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 100 STAT. 144 42 USC note prec. 8791.

42 USC 8701 note.

42 USC note prec. 8791.

42 USC 8791. 42 USC note prec. 8791.

42 USC 8731.

42 USC 8731.

42 USC note prec. 8791. contracts.

PUBLIC LAW 99-272—APR. 7, 1986

SEC. 7402. CESSATION OF FINANCIAL ASSISTANCE AUTHORITY.

Effective on the date of enactment of this Act, the United States Synthetic Fuels Corporation (hereafter in this subtitle referred to as the "Corporation") may not make any legally binding awards or commitments for financial assistance (including any changes in an existing award or commitment) pursuant to the Energy Security Act for synthetic fuel project proposals, except that nothing in this Act shall impair or alter the powers, duties, rights, obligations, privileges, or liabilities of the Corporation, its Board or Chairman, or project sponsors in the performance and completion of the terms and undertakings of a legally binding award or commitment entered into prior to the date of enactment of this Act. SEC. 7403. TERMINATION OF THE CORPORATION.

(a) Within 60 days of the date of enactment of this Act, the Directors of the Corporation shall terminate their duties under the Energy Security Act and be discharged. (b) Within 120 days of the date of enactment of this Act, the Corporation shall terminate, except as otherwise provided in this subtitle, in accordance with subtitle J of part B of title I of the Energy Security Act. SEC. 7404. DUTIES OF SECRETARY OF THE TREASURY.

(a) Within 60 days of the date of enactment of this Act (or earlier, in the event of absence of a Chairman of the Board of Directors of the Corporation), the Secretary of the Treasury shall assume the duties of the Chairman of the Board of Directors of the Corporation. (b) Notwithstanding any other provision of law, the duties and responsibilities of the Secretary of the Treasury under subtitle J of part B of title I of the Energy Security Act or this Act may not be transferred to any other Federal department or agency. (c) Notwithstanding such termination of the Corporation, the Advisory Committee established under jection 123 of the Energy Security Act (42 U.S.C 8719) shall remain in effect to advise the Secretary of the Treasury regarding the administration of any contract or obligation of the Corporation pursuant to subtitle D of part B of title I of such Act. (d) To the extent that the Secretary of the Treasury may be required to take an action under section 131(q) of the Energy Security Act in connection with an award or commitment of financial assistance under such Act, the Secretary shall complete such action within 30 days of the date of enactment of this Act. SEC. 7405. SALARIES AND COMPENSATION RIGHTS.

(a) The Director of the Office of Personnel Management shall, before February 1, 1986, determine the amount of compensation or benefits which each Director, officer, or employee of the Corporation shall be legally entitled to under any contract as of the date of enactment of this Act. (b) Effective on the date of enactment of this Act, no change in any Director, officer, or employee compensation or benefits shall be allowed or permitted, unless the Director of the Office of Personnel Management agrees that such change is reasonable. (c) Effective on the date of enactment of this Act— (1) no officer or employee of the Corporation shall receive a salary in excess of the rate of basic pay payable for level IV of

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100 STAT. 145

the Executive Schedule under title 5 of the United States Code; and (2) the Corporation shall not waive any requirements in its By-Laws which are necessary for a Director, officer, or employee to qualify for pension or termination benefits under the ByLaws and written personnel policies and procedures in effect on the date of enactment of this Act. SEC. 7406. REPORT TO THE CONGRESS.

42 USC note

The Corporation shall, within 60 days of the date of enactment of this Act, transmit to the Committee on Energy and Natural Resources of the Senate and to the Committee on Energy and Commerce and Committee on Banking, Housing and Urban Affairs of the House of Representatives a report— (1) containing a review of implementation of its Phase I Business Plan dated February 19, 1985; and (2) fulfilling the requirements of section 126(b)(3) of the Energy Security Act (42 U.S.C. 8722(b)(3)).

^^^'

Subtitle F—Uranium Enrichment SEC. 7501. AUTHORIZATION OF APPROPRIATIONS.

In accordance with section 660 of the Department of Energy Organization Act (42 U.S.C. 7270), there is authorized to be appropriated to the Department of Energy for each of the fiscal years 1986, 1987, and 1988 to carry out uranium enrichment service activities an amount equal to the difference between— (1) the revenues to be received during each such fiscal year by the Department of Energy in providing uranium enrichment service activities, as estimated in the budget submitted by the President to the Congress for each such fiscal year; and (2) the amount determined by the Secretary of Energy under section 7502(c)(1) for each such fiscal year. SEC. 7502. REPAYMENTS TO UNITED STATES TREASURY. (a) PARTIAL REPAYMENT OF UNRECOVERED COSTS.—

^'

(1) IN GENERAL.—The Secretary of Energy shall deposit in the general fund of the Treasury of the United States, in partial repayment of unrecovered Federal Government costs for uranium enrichment service activities, an amount determined by the Secretary under subsection (c) for each of the fiscal years 1986, 1987, and 1988. (2) REVENUES IN EXCESS OF EXPENDITURES.—In addition to

the

. '

payments required under paragraph (1), the Secretary of Energy shall deposit in the general fund of the Treasury of the United States, in partial repayment of amounts identified by the Secretary under subsection (c)(4)(B), any revenues in excess of expenditures received for the provision of such activities during the 3-year period referred to in paragraph (1). (b) REPAYMENT SCHEDULE.—The Secretary of Energy may make the repayments required in subsection (a) for any fiscal year on a quarterly basis. (c) DETERMINATION OF SECRETARY.—

(1) IN GENERAL.—The Secretary of Energy shall determine, in his or her discretion, the amount of partial repayment to be made under subsection (a)(1) for each of the fiscal years 1986,

^

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license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


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1987, and 1988, consistent with the financial integrity of the uranium enrichment service activities program during a period of not less than 10 years. The amount of such repayment shall not adversely affect the reliability of the supply of uranium enrichment services at competitive prices for existing and potential customers. The determinations under this paragraph shall be made after notice and opportunity for public comment. (2) REPAYMENT GOALS.—The Secretary of Energy shall seek to achieve the following repayment amounts under subsection (a)(1): ., (A) $110,000,000 for fiscal year 1986; v (B) $150,000,000 for fiscal year 1987; and - ' (C) $150,000,000 for fiscal year 1988. I,j. (3) SCHEDULE FOR DETERMINATION.—The Secretary of Energy shall make the determination required in paragraph (1) for any j i fiscal year before the President submits to the Congress the budget for such fiscal year, except that the Secretary may make subsequent revisions in such determination. (4) SUBMISSION TO CONGRESS.—

(A) IN GENERAL.—The Secretary of Energy shall submit to the Congress any determination made under paragraph (1), together with the reasons underlying such determination. (B) INITIAL SUBMISSION.—The Secretary shall include in the initial submission under this paragraph an estimate of the amount of prior investment in the uranium enrichment service activities program that remains unrecovered. SEC. 7503. URANIUM ENRICHMENT REPORT. Congress.

Not later than 60 days after the date of the enactment of this Act, the Secretary of Energy shall submit to the Committee on Energy and Natural Resources of the Senate and the Committees on Energy and Commerce and on Interior and Insular Affairs of the House of Representatives a report regarding the effects of the September 19, 1985, decision of the United States District Court for the District of Colorado holding that the utility services uranium enrichment con tracts of the Department of Energy are null and void (Western Nuclear Inc. v. F. Clark Huffman, Civil No. 84-C-2315). To the extent that it will not compromise the appeals process or the competitive position of the Department of Energy with regard to uranium enrichment, the report shall identify— (1) the effects of the decision on— (A) the operation of the uranium enrichment facilities of ,,|4 ^i,. the Department of Energy; and (B) the revenues of the uranium enrichment program; and (2) how the response of the Department of Energy may mitigate such effects.

Subtitle G—Nuclear Regulatory Commission Annual Charges 42 USC 2213. Congress.

SEC. 7601. NUCLEAR REGULATORY COMMISSION ANNUAL CHARGES.

