B) Section 1833(i)(6) of the Social Security Act, as added by section 4063(e)(1) of OBRA as amended by section 411(g)(2)(E) of102 STAT. 2421 MCCA, is amended by striking “other than” the first place it appears and inserting “including”. (C) Section 411(g)(3)(G)(i)(I) of MCCA is amended by striking “and ‘certification’ ” and by striking “and ‘approval’, respectively” (D) Section 411(g)(4)(C)(i) of MCCA is amended by striking the comma after “1988” the first place it appears. (23) Section 411(h).— (A) Section 411(h)(3)(B) of MCCA is amended by redesignating clauses (i) and (ii) as clauses (ii) and (iii), respectively, and by inserting before clause (ii), as so redesignated, the following new clause: “(i) by striking ‘1395’ and inserting ‘13951’,”. (B) Section 1861(s)(2)(K)(i)(I) of the Social Security Act, as designated by the amendment made by section 411(h)(6) of MCCA, is amended by striking “intermediate care facility (as defined in section 1905(c))” and inserting “nursing facility (as defined in section 1919(a))”. (24) Section 4ii(i).— (A) Section 411(i)(1)(E) of MCCA is amended by striking the comma after “1988”. (B) The paragraph (26) added by section 411(i)(4)(C)(vi) of MCCA is amended— (i) by striking “and” at the end of subparagraph (A), (ii) by adding “and” at the end of clause (i) of subparagraph (B), and (iii) by redesignating clause (iii) of subparagraph (B) as subparagraph (C) and by moving the indentation of such subparagraph 2 ems to the left. (C) Section 411(i)(4) of MCCA is amended— (i) in subparagraph (D)(i)(I), by striking “, 1842(j)(2), or 1867(d)” and inserting “or 1842(j)(2)”, and (ii) in subparagraph (D)(ii)— (I) by inserting “and” at the end of subclause (III), (II) by striking subclause (IV), and (III) by redesignating subclause (V) as subclause (IV). (25) Section 4ii(j).— (A) Section 411(j)(3) of MCCA is amended by adding at the end the following new subparagraph: “(C) Section 4094(e) of OBRA is amended by striking ‘feasability’ and inserting ‘feasibility’.”. (B) Section 411(j)(4)(C) of MCCA is amended by striking “before ‘paragraph (2)’”. (26) Section 4ii(k).— (A) Section 4U(k)(6)(A)(vi)(IV) of MCCA is amended by striking “the election made by a State under” and inserting “whether the hospital is described in subparagraph (A) or (B) of”. (B) Section 411(k)(6)(A)(vii)(II) of MCCA is amended by inserting “the first place it appears” before the comma. (C) The paragraph added by section 411(k)(6)(A)(vii)(III) of MCCA is amended by striking “Statewide” and inserting “statewide”. (D) Section 1923(b)(3)(B)(i) of the Social Security Act, as designated by section 411(k)(6)(B)(i) of MCCA and as amended by section 411(k)(6)(A)(v) of MCCA, is amended by inserting “of subparagraph (A)” after “clause (i)(II)”. (E) Section 1923(c) of the Social Security Act, as designated by section 411(k)(6)(B)(i) of MCCA, by striking “subsection (c)” and inserting “this subsection”. 102 STAT. 2422 (F) Section 411(k)(6)(B)(vi) of MCCA is amended by striking “(c)” and inserting “(d)”. (G) Section 411(k)(9) of MCCA is amended by striking “(A)” immediately after “.—”. (H) Section 411(k)(10)(B)(ii)(II) of MCCA is amended by striking “1128(a)” and “1320a–7(a)” and inserting “U28A(a)” and “1320a–7a(a)”, respectively. (I) Section 1128A(1) of the Social Security Act, as added by section 4118(e)(1)(B) of OBRA and as amended by section 411(k)(10)(B)(ii)(III) of MCCA, is amended by inserting “for penalties, assessments, and an exclusion” after “liable”. (J) Section 4118(e)(10)(C) of OBRA, as inserted by section 411(k)(10)(D) of MCCA, is amended by inserting “of subsection (i)” after “at the end”. (K) Section 411(k)(10)(D) of MCCA is amended— (i) in the paragraph (6)(B) inserted by such section, by striking “or section 1867(d)(2)”, and (ii) in