(a) SUBMISSION OF REPORT.—Within 90 days after the date of the enactment of this Act, the Nuclear Regulatory Commission shall submit to the Committee on Energy and Commerce and the Commit-

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100 STAT. 147

tee on Interior and Insular Affairs of the House of Representatives and the Committee on Environment and Public Works of the Senate a report evaluating the feasibility and necessity of establishing a system for the assessment and collection of annual charges from persons licensed by the Commission pursuant to the Atomic Energy Act of 1954 (42 U.S.C. 2011 et seq.) to fund all or part of the activities conducted by the Commission pursuant to such Act. Such report shall include an analysis of— (1) the extent to which the Commission's existing statutory or regulatory authority to assess and collect annual charges, including the authority of the Commission to assess and collect fees pursuant to title V of the Independent Offices Appropriation Act of 1952, is adequate to enable the Commission to assess 31 USC 9701. and collect fees commensurate with the value of the benefit rendered to the licensee and the cost to the Commission of rendering such benefit; (2) the amounts currently assessed and collected by the Commission pursuant to existing statutory or regulatory authority, and the purposes for which such fees are assessed and collected; and (3) any recommendations of the Commission for expanding the existing statutory authority to assess and collect fees, including the Commission's justification for such expansion. Qi) ASSESSMENT AND COLLECTION.—

(1) IN GENERAL.—Upon the expiration of a period of 45 calendar days (excluding any day in which either House of Congress is not in session because of an adjournment of more than 3 calendar days to a day certain or an adjournment sine die) £ following receipt by the Congress of the report required pursuant to subsection (a), the Nuclear Regulatory Commission shall assess and collect annual charges from its licensees on a fiscal year basis, except that— (A) the maximum amount of the aggregate charges as• sessed pursuant to this paragraph in any fiscal year may . not exceed an amount that, when added to other amounts '"^ collected by the Commission for such fiscal year under other provisions of law, is estimated to be equal to 33 percent of the costs incurred by the Commission with respect to such fiscal year; and (B) any such charge assessed pursuant to this paragraph • shall be reasonably related to the regulatory service provided by the Commission and shall fairly reflect the cost to V..>? the Commission of providing such service. (2) ESTABLISHMENT OF AMOUNT BY RULE.—The amount of the charges assessed pursuant to this paragraph shall be established by rule.

TITLE VIII—OUTER CONTINENTAL SHELF AND RELATED PROGRAMS SEC. 8001. SHORT TITLE.

This title may be referred to as the 'Outer Continental Shelf Lands Act Amendments of 1985".

Outer Continental Shelf Lands Act Amendments of 1985. 43 USC 1301 note.

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 100 STAT. 148

PUBLIC LAW 99-272—APR. 7, 1986

SEC. 8002. NATIONAL POLICY FOR THE OUTER CONTINENTAL SHELF. 43 USC 1332.

Minerals and mining. State and local governments. Infra.

The Outer Continental Shelf Lands Act (43 U.S.C. 1331 et seq.) is amended in paragraph (4) of section 3 by deleting the word "and" at the end of subparagraph (A); deleting the semicolon at the end of subparagraph (B) and inserting in lieu thereof a period; designating subparagraph (B) as subparagraph (C); and inserting after subparagraph (A) the following new subparagraph (B): "(B) the distribution of a portion of the receipts from the leasing of mineral resources of the outer Continental Shelf adjacent to State lands, as provided under section 8(g), will provide affected coastal States and localities with funds which may be used for the mitigation of adverse economic and environmental effects related to the development of such resources; and", sf SEC. 8003. REVISION OF SECTION 8(g).

Contracts. State and local governments. Energy. 43 USC 1352.

Alaska.

43 USC 1336.

Section 8(g) of the Outer Continental Shelf Lands Act (43 U.S.C. 1337(g)) is amended to read as follows: "(g)(1) At the time of soliciting nominations for the leasing of lands containing tracts wholly or partially within three nautical miles of the seaward boundary of any coastal State, and subsequently as new information is obtained or developed by the Secretary, the Secretary shall, in addition to the information required by section 26 of this Act, provide the Governor of such State— "(A) an identification and schedule of the areas and regions proposed to be offered for leasing; "(B) at the request of the Governor of such State, all information from all sources concerning the geographical, geological, and ecological characteristics of such tracts; "(C) an estimate of the oil and gas reserves in the areas proposed for leasing; and "(D) at the request of the Governor of such State, an identification of any field, geological structure, or trap located wholly or partially within three nautical miles of the seaward boundary of such coastal State, including all information relating to the entire field, geological structure, or trap. The provisions of the first sentence of subsection (c) and the provisions of subsections (e)-(h) of section 26 of this Act shall be applicable to the release by the Secretary of any information to any coastal State under this paragraph. In addition, the provisions of subsections (c) and (e)-(h) of section 26 of this Act shall apply in their entirety to the release by the Secretary to any coastal State of any information relating to Federal lands beyond three nautical miles of the seaward boundary of such coastal State. "(2) Notwithstanding any other provision of this Act, the Secretary shall deposit into a separate account in the Treasury of the United States all bonuses, rents, and royalties, and other revenues (derived from any bidding system authorized under subsection (a)(1)), excluding Federal income and windfall profits taxes, and derived from any lease issued after September 18, 1978 of any Federal tract which lies wholly (or, in the case of Alaska, partially until seven years from the date of settlement of any boundary dispute that is the subject of an agreement under section 7 of this Act entered into prior to January 1, 1986 or until April 15, 1993 with respect to any other tract) within three nautical miles of the seaward boundary of any coastal State, or, (except as provided above for Alaska) in the case where a Federal tract lies partially within three

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100 STAT. 149

nautical miles of the seaward boundary, a percentage of bonuses, rents, royalties, and other revenues (derived from any bidding system authorized under subsection (a)(1)), excluding Federal income and windfall profits taxes, and derived from any lease issued after September 18, 1978 of such tract equal to the percentage of surface acreage of the tract that lies within such three nautical miles. Except as provided in paragraph (5) of this subsection, not later than the last business day of the month following the month in which those revenues are deposited in the Treasury, the Secretary shall transmit to such coastal State 27 percent of those revenues, together with all accrued interest thereon. The remaining balance of such revenues shall be transmitted simultaneously to the miscellaneous receipts account of the Treasury of the United States. "(3) Whenever the Secretary or the Governor of a coastal State determines that a common potentially hydrocarbon-bearing area may underlie the Federal and State boundary, the Secretary or the Governor shall notify the other party in writing of his determination and the Secretary shall provide to the Governor notice of the current and projected status of the tract or tracts containing the ,,,. common potentially hydrocarbon-bearing area. If the Secretary has ' ' leased or intends to lease such tract or tracts, the Secretary and the Governor of the coastal State may enter into an agreement to divide the revenues from production of any common potentially hydrocarbon-bearing area, by unitization or other royalty sharing agreement, pursuant to existing law. If the Secretary and the Governor do not enter into an agreement, the Secretary may nevertheless proceed with the leasing of the tract or tracts. Any revenues received by the United States under such an agreement shall be subject to the requirements of paragraph (2). "(4) The deposits in the Treasury account described in this section shall be invested by the Secretary of the Treasury in securities backed by the full faith and credit of the United States having maturities suitable to the needs of the account and yielding the highest reasonably available interest rates as determined by the Secretary of the Treasury. "(5)(A) When there is a boundary dispute between the United States and a State which is subject to an agreement under section 7 of this Act, the Secretary shall credit to the account established 43 USC 1336. pursuant to such agreement all bonuses, ren's, and royalties, and other revenues (derived from any bidding sys 3m authorized under subsection (a)(1)), excluding Federal income and windfall profits taxes, and derived from any lease issued after September 18, 1978 of any Federal tract which lies wholly or partially within three nautical miles of the seaward boundary asserted by the State, if that money has not otherwise been deposited in such account. Proceeds of such account shall be distributed as follows: ,.,^ "Upon the settlement of any boundary dispute which is sub' 1.: ject to a section 7 agreement between the United States and a State, the Secretary shall pay to such State all moneys due such State from amounts deposited in the escro account. If there is insufficient money deposited in the escrc v account, the Secretary shall transmit, from any revenues derived from any lease of Federal lands under this Act, the remaining balance due such State in accordance with the formula set forth in section 8004(b)(l)(B) of the Outer Continental Shelf Lands Act Amendments of 1985. Post, p. 150.

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 100 STAT. 150

PUBLIC LAW 99-272—APR. 7, 1986

"(B) This paragraph applies to all Federal oil and gas lease sales, under this Act, including joint lease sales, occurring after September 18, 1978. "(6) This section shall be deemed to take effect on October 1, 1985, for purposes of determining the amounts to be deposited in the separate account and the States' shares described in paragraph (2). "(7) When the Secretary leases any tract which lies wholly or partially within three miles of the seaward boundary of two or more States, the revenues from such tract shall be distributed as otherwise provided by this section, except that the State's share of such revenues that would otherwise result under this section shall be divided equally among such States.". 43 USC 1337

SEC. 8004. DISTRIBUTION OF SECTION 8(g) ACCOUNT.

State and local governments.

(a) Prior to April 15, 1986, the Secretary shall distribute to the designated coastal States the sum of— (1) the amounts due and payable to each such State under paragraph (2) of section 8(g) of the Outer Continental Shelf Lands Act, as amended by this title, for the period between October 1, 1985, and the date of such distribution, and (2) the amounts due each such State under subsection (b)(l)(A) of this section for the period prior to October 1, 1985. (b)(1) As a fair and equitable disposition of all revenues (including interest thereon) derived from any lease of Federal lands wholly or partially within 3 miles of the seaward boundary of a coastal State prior to October 1, 1985, the Secretary shall distribute: (A) from the funds which were deposited in the separate account in the Treasury of the United States under section 8(g)(4) of the Outer Continental Shelf Lands Act (43 U.S.C. 1337(g)(4)) which was in effect prior to the date of enactment of section 8003 of this title the following sums:

Ante, p. 148.

ijg^«j ^ -^ >^ i •

43 USC 1301 ^°^-

Louisiana Texas California Alabama Alaska Mississippi Florida

($ million) 572 382 338 66 51 14 0.03

as well as 27 percent of the royalties, derived from any lease of Federal lands, which have been deposited through September 30, 1985, in the separate account described in this paragraph and interest thereon accrued through September 30, 1985, and shall transmit any remaining amounts to the miscellaneous receipts account of the Treasury of the United States; and (B) from revenues derived from any lease of Federal lands under the Outer Continental Shelf Lands Act, as amended, prior to April 15 of each of the fifteen fiscal years following the fiscal year in which this title is enacted, 3 percent of the following sums in each of the five fiscal years following the date of enactment of this Act, 7 percent of such sums in each of the next five fiscal years, and 10 percent of such sums in each of the following five fiscal years: Louisiana

($ million) 84

Texas

t

n Ay/

134

California Alabama Alaska Mississippi

289 7 134 2.

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100 STAT. 151

(2) The acceptance of any payment by a State under this section Claims, shall satisfy and release any and all claims of such State against the United States arising under, or related to, section 8(g) of the Outer Continental Shelf Lands Act, as it was in effect prior to the date of Ante, p. 148. enactment of this Act and shall vest in such State the right to receive payments as set forth in this section. (c) Notwithstanding any other provision of this Act, the amounts Louisiana. due and payable to the State of Louisiana prior to October 1, 1986, under subtitle A of title VIII (Outer Continental Shelf and Related Programs) of this Act shall remain in their separate accounts in the Treasury of the United States and continue to accrue interest until October 1, 1986, except that the $572,000,000 set forth in subsection 8004(b)(1)(A) of this section shall only accrue interest from April 15, 1986 to October 1, 1986, at which time the Secretary shall immediately distribute such sums with accrued interest to the State of Louisiana. SEC. 8005. IMMOBILIZATION OF BOUNDARIES.

Section 2(b) of the Submerged Lands Act (43 U.S.C. 1301(b)) is amended by inserting before the semicolon at the end a comma and the following: "except that any boundary between a State and the State and local United States under this Act which has been or is hereafter fixed by governments, coordinates under a final decree of the United States Supreme Court shall remain immobilized at the coordinates provided under such decree and shall not be ambulatory".

TITLE IX—MEDICARE, MEDICAID, AND MATERNAL AND CHILD HEALTH PROGRAMS SEC. 9000. SHORT TITLE; TABLE OF CONTENTS OF TITLE.

This title may be cited as the "Medicare and Medicaid Budget Reconciliation Amendments of 1985". TABLE OF CONTENTS OF TITLE , till:,

. ',

Subtitle A—Medicare

":. «> PART 1—PROVISIONS RELATING TO PART A OF MEDICARE SUBPART A—HOSPITAL REIMBURSEMENT

Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec.

9101. Rate of increase in payments for inpatient hospital services. 9102. One-year extension of PPS transition. 9103. Application of revised hospital wage index. 9104. Payments to hospitals for indirect costs of medical education. 9105. Payments for hospitals which serve a disproportionate share of lowincome patients. 9106. Treatment of certain rural osteopathic hospitals as rural referral centers. 9107. Return on equity capital for inpatient hospital services and other services. 9108. Continuation of medicare reimbursement waivers for certain hospitals participating in regional hospital reimbursement demonstrations. 9109. Four-year test for State waivers for certain States. 9110. Asset valuation for donations of State property to nonprofit corporations. 9111. Payments to sole community hospitals. 9112. Indirect teaching adjustment for certain clinics. 9113. Report on impact of outlier and transfer policy on rural hospitals. 9114. Information on impact of PPS payments on hospitals.

Medicare and Medicaid Budget Reconciliation Amendments of 1985. 42 USC 1305 note.

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14 all about Indian matters" without ever having given a moment's study to that large and complicated subject, has been incredibly great, and the readiness and volubility of their criticism, mostly condemnatory of everything that is done, seems inspired by an inexhaustible fertility of imagination as to facts. No story, ever so extravagant and absurd, can be told about Indian management without finding ready belief. But recently I saw a statement, seriously put forth in respectable newspapers, that the guns and ammunition with which the Indians fight our soldiers are to this day regularly furnished to the savages by the Indian Bureau, or are permitted to be sold to them by licensed traders on the Indian reservations. Whenever an Indian misconducts himself, or the greed or recklessness of white men provoke an Indian trouble, an outcry follows about the disgraceful remissness of the government, and it is at once proclaimed that we are as far as ever from the solution of the Indian problem.

No doubt the history of Indian management, under military as well as civil control, shows many instances of mistake, failure, and wrongdoing; but no fair-minded man can examine that history or the present state of things without admitting that the government has had to contend against enormous difficulties, and that the greatest of these and the most prolific of trouble was the pushing of settlements into the country inhabited by the Indians and the crowding out of the latter, regardless of their rights of occupancy, in many cases guaranteed by treaties. This difficulty could in many instances not be controlled by the Indian Department, which was held responsible for many complications and evils not in its power to avert. It must also be acknowledged that while every disturbance was generally and loudly noticed and commented upon, the good things done escaped in many, if not most cases, public observation and recognition.

It cannot be my purpose, however, here to go into a minute review of the past. Looking at the present condition of things it may be said, without exaggeration, that on the whole the Indian situation is now more hopeful than ever before. The desire of the Indians to maintain friendly relations with their white neighbors, to go to work for their own support, to cultivate the soil, to acquire permanent homes, to have their children educated, and to assimilate themselves to the civilization of the country, is growing stronger and more general every day. The measures prosecuted and in part originated under this administration, which have been mentioned before: the enlargement of the agricultural activity of the Indians; the distribution of cattle among them to promote the industry of herding; the extensive introduction of the freighting business; the encouragement of mechanical industry; the institution of the Indian police, stimulating their respect for law and authority; the increase of their educational facilities, notably among them the education of Indians at Hampton and in North Carolina, and the establishment, by the government, of the Indian


text:
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 100 STAT. 152 ,,r,.

PUBLIC LAW 99-272—APR. 7, 1986

Sec. 9115. Special rules for implementation of subpart. SUBPART B—MISCELLANEOUS PROVISIONS

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' '

Sec. 9121. Responsibilities of medicare hospitals in emergency cases. Sec. 9122. Requirement for medicare hospitals to participate in CHAMPUS and CHAMPVA programs. Sec. 9123. Extension and payment for hospice care. Sec. 9124. Limiting the penalty for late enrollment in part A. ' ^; Sec. 9125. Promulgation of inpatient hospital deductible. , Sec. 9126. Access to skilled nursing facilities. Sec. 9127. Additional members of Prospective Payment Assessment Commission. Sec. 9128. Sense of the Senate with respect to inpatient hospital deductible. Sec. 9129. Medicare coverage of State and local employees. PART 2—PROVISIONS RELATING TO PARTS A AND B OF MEDICARE SUBPART A—PAYMENT-RELATED PROVISIONS

Sec. Sec. Sec. Sec.

9201. 9202. 9204. 9205.

Extension of working aged provision. Payments to hospitals for direct costs of medical education. Moratorium on laboratory payment demonstration. Home health waiver of liability.

,

-

SUBPART B—OTHER PROVISIONS

1

J

Sec. 9211. Provisions relating to health maintenance organizations and competitive medical plans. Sec. 9213. Removal of prohibition on comments by medicare and social security actuaries relating to economic assumptions. Sec. 9214. Limitation on merger of end stage renal disease networks. Sec. 9215. Extension of certain medicare municipal health services demonstration projects. Sec. 9216. Audit and medical claims review. Sec. 9217. Liver transplants. Sec. 9218. Studies relating to physical therapists and other professionals. ''i'fj Sec. 9219. Technical corrections. Sec. 9220. Extension of on lok waiver. Sec. 9221. Continuation of "Access: Medicare" demonstration project. PART 3—PROVISIONS RELATING TO PART B OF MEDICARE SUBPART A—PAYMENT-RELATED PROVISIONS

Sec. 9301. Medicare physician payment provisions. Sec. 9303. Payment for clinical laboratory services. Sec. 9304. Determinations of inherent reasonableness of charges and customary charges for certain former hospital-compensated physicians. Sec. 9305. Physician Payment Review Commission and development of relative value scale. Sec. 9306. Limitation on medicare payment for post-cataract surgery patients. Sec. 9307. Payment for assistants at surgery for certain cataract operations and other operations. SUBPART B—BENEFITS AND OTHER PROVISIONS

Sec. 9313. Part B premium. Sec. 9314. Demonstration of preventive health services under medicare. Sec. 9315. Extension of GAO reporting date. PART 4—PEER REVIEW ORGANIZATIONS

Sec. Sec. Sec. Sec.