subparagraphs (A) and (B) of the paragraph (11) inserted by such section and in the paragraphs (12) and (13) inserted by such section, by striking “1842(j)(2), or 1867(d)(2)” and inserting “or 1842(j)(2)”. (L) Section 411(k)(16)(B) of MCCA is amended— (i) by striking “and” at the end of clause (ii), (ii) by redesignating clause (iii) as clause (iv), and (iii) by inserting after clause (ii) the following new clause: “(iii) in clause (iii), by striking the period at the end and inserting ‘; or’, and”. (M) Section 411(k)(17)(A)(iv) of MCCA is amended by inserting a comma immediately before “(d)” the second place it appears. (27) Section 411(1).— (A) Section 411(l))(1)(A) of MCCA is amended by redesignating clauses (iv) through (xi) as clauses (v) through (xii), respectively, and by inserting after clause (iii) the following new clause: “(iv) in subsection (c)(1), by adding at the end the following new subparagraph: “ ‘(D) Use of psychopharmacologic drugs.— Psychopharmacologic drugs may be administered only on the orders of a physician and only as part of a plan (included in the written plan of care described in paragraph (2)) designed to eliminate or modify the symptoms for which the drugs are prescribed and only if, at least annually, an independent, external consultant reviews the appropriateness of the drug plan of each resident receiving such drugs.’;”. (B) Section 411(l)(1) of MCCA is amended by adding at the end the following new subparagraph: “(C) Section 4201(d) of OBRA, as amended by subparagraph (B), is further amended by adding at the end the following new paragraphs: “ ‘(3) Section 1883(f) of such Act (42 U.S.C. 1395tt(f)) is amended by striking “section 1861(j)(15)” and inserting “section 1819”. “ ‘(4) The third sentence of section 1864(a) of such Act (42 U.S.C. 1395aa(a)) is amended by striking “1861(j)” and inserting “1819(a)” “ ‘(5) Section 1861(n) of such Act (42 U.S.C. 1395x(n)) is amended by striking “or (j)(1) of this section” and inserting “of this section or section 1819(a)(1)”.’.”. 102 STAT. 2423 (C) Section 411(l)(2)(A) of MCCA is amended by inserting a comma immediately after “this title” and immediately after “title XVIII”. (D) Section 411(l)(2)(D)(i) of MCCA is amended by striking “care”. (E) Section 411(l)(3)(C) of MCCA is amended by inserting “(i)” after “(C)” and by adding at the end the following new clauses: “(ii) Section 4211 of OBRA (101 Stat. 1330–196) is amended by striking the following (and the immediately preceding quotation marks and period): “ ‘(c) State Requirements Relating to Nursing Facility Requirements.— Section 1919 of such Act is further amended by adding at the end the following new subsection:’. “(iii) Section 1919(c)(2)(B)(iii)(III) of the Social Security Act, as inserted by section 4211(a)(3) of OBRA, is amended by striking ‘responsibile’ and inserting ‘responsible’.”. (F) Section 411(l)(3)H)(i) of MCCA is amended by striking “each place it appears”. (G) Section 411(l)(3)(H)(iii) of MCCA is amended by inserting “services” immediately after “nursing facility” the first place it appears. (H) Section 411(l)(3) of MCCA is amended by adding at the end the following new subparagraph: “(J) Section 4211(h)(2)(B) of OBRA is amended by inserting a comma before ‘nursing facility,’ the second place it appears.”. (I) Section 411(1)(5) of MCCA is amended by redesignating subparagraphs (F) and (G) as subparagraphs (G) and (H), respectively, and by inserting after subparagraph (E) the following new subparagraph: “(F) in paragraph (2)(B)(ii), by striking ‘practical’ and inserting ‘practicable’;”. (J) Section 411(1)(6) of MCCA is amended by adding at the end the following new subparagraph: “(F) Section 1910(b)(1) of the Social Security Act, as redesignated by section 4212(e)(3)(C) of OBRA, is amended by inserting ‘or section 1919’ after ‘1902(a)(28)’.”