9401. 9402. 9403. 9404.

100 percent peer review of certain surgical procedures. Peer review organization reimbursement. Denial of payment for substandard care. Health maintenance organization membership on peer review organization boards. Sec. 9405. Peer review organization review of health maintenance organizations. Sec. 9406. Substitute review pending termination of a peer review organization contract. Sec. 9501. Sec. 9502. Sec. 9503. Sec. 9505.

Subtitle B—Medicaid and Maternal and Child Health Services for pregnant women. Modifications of waiver provisions for home and community-based services. Third-party liability. Optional hospice benefits.

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 PUBLIC LAW 99-272—APR. 7, 1986 Sec. Sec. Sec. Sec. Sec.

9506. 9507. 9508. 9509. 9510.

Sec. Sec. Sec. Sec. Sec.

9511. 9512. 9514. 9515. 9516.

Sec. 9517. Sec. 9518. Sec. 9519. Sec. Sec. Sec. Sec. Sec.

9520. 9522. 9523. 9524. 9525.

Sec. 9526. Sec. 9527. Sec. 9528. Sec. 9529.

100 STAT. 153

Treatment of potential payments from medicaid qualifying trusts. Written standards for provision of organ transplants. Optional targeted case management services. Revaluation of assets. Beginning date of optional coverage for individuals in medical institutions. Optional coverage of children. Overpayment recovery rules. Regulations for intermediate care facilities for the mentally retarded. Life safety code recognition. Correction and reduction plans for intermediate care facilities for the mentally retarded. Modifying application of medicaid HMO provisions for certain health centers. Extension of MMIS deadline. Report on adjustment in medicaid payments for hospitals serving disproportionate numbers of low income patients. Task Force on Technology-Dependent Children. Expansion of services under demonstration waivers. Extension of Texas waiver project. Wisconsin health maintenance organization waiver. New Jersey demonstration project relating to training of AFDC recipients as home health aides. Reference to provisions of law providing coverage under, or directly affecting, the medicaid program. Children with special health care needs. Annual calculation of Federal medical assistance percentage. Medicaid coverage relating to adoption assistance and foster care.

Subtitle C—Task Force on Long-Term Health Care Policies Sec. 9601. Recommendations for long-term health care policies.

,j: ^ '• -;

Subtitle A—Medicare PART 1—PROVISIONS RELATING TO PART A OF MEDICARE Subpart A—Hospital Reimbursement SEC. 9101. RATE OF INCREASE IN PAYMENTS FOR INPATIENT HOSPITAL SERVICES. (a) EXTENSION OF CURRENT FREEZE ON PAYMENT RATES THROUGH

APRIL 30, 1986.—Section 5(c) of the Emergency Extension Act of 1985 (Public Law 99-107) is amended to read as follows: "(c) EXTENSION PERIOD DEFINED.— "(1) HOSPITAL PAYMENTS.—For

purposes of subsection (a), the term 'extension period' means the period beginning on October 1, 1985, and ending on April 30, 1986.".

(b) APPLICABLE PERCENTAGE INCREASE.—Section 1886(b)(3)(B) of

the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)) is amended to read as follows: "(B)(i) For purposes of subparagraph (A) for 12-month cost reporting periods beginning during a fiscal year and for purposes of subsection (d) for discharges occurring during a fiscal year, the 'applicable percentage increase' shall be— "(I) for fiscal year 1986, Vz percent, "(II) for fiscal years 1987 and 1988, a percentage determined by the Secretary pursuant to subsection (e)(4), but not to exceed the market basket percentage increase (as defined in clause (ii)), and

42 USC I395ww ^°^-

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 100 STAT. 154

42 USC 1395WW note.

42 USC 1395WW note.

PUBLIC LAW 99-272—APR. 7, 1986

"(III) for fiscal year 1989 and subsequent fiscal years, the percentage determined by the Secretary pursuant to subsection (e)(4). "(ii) For purposes of clause (i), the term 'market basket percentage increase' means, with respect to cost reporting periods and discharges occurring in a fiscal year, the percentage, estimated by the Secretary before the beginning of the period or fiscal year, by which the cost of the mix of goods and services (including personnel costs but excluding nonoperating costs) comprising routine, ancillary, and special care unit inpatient hospital services, based on an index of appropriately weighted indicators of changes in wages and prices which are representative of the mix of goods and services included in such inpatient hospital services, for the period or fiscal year will exceed the cost of such mix of goods and services for the preceding 12-month cost reporting period or fiscal year.". (c) CONFORMING AMENDMENTS.—(1) Section 1886(d)(3)(A) of such Act (42 U.S.C. 1395ww(d)(3)(A)) is amended by striking out "for fiscal year 1985" and inserting in lieu thereof "for each of fiscal years 1985 and 1986". (2) Section 1886(e)(3) of such Act is amended by striking out "(instead of the applicable percentage increase described in subsection (b)(3)(B))". (3) Section 1886(e)(4) of such Act is amended by striking out "1986" and inserting in lieu thereof "1987". (d) EFFECTIVE DATE OF FREEZE EXTENSION.—The amendment made by subsection (a) shall take effect on March 15, 1986, and the amendments made by subsection (c) shall take effect on the date of the enactment of this Act. (e) EFFECTIVE DATE FOR INCREASE.—

(1) PPS HOSPITALS, DRG PORTION OF PAYMENT.—In the case of a subsection (d) hospital (as defined in paragraph (4))— (A) the amendment made by subsection (b) shall apply to payments made under section 1886(d)(1)(A) of such Act made on the basis of discharges occurring on or after May 1, 1986; and ^ (B) for discharges occurring on or after October 1, 1986, the applicable percentage increase (described in section 1886(b)(3)(B)) for discharges occurring during fiscal year B.i"-U 1986 shall be deemed to have been V2 percent.

wwdfiJCf "'>;= I Si

(2) P P S HOSPITALS, HOSPITAL SPECIFIC PORTION OF PAYMENT.—

OJ

In the case of a subsection (d) hospital— (A) the amendment made by subsection (b) shall apply to payments under section 1886(d)(l)(A) of the Social Security Act made on the basis of discharges occurring during a cost reporting period of a hospital, for the hospital's cost reporting periods beginning on or after October 1, 1985; (B) notwithstanding subparagraph (A), for the cost reporting period beginning during fiscal year 1986, the applicable percentage incresise (as defined in section 1886(b)(3)(B) of such Act) for the— (i) first 7 months of the cost reporting period shall be 0 percent, and ' ' (ij) for the remaining 5 months of the cost reporting period shall be V2 percent; and (C) for cost reporting periods beginning on or after October 1, 1986, the applicable percentage increase (as so

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 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 155

defined) with respect to the previous cost reporting period shall be deemed to have been V2 percent. (3) PPS-EXEMPT HOSPITALS.—In the case of a hospital that is not a subsection (d) hospital— (A) the amendment m a d e by subsection (b) shall apply to cost reporting periods beginning on or after October 1, 1985;

(B) notwithstanding subparagraph (A), for the hospital's cost reporting period beginning during fiscal year 1986, payment under title XVIII of the Social Security Act shall 42 USC 1395. be made as though the applicable percentage increase described in section 1886(b)(3)(B) were equal to %4 of 1 per- 42 USC I395ww. cent; and i?;^

(C) for cost reporting periods beginning on or after October 1, 1986, the applicable percentage increase (as so defined) with respect to the cost reporting period beginning during fiscal year 1986 shall be deemed to have been V 2

percent. (4) DEFINITION.—In this subsection, the term "subsection (d) hospital" has the meaning given such term in section 1886(d)(1)(B) of the Social Security Act. SEC. 9102. ONE-YEAR EXTENSION OF PPS TRANSITION. (a) ONE-YEAR DELAY OF F U L L IMPLEMENTATION OF PROSPECTIVE

PAYMENT SYSTEM.—Section 1886(d)(1)(A) of the Social Security Act (42 U.S.C. 1395ww(d)(l)(A)) is amended by striking out "1986" in clauses (ii) and (iii) and inserting in lieu thereof "1987". (b) N E W T A R G E T A N D D R G P E R C E N T A G E S FOR R E M A I N D E R OF FISCAL

YEAR 1986.—Section 1886(d)(1)(C) of such Act is amended—

(1) by striking out ", or discharges occurring", (2) by striking out "and" at the end of clause (ii), (3) by striking o u t "(iii) on or after October 1, 1985, and before October 1, 1986" in clause (iii) and inserting in lieu thereof "(iv) on or after October 1, 1986, and before October 1, 1987", and

(4) by inserting after clause (ii) the following new clause: "(iii) on or after October 1, 1985, and before October 1, 1986, the 'target percentage' is 45 percent and the 'DRG percentage' is 55 percent; and". (c) NEW BLENDED NATIONAL-REGIONAL DRG RATE FOR REMAINDER OF FISCAL YEAR 1986.—Section 1886(d)(1)(D) of such Act is

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amended— (1) by striking out "cost reporting periods beginning, or", and (2) by striking out "1985" and "1986" and inserting in lieu thereof "1986" and "1987", respectively, each place it appears. (d) EFFECTIVE D A T E S. —

42 USC I395ww

(1) DELAY IN FINAL TRANSITION.—The amendment made by note, subsection (a) shall take effect on the date of the enactment of this Act. (2) C H A N G E I N HOSPITAL SPECIFIC PERCENTAGE.—The amend -

m e n t s m a d e by subsection (b) shall apply—

'^ ^-

(A) to cost reporting periods beginning on or after October 1, 1985, but (B) notwithstanding subparagraph (A), for a hospital's cost reporting period beginning during fiscal year 1986, for purposes of section 1886(d)(1)(A) of the Social Security Act— (i) during the first 7 months of the period the "target percentage" is 50 percent and the "DRG percentage' is 50 percent, and

«- O O B

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Page:United States Statutes at Large Volume 100 Part 1.djvu/192

 100 STAT. 156

PUBLIC LAW 99-272—APR. 7, 1986

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.

(ii) during the remaining 5 months of the period the "target percentage" is 45 percent and the "DRG percentage" is 55 percent. (3) CHANGE IN BLENDED RATE.—The amendments made by subsection (c) shall apply to discharges occurring on or after May 1, 1986. (4) EXCEPTION.—

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42 USC 1395WW.

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(A) Notwithstanding any other provision of this subsection, the amendments made by this section shall not apply to payments with respect to the operating costs of inpatient hospital services (as defined in section 1886(a)(4) of the Social Security Act) of a subsection (d) hospital (as defined in section 1886(d)(1)(B) of such Act) located in the State of Oregon. (B) Notwithstanding any other provision of law, for a cost reporting period beginning during fiscal year 1986 of a subsection (d) hospital to which the amendments made by this section do not apply, for purposes of section 1886(d)( 1)(A) of of Social Security Act— (i) during the first 7 months of the period the "target percentage" is 50 percent and the "DRG percentage" is 50 percent, and . (ii) during the remaining 5 months of the period the "target percentage" is 25 percent and the "DRG percentage" is 75 percent. (C) Notwithstanding any other provision of law, for purposes of section 1886(d)(1)(D) of such Act, the applicable combined adjusted DRG prospective payment rate for a subsection (d) hospital to which the amendments made by this section do not apply is, for discharges occurring on or after October 1, 1985, and before May 1, 1986, a combined rate consisting of 25 percent of the national adjusted DRG prospective payment rate and 75 percent of the regional adjusted DRG prospective payment rate for such discharges.

SEC. 9103. APPLICATION OF REVISED HOSPITAL WAGE INDEX.

••

(a) APPLICATION OF REVISED INDEX PROSPECTIVELY.—(1) Section 42 USC 1395WW note.

42 USC 1395WW.

42 USC 1395WW note. 26 USC 1 note. 42 USC 1395ww note.

2316(b) of the Deficit Reduction Act of 1984 (98 Stat. 1081) is amended to read as follows: "(b) The Secretary shall adjust the payment amounts for hospitals for discharges occurring on or after May 1, 1986, to reflect the changes the Secretary has promulgated in final regulations (on September 3, 1985) relating to the hospital wage index under section 1886(d)(3)(E) of the Social Security Act. For discharges occurring after September 30, 1986, the Secretary shall provide for such periodic adjustments in the appropriate wage index used under that section as may be necessary, taking into account changes in the wage levels and relative proportions of full-time and part-time workers.". (2) The amendment made by paragraph (1) shall be effective as if it had been included in the Deficit Reduction Act of 1984. (b) STUDY OF METHODOLOGY FOR AREA WAGE ADJUSTMENT FOR CENTRAL CITIES.—(1) The Secretary of Health and Human Services,

in consultation with the Prospective Payment Assessment Commission, shall collect information and shall develop one or more methodologies to permit the adjustment of the wage indices used for

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Page:United States Statutes at Large Volume 100 Part 1.djvu/193

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 157

purposes of sections 1886(d)(2)(C)(ii), 1886(d)(2)(H), and 1886(d)(3)(E) of the Social Security Act, in order to more accurately reflect hospital 42 USC 1395WW. labor markets, by taking into account variations in wages and wagerelated costs between the central city portion of urban areas and other parts of urban areas. (2) The Secretary shall report to Congress on the information Reports. collected and the methodologies developed under paragraph (1) not later than May 1, 1987. The report shall include a recommendation as to the feasibility and desirability of implementing such methodologies. SEC. 9104. PAYMENTS TO HOSPITALS FOR INDIRECT COSTS OF MEDICAL EDUCATION. (a) PAYMENT FOR INDIRECT COSTS OF MEDICAL EDUCATION.—Section

1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended to read as follows: "(B) The Secretary shall provide for an additional payment amount for subsection (d) hospitals with indirect costs of medical education, in an amount computed in the same manner as the adjustment for such costs under regulations (in effect as of January 1, 1983) under subsection (a)(2), except as follows: "(i) The amount of such additional payment shall be determined by multiplying (I) the sum of the amount determined under paragraph (l)(A)(ii)(II) (or, if applicable, the amount determined under paragraph (l)(A)(iii)) and the amount paid to the hospital under subparagraph (A), by (II) the indirect teaching adjustment factor described in clause (ii). "(ii) For purposes of clause (i)(II), the indirect teaching adjustment factor for discharges occurring— "(I) on or after May 1, 1986, and before October 1, 1988, is equal to 2 X (d + r)- ""S-1), or "(II) on or after October 1, 1988, is equal to 1.5x((l + r) " ^ ^ - l), where 'r' is the ratio of the hospital's full-time equivalent interns and residents to beds. "(iii) In determining such adjustment the Secretary shall not distinguish between those interns and residents who are employees of a hospital and those interns and residents who furnish services to a hospital but are not employees of such hospital. "(iv) In determining such adjustment, the Secretary shall ^ continue to count interns and residents assigned to outpatient services of the hospital as part of the calculation of the fulltime-equivalent number of interns and residents.". (b) ADJUSTMENT OF PAYMENT AMOUNTS.— (1) RESTANDARDIZING DRG PAYMENT AMOUNTS TO REFLECT CHANGE IN FORMULA.—Section 1886(d)(2)(C)(i) of such Act is

amended by inserting "(taking into account, for discharges occurring after September 30, 1986, the amendments made by section 9104(a) of the Medicare and Medicaid Budget Reconciliation Amendments of 1985)" after "medical education costs". (2) PROVIDING FOR SYSTEM SAVINGS FROM CHANGE IN FOR-

MULA.—Subparagraph (C) of section 1886(d)(3) of such Act is amended— (A) by inserting "(i)" after "(C)", (B) by inserting "FOR FISCAL YEAR 1985" after "NEUTRALITY",

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Page:U.S. Department of the Interior Annual Report 1880.djvu/17

Rh schools at Carlisle and Forest Grove, may be said to have been very effective in this direction. When, in addition to all this, the bill advocated by this department to allot lands among the Indians in severalty, and to confer upon them individual title in fee simple, inalienable for a certain period, shall have been made a law, and that law shall have been applied among all the Indian tribes, which, in my opinion, it can be in a few years, and the rights of the Indians are accorded equal protection in the courts of the country with those of white men, then it may be said that all essential measures will have been taken to solve the Indian problem, and the time may be confidently looked for when the Indian population may be merged in the great body of American citizenship. We are on the straight road to that solution and nearer to its accomplishment than is generally supposed. It is essential, however, that the policy here set forth should be carefully protected against hostile interferences and guarded against ill-advised precipitancy.