. (K) Section 411(l)(9)(B)(ii) of MCCA is amended by striking “(c) as subsection (d)” and inserting “(b) as subsection (c)”. (L) Section 411(1) of MCCA is further amended by adding at the end the following new paragraph: “(11) Section 4203.—Section 1819(h)(5) of the Social Security Act, as added by section 4203(a)(2) of OBRA, is amended by striking ‘(iii), and (iv) of paragraph (2)(A)’ and inserting ‘and (iii) of paragraph (2)(B)’.”. (28) Section 4ii(n).— Section 411(n) of MCCA is amended by redesignating paragraph (3) as paragraph (4) and by inserting after paragraph (2) the following new paragraph: “(3) Section 9116.— Subsection (d) of section 9116 of OBRA is amended to read as follows: “ ‘(d) Conforming Amendment.— Section 1923(a)(2) of the Social Security Act, as amended by section 4118(p)(9) of this Act, is amended by adding at the end the following new subparagraph: “ ‘ “(E) Section 1634(d) of this Act (relating to individuals who lose eligibility for SSI benefits due to entitlement to early widow’s or widower’s insurance benefits under section 202 (e) or (f) of this Act).” 102 STAT. 2424 (29) Section 4ii(p).— Section 411 of MCCA is amended by adding at the end the following new subsection: “(p) Miscellaneous.— Section 2312(c) of the Deficit Reduction Act of 1984, as amended by section 9320(a) of the Omnibus Budget Reconciliation Act of 1986, is amended by striking ‘end’ and inserting ‘ends’.”. (30) Section 428.— (A) Subsection (c)(1) of section 1140 of the Social Security Act, as added by section 428(a) of MCCA, is amended to read as follows: “(c) (1) The provisions of section 1128A (other than subsections (a), (b), (f), (h), and (i)) shall apply to civil money penalties under subsection (b) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”. (B) Section 428(b) of MCCA is amended by striking “Medical” and inserting “Medicare”. (e) Extension of Pilot Program.— The Secretary of Health and Human Services shall extend through December 31, 1989, the pilot test program, being conducted by States under the Annual Grant Award Study established by the Joint State/Federal Cash Management Reform Task Force, on the same terms and conditions that existed as of September 30, 1988. (f) Miscellaneous Corrections.— (1) Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is amended by striking subsection (f). (2) Section 1915(a)(2) of the Social Security Act, as amended by section 8(h)(2) of Public Law 100–93, is amended by striking “Restricts” and inserting “restricts”. (3) Section 1905(o) of the Social Security Act is amended by moving the indentation of paragraph (3), as added by section 9435(b)(2) of Public Law 99–509, 2 eras to the left. (4) Section 1903(m)(2)(B)(i)(II) of the Social Security Act is amended by striking “1902(a)(13)(A)(ii)” and inserting “1902(a)(10)(D)”. (5) Effective as of the date of the enactment of Public Law 95–292, section 226(a) of the Social Security Act (42 U.S.C. 426(a)) is amended by striking “condition specified in paragraph (1)” and inserting “condition specified in paragraph (2)”. (g) Effective Date.— (1) The amendments made by subsections (a), (b), and (d) shall be effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988. (2) The amendments made by subsection (c) and subsection (f) (other than paragraph (5)) shall take effect on the date of the enactment of this Act. (h) Quality Control Transition.— There shall not be taken into account, for purposes of section 1903(u) of the Social Security Act, payments and expenditures for medical assistance which are made on or after January 1, 1989, and before July 1, 1989, and which are attributable to medicare-cost sharing for qualified medicare beneficiaries (as defined in section 1905(p) of such Act).