The management of Indian affairs has to deal with two distinct currents of sentiment in this country. The one is that Indians will not work; that to recognize any rights of the Indians is a wrong to the white people; that to secure them in the possession of lands, whatever title they may have to them, is an obstruction to the progress of the country, by depriving whites of the lands they ought to have for their use; and that the only proper thing to do is to get the Indians out of the way altogether. This theory, I regret to say, is most strongly upheld in that part of the country which is inhabited by most of the Indians themselves. The pressure of the white population upon Indian reservations, animated with this spirit, has, in fact, been the principal source of our Indian troubles. It is scarcely necessary to point out to fair-minded men the injustice and inhumanity of such principles, or to show to those who have the experience of the past before their eyes that to act upon those principles would not only be a great wrong to the race which was the original occupant of this continent, but must also lead to most costly and disastrous conflicts with them. The other current of opinion is that the Indians, even as they now are, must at once be relieved of all restraints to which white people are not subjected, and must, without further preparation, be accorded the enjoyment and exercise of all the rights which the civilized citizens of this country enjoy and exercise. This view is entertained and advocated most warmly in that part of the country which is farthest removed from the ground upon which the Indian problem has to be solved. While this will certainly be the ultimate end of a wise policy, and should be applied to all who are capable of intelligently exercising and enjoying such rights, it must be admitted that the number of Indians fitted for their intelligent enjoyment and exercise, and, in fact, even for an intelligent understanding and appreciation of them, is still comparatively small, and that to throw the uncivilized red man, such as he now is, into the struggles and competitions of life with his white neighbor, without sufficient preparation and active


text:
Page:United States Statutes at Large Volume 100 Part 1.djvu/194

 100 STAT. 158

,

PUBLIC LAW 99-272—APR. 7, 1986 (C) by striking out "The Secretary" and inserting in lieu thereof "For discharges occurring in fiscal year 1985, the Secretary", and (D) by adding at the end the following new clause: "(ii) REDUCING FOR SAVINGS FROM AMENDMENT TO INDIRECT TEACHING ADJUSTMENT FOR DISCHARGES AFTER SEPTEMBER 30,

42 USC 1395WW. 42 USC 1395WW note.

1986.—For discharges occurring after September 30, 1986, the Secretary shall further reduce each of the average standardized amounts (in a proportion which takes into account the differing effects of the standardization effected under paragraph (2)(C)(i)) so as to provide for a reduction in the total of the payments (attributable to this paragraph) made for discharges occurring— "(I) on or after October 1, 1986, and before October 1, 1988, of an amount equal to the estimated reduction in the payment amounts under paragraph (5)(B) that would have resulted from the enactment of the amendments made by section 9104 of the Medicare and Medicaid Budget Reconciliation Amendments of 1985 if the factor described in ^ clause (ii)(II) of paragraph (5)(B) were applied for discharges occurring during such period instead of the factor described in clause (ii)(I) of that paragraph, and "(II) on or after October 1, 1988, of an amount equal to the estimated reduction in the payment amounts under paragraph (5)(B) for those discharges that has resulted from , the enactment of the amendments made by section 9104 of the Medicare and Medicaid Budget Reconciliation Amendments of 1985.". (3) CONFORMING AMENDMENT.—Clauses (i)(I) and (ii)(I) of section 1886(d)(3)(D) of such Act are each amended by inserting "or reduced" after "(B), and adjusted", (c) EFFECTIVE DATE.—(1) Except as provided in paragraph (2), the amendments made by this section shall apply to discharges occurring on or after May 1, 1986. (2) The amendments made by this section shall not first be applied to discharges occurring as of a date unless, for discharges occurring on that date, the amendments made by section 9105 are also being applied. SEC. 9105. PAYMENTS FOR HOSPITALS WHICH SERVE A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS. (a) PAYMENT FOR HOSPITALS WHICH SERVE A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS.—Section 1886(d)(5) of the Social

Urban areas. State and local governments.

Security Act (42 U.S.C. 1395ww(d)(5)) is amended by adding at the end the following new subparagraph: "(F)(i) For discharges occurring on or after May 1, 1986, and before October 1, 1988, the Secretary shall provide, in accordance with this subparagraph, for an additional payment amount for each subsection (d) hospital which— "(I) serves a significantly disproportionate number of lowincome patients (as defined in clause (v)), or "(II) is located in an urban area, has 100 or more beds, and can demonstrate that its net inpatient care revenues (excluding any of such revenues attributable to this title or State plans approved under title XIX), during the cost reporting period in which the discharges occur, for indigent care from State and local government sources exceed 30 percent of its total of such revenues during the period.

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Page:United States Statutes at Large Volume 100 Part 1.djvu/195

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 159

"(ii) The amount of such payment for each discharge shall be determined by multiplying (I) the sum of the amount determined under paragraph (IXAXiiXII) (or, if applicable, the amount determined under paragraph (IXAXiii)) and the amount paid to the hospital under subparagraph (A) for that discharge, by (II) the disproportionate share adjustment percentage established under clause (iii) or (iv) for the cost reporting period in which the discharge occurs. "(iii) The disproportionate share adjustment percentage for a cost reporting period for a hospital described in clause (i)(II) is equal to 15 percent. "(iv) The disproportionate share adjustment percentage for a cost Rural areas. reporting period for a hospital that is not described in clause (i)(II) and that— "(I) is located in an urban area and has 100 or more beds, is equal to the lesser of 15 percent, or the percent determined in accordance with the following formula: (P—15X.5) + 2.5, where 'P' is the hospital's disproportionate patient percentage (as defined in clause (vi)); "(II) is located in an urban area and has less than 100 beds, is equal to 5 percent; or "(III) is located in a rural area, is equal to 4 percent. "(v) In this subparagraph, a hospital 'serves a significantly dis- Rural areas. proportionate number of low income patients' for a cost reporting period if the hospital has a disproportionate patient percentage (as defined in clause (vi)) for that period which equals, or exceeds— "(I) 15 percent, if the hospital is located in an urban area and has 100 or more beds, "(II) 40 percent, if the hospital is located in an urban area and has less than 100 beds, or "(III) 45 percent, if the hospital is located in a rural area. "(vi) In this subparagraph, the term 'disproportionate patient percentage' means, with respect to a cost reporting period of a hospital, the sum of— "(I) the fraction (expressed as a percentage), the numerator of which is the number of such hospital's patient days for such period which were made up of patients who (for such days) were entitled to benefits under part A of this title and were entitled to supplementary security income benefits (excluding any State supplementation) under title XVI of this Act, and the denominator of which is the number of such hospital's patient days for such fiscal year which were made up of patients who (for such days) were entitled to benefits under part A of this title, and (II) the fraction (expressed as a percentage), the numerator of which is the number of the hospital's patient days for such period which consist of patients who (for such days) were eligible for medical assistance under a State plan approved under title XIX, but who were not entitled to benefits under part A of this title, and the denominator of which is the total number of the hospital's patient days for such period.". (b) RESTANDARDIZING D R G PAYMENT AMOUNTS TO REFLECT DIS- 42 USC I395ww. PROPORTIONATE SHARE PAYMENTS.—Section 1886(d)(2)(C) of such Act is amended— (1) by striking out "and" at the end of clause (ii), (2) by striking out the period at the end of clause (iii) and inserting in lieu thereof ", and", and (3) by adding at the end the following new clause:

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Page:United States Statutes at Large Volume 100 Part 1.djvu/196

 100 STAT. 160

42 USC 1395WW.

42 USC 1395WW note.

PUBLIC LAW 99-272—APR. 7, 1986

"(iv) for discharges occurring on or after October 1, 1986, and before October 1, 1988, excluding an estimate of the additional payments to certain hospitals to be made under paragraph (5)(F).". (c) CONFORMING AMENDMENT.—Section 1886(d)(5)(C)(i) of such Act is amended by striking out ", and of public or other hospitals that serve a significantly disproportionate number of patients who have low income or are entitled to benefits under part A of this title". (d) CBO REPORT.—The Congressional Budget Office shall study, and report to Congress not later than January 1, 1987, on the impact of the implementation of this section on hospitals, including the appropriateness of the factors used in determining which hospitals are eligible for additional payments under section 1886(d)(5)(F) of the Social Security Act and the amount of the additional payments made to those hospitals. (e) EFFECTIVE DATE.—The amendments made by this section shall apply to discharges occurring on or after May 1, 1986. SEC. 9106. TREATMENT OF CERTAIN RURAL OSTEOPATHIC HOSPITALS AS RURAL REFERRAL CENTERS.

42 USC 1395WW note.

(a) IN GENERAL.—Section 1886(d)(5)(C)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(C)(i)) is amended by inserting before the period at the end of the second sentence the following: "and which shall not require a rural osteopathic hospital to have more than 3,000 discharges in a year in order to be classified as a rural referral center". (b) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to cost reporting periods beginning on or after January 1, 1986. SEC. 9107. RETURN ON EQUITY CAPITAL FOR INPATIENT HOSPITAL SERVICES AND OTHER SERVICES. (a) INPATIENT HOSPITAL SERVICES.— (1) PHASE-DOWN IN PAYMENT FOR RETURN ON EQUITY CAPITAL.—

Section 1886(g)(2) of the Social Security Act (42 U.S.C. 1395ww(g)(2)) is amended— (A) by inserting "the applicable percentage (described in subparagraph (B)) o f before "the average of the rates of interest" (B) by inserting "(A)" after "(2)", and (C) by adding at the end the following new subparagraph: "(B) In this paragraph, the 'applicable percentage' is— • "(i) 75 percent, for cost reporting periods beginning during fiscal year 1987, "(ii) 50 percent, for cost reporting periods beginning during fiscal year 1988, "(iii) 25 percent, for cost reporting periods beginning ^ during fiscal year 1989, and M:- 1' ««^^^) Q percent, for cost reporting periods beginning on or after October 1, 1989.". (2) EXCLUSION FROM PROSPECTIVE PAYMENT.—The second sentence of section 1886(a)(4) of such Act is amended— (A) by inserting "a return on equity capital," after "anesI. thetist,", and "" (B) by inserting "other" before "capital-related costs". (b) OTHER SERVICES.—

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Page:Collodi - The Story of a Puppet, translation Murray, 1892.djvu/125

 Seized with a sad presentiment he began to run with all the strength he had left, and in a few minutes he reached the field where the little white house had once stood. But the little white house was no longer there. He saw instead a marble stone, on which were engraved these sad words:

I leave you to imagine the puppet's feelings when he had with difficulty spelt out this epitaph. He fell with his face on the ground, and covering the tombstone with a thousand kisses burst into an agony of tears. He cried all night, and when morning came he was still crying although he had no tears left, and his sobs and lamentations were so acute and heartbreaking that they roused the echoes in the surrounding hills.

And as he wept he said:

'Oh, little Fairy, why did you die? Why did not I die instead of you, I who am so wicked, whilst you were so good? . . . And my papa? Where can he be? Oh, little Fairy, tell me where I can find him, for I


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Page:United States Statutes at Large Volume 100 Part 1.djvu/197

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 161

(1) LIMITATION ON RATE.—Section 1861(v)(l) of such Act (42 U.S.C. 1395x(v)(l)) is amended by adding at the end the following new subparagraph: "(P) If such regulations provide for the payment for a return on equity capital (other than with respect to costs of inpatient hospital services), the rate of return to be recognized, for determining the reasonable cost of services furnished in a cost reporting period, shall be equal to the average of the rates of interest, for each of the months any part of which is included in the period, on obligations issued for purchase by the Federal Hospital Insurance Trust Fund.". (2) CONFORMING AMENDMENTS.—Section 1861(v)(l)(B) of such Act is amended— (A) by striking out "any fiscal period" and "such fiscal period" and inserting in lieu thereof "any cost reporting .,, period" and "the period", respectively, and (B) by striking out "not exceed one and one-half times" in the second sentence and inserting in lieu thereof "be equal to". (c) EFFECTIVE DATES.—(1) The amendments made by subsection (a) 42 USC 1395WW shall apply to hospital cost reporting periods beginning on or after note. October 1, 1986. (2) The amendments made by subsection (b) shall apply to cost 42 USC 1395x note. reporting periods beginning on or after October 1, 1985. SEC. 9108. CONTINUATION OF MEDICARE REIMBURSEMENT WAIVERS FOR CERTAIN HOSPITALS PARTICIPATING IN REGIONAL HOSPITAL REIMBURSEMENT DEMONSTRATIONS.

(a) CONTINUATION OF WAIVERS.—A hospital reimbursement control system which, on January 1, 1985, was carrying out a demonstration under a contract which had been approved by the Secretary of Health and Human Services pursuant to section 222(a) of the Social Security Amendments of 1972, or under section 402 of the Social Security Amendments of 1967 (as amended by section 222(b) of the Social Security Amendments of 1972), shall be deemed to meet the requirements of section 1886(c)(1)(A) of the Social Security Act if such system applies— (1) to substantially all non-Federal acute care hospitals (as defined by the Secretary) in the geographic area served by such system on January 1, 1985, and (2) to the review of at least 75 percent of— (A) all revenues or expenses in such geographic area for inpatient hospital services, and (B) revenues or expenses in such geographic area for inpatient hospital services provided under the State's plan approved under title XIX. (b) APPROVAL.—In the case of a hospital cost control system described in subsection (a), the requirements of section 1886(c) of the Social Security Act which apply to States shall instead apply to such system and, for such purposes, any reference to a State is deemed a reference to such system. (c) EFFECTIVE DATE.—This section shall become effective on the date of the enactment of this Act. SEC. 9109. FOUR-YEAR TEST FOR STATE WAIVERS FOR CERTAIN STATES.

(a) IN GENERAL.—Section 1886(c) of the Social Security Act (42 U.S.C 1395ww(c)) is amended by adding at the end the following new paragraph:

42 USC 1395WW note.

42 USC 1395b-l note.

Infra.

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Page:United States Statutes at Large Volume 100 Part 1.djvu/198

 100 STAT. 162

42 USC 1395WW note.

PUBLIC LAW 99-272—APR. 7, 1986

"(7) In the case of a State which made a request under paragraph (5) before December 31, 1984, for the approval of a State hospital reimbursement control system and which request was approved— "(A) in applying paragraphs (1)(C) and (6), a reference to a '36month period' is deemed a reference to a '48-month period', and "(B) in order to allow the State the opportunity to provide the assurances described in paragraph (1)(C) for a 48-month period, the Secretary may not discontinue payments under the system, under the authority of paragraph (3)(A) because the Secretary has reason to believe that such assurances are not being (or will not be) met, before July 1, 1986.". (b) EFFECTIVE DATE.—The amendment made by subsection (a) shall take effect on the date of the enactment of this Act. SEC. 9110. ASSET VALUATION FOR DONATIONS OF STATE PROPERTY TO NONPROFIT CORPORATIONS.

42 USC 1395x note. 26 USC 1 note.

(a) GENERAL RULE.—Section 1861(v)(l)(0) of the Social Security Act (42 U.S.C. 1395x(v)(l)(0)) is amended— (1) by inserting ", except as provided in clause (iv)," in clause (i) after "such regulations shall provide", and (2) by adding at the end the following new clause: "(iv) In the case of the transfer of a hospital from ownership by a State to ownership by a nonprofit corporation without monetary consideration, the basis for capital allowances to the new owner shall be the book value of the hospital to the State at the time of the transfer.". (b) EFFECTIVE DATE.—The amendments made by subsection (a) shall be applied as though they were originally included in the Deficit Reduction Act of 1984. SEC. 9111. PAYMENTS TO SOLE COMMUNITY HOSPITALS.

42 USC 1395WW note.

(a) ADJUSTMENT TO PAYMENT AMOUNT.—Section 1886(d)(5)(C)(ii) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(C)(ii)) is amended by inserting after the second sentence thereof the following: "In the case of a sole community hospital which experiences, in any cost reporting period after the cost reporting period which was used as the base for determining the target amount for payments to such hospital under paragraph (l)(A)(i)(I), a significant increase in operating costs attributable to the addition of new inpatient facilities or services at such hospital (including the opening of a special care unit), the Secretary shall provide for such adjustment to the payment amounts under this subsection for such cost reporting period and subsequent cost reporting periods as may be necessary to reasonably compensate such hospital for such increased costs.". (b) EFFECTIVE DATE.—The amendment made by this section shall apply to payments for cost reporting periods beginning on or after October 1, 1983, and before October 1, 1989. (c) STUDY.—The Secretary of Health and Human Services shall conduct a study of the effects of the amendment made by subsection (a). The Secretary shall report the results of such study, including recommendations for a permanent mechanism to take into account needed expansions of services by sole community hospitals and the hospital-specific medicare payment rates thereof, to the Congress prior to January 1, 1987.

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Page:United States Statutes at Large Volume 100 Part 1.djvu/199

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 163

SEC. 9112. INDIRECT TEACHING ADJUSTMENT FOR CERTAIN CLINICS.

(a) IN GENERAL.—Section 602(k) of the Social Security Amendments of 1983 (97 Stat. 165) is amended by inserting "(1)" after "(k)" and by adding at the end the following new paragraphs: "(2) In the case of a hospital which is receiving payments pursuant to a waiver under paragraph (1), payment of the adjustment for indirect costs of approved educational activities shall be made as if the hospital were receiving under part A of title XVIII of the Social Security Act all the payments which are made under part B of such title solely by reason of such waiver. "(3) Any waiver granted under paragraph (1) shall provide that, with respect to those items and services billed under part B of title XVIII of the Social Security Act solely by reason of such waiver— "(A) payment under such part shall be equal to 100 percent of the reasonable charge or other applicable payment base for the items and services; and "(B) the entity furnishing the items and services must agree to accept the amount paid pursuant to subparagraph (A) as the full charge for the items and services.". (b) EFFECTIVE DATES.—(1) Section 602(k)(2) of the Social Security Amendments of 1983 (as added by subsection (a)) shall apply to cost reporting periods beginning on or after January 1, 1986. (2) Section 602(k)(3) of the Social Security Amendments of 1983 (as added by subsection (a)) shall apply to items and services furnished after the end of the 10-day period beginning on the date of the enactment of this Act. SEC. 9113. REPORT ON IMPACT OF OUTLIER AND TRANSFER POLICY ON RURAL HOSPITALS.

42 USC 1495y note.

42 USC 1395c. 42 USC 1395J.

42 USC 1395y note.

- ^ S>

(a) REVIEW.—The Secretary of Health and Human Services shall review the impact of policies respecting outliers and patient transfers on payments under section 1886(d) of the Social Security Act to 42 USC I395ww. rural hospitals (particularly on rural hospitals with less than 100 beds). (b) REPORT.—The Secretary shall report to Congress on the findings of the review not later than January 1, 1987, and shall include in the report recommendations on changes in policies respecting outliers and patient transfers to the extent they adversely affect rural hospitals. SEC. 9114. INFORMATION ON IMPACT OF PPS PAYMENTS ON HOSPITALS.

(a) DISCLOSURE OF INFORMATION.—The Secretary of Health and

Human Services shall make available to the Prospective Payment Assessment Commission, the Congressional Budget Office, the Comptroller General, and the Congressional Research Service the most current information on the payments being made under section 1886 of the Social Security Act to individual hospitals. Such information shall be made available in a manner that permits examination of the impact of such section on hospitals. (h) CONFIDENTIALITY.—Information disclosed under subsection (a) shall be treated as confidential and shall not be subject to further disclosure in a manner that permits the identification of individual hospitals.

42 USC 1395WW note.

SEC. 9115. SPECIAL RULES FOR IMPLEMENTATION OF SUBPART.

(a) WAIVER OF PAPERWORK REDUCTION.—Chapter 35 of title 44, 42 USC I395ww United States Code, shall not apply to information required for "°*f • ^ „^„, 44 USC 3501 et

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Page:United States Statutes at Large Volume 100 Part 1.djvu/200

 100 STAT. 164

PUBLIC LAW 99-272—APR. 7, 1986 purposes of carrying out this subpart and implementing the amendments made by this subpart. (b) USE OF INTERIM FINAL REGULATIONS.—The Secretary of Health and Human Services shall issue such regulations (on an interim or other basis) as may be necessary to implement this subpart and the amendments made by this subpart.

Subpart B—Miscellaneous Provisions SEC. 9121. RESPONSIBILITIES OF MEDICARE HOSPITALS IN EMERGENCY CASES. (a)

Infra.

REQUIREMENT OF MEDICARE

HOSPITAL

PROVIDER AGREE-

MENTS.—Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(l)) is amended— (1) by striking out "and" at the end of subparagraph (G), (2) by striking out the period at the end of subparagraph (H) and inserting in lieu thereof ", and", and (3) by inserting after subparagraph (H) the following new subparagraph: "(I) in the case of a hospital, to complv with the requirements of section 1867 to the extent applicable.'. (b) REQUIREMENTS.—Title XVIII of such Act is amended by inserting after section 1866 the following new section: "EXAMINATION AND TREATMENT FOR EMERGENCY MEDICAL CONDITIONS AND WOMEN IN ACTIVE LABOR

42 USC I395dd.

1867. (a) MEDICAL SCREENING REQUIREMENT.—In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this title) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1)) exists or to determine if the individual is in active labor (within the meaning of subsection (e)(2)). "SEC.

"(b) NECESSARY STABILIZING TREATMENT FOR EMERGENCY MEDICAL CONDITIONS AND ACTIVE LABOR.—

"(1) IN GENERAL.—If any individual (whether or not eligible for benefits under this title) comes to a hospital and the hospital determines that the individual has an emergency medical condition or is in active labor, the hospital must provide either— "(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition or to provide for treatment of the labor, or "(B) for transfer of the individual to another medical facility in accordance with subsection (c). "(2)

,^

REFUSAL TO CONSENT TO TREATMENT.—A hospital

is

deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph but the individual (or a legally responsible person acting on the individual's behalf) refuses to consent to the examination or treatment.

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Page:United States Statutes at Large Volume 100 Part 1.djvu/201

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 165

"(3) REFUSAL TO CONSENT TO TRANSFER.—A hospital is deemed to meet the requirement of paragraph (1) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) but the individual (or a legally responsible person acting on the individual's behalf) refuses to consent to the transfer. '(c) RESTRICTING TRANSFERS UNTIL PATIENT STABILIZED.—

"(1) RULE.—If a patient at a hospital has an emergency medical condition which has not been stabilized (within the meaning of subsection (e)(4)(B)) or is in active labor, the hospital may not transfer the patient unless— "(A)(i) the patient (or a legally responsible person acting on the patient's behalf) requests that the transfer be effected, or "(ii) a physician (within the meaning of section 1861(r)(l)), 42 USC I395x. or other qualified medical personnel when a physician is not readily available in the emergency department, has signed a certification that, based upon the reasonable risks and benefits to the patient, and based upon the information available at the time, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual's medical condition from effecting the transfer; and "(B) the transfer is an appropriate transfer (within the meaning of paragraph (2)) to that facility. "(2) APPROPRIATE TRANSFER.—An appropriate transfer to a

medical facility is a transfer— "(A) in which the receiving facility— "(i) has available space and qualified personnel for the treatment of the patient, and "(ii) has agreed to accept transfer of the patient and to provide appropriate medical treatment; "(B) in which the transferring hospital provides the receiving facility with appropriate medical records (or copies thereof) of the examination and treatment effected at the transferring hospital; "(C) in which the transfer is effected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer; and "(D) which meets such other requirements as the Secretary may find necessary in the interest of the health and safety of patients transferred. '(d) ENFORCEMENT.— "(1) As REQUIREMENT OF MEDICARE PROVIDER AGREEMENT.—If a

hospital knowingly and willfully, or negligently, fails to meet the requirements of this section, such hospital is subject to— "(A) termination of its provider agreement under this title in accordance with section 1866(b), or 42 USC I395cc. "(B) at the option of the Secretary, suspension of such agreement for such period of time as the Secretary determines to be appropriate, upon reasonable notice to the hospital and to the public. "(2) CIVIL MONETARY PENALTIES.—In addition to the other grounds for imposition of a civil money penalty under section 1128A(a), a participating hospital that knowingly violates a 42 USC 1320a-7a.

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Page:U.S. Department of the Interior Annual Report 1880.djvu/18

16 care and guidance on the part of the government during the intermediate period, would be the greatest cruelty to him. The adoption of the principles first mentioned would keep the Indians in barbarism for the purpose of accelerating their extinction; but general and premature action upon the second would precipitate upon them a conflict with overwhelming superior forces, unprotected and unguided by the hand of a friendly power, and thus accelerate their destruction likewise.

While the government, therefore, must recognize its duty to protect the rights of the Indian, it should at the same time not forget that, during the period of transition from savage life to civilization, he stands very much in need of its care and guidance. That period is one of hope, but at the same time one of great danger. Then the picturesque, warlike, self-relying Indian of the wilderness gradually disappears. He enters into conditions and relations of life entirely new to him; his self-reliance gives way; he does not know whether that which he learns is good or evil; he is liable to acquire with the virtues of civilization its vices, and the latter more easily than the former; he is a mere child, alike accessible to evil and to good influences; if prematurely relieved of all restraints of intercourse, he is apt in the sparsely-settled countries of the far West to fall first into the hands of elements of population whose influence upon him will not be elevating; he is in danger of becoming a drunkard before he is able to measure the evils of drunkenness; he is liable to be tricked out of his property before he has a full estimate of its value; he has to overcome his life-long habit of careless improvidence as to the coming day; his first introduction into the contests of civilized life will be likely to overwhelm him with a feeling of helplessness, and he naturally looks up to the “Great Father” for a protecting and guiding hand. That hand must not be prematurely withdrawn on the theory that the mere recognition of the Indian's rights will be sufficient to enable him intelligently to exercise and to maintain them.

We must not expect too much of his first efforts. If the results of those efforts do not speedily rise to the white man's standard, patient help must be given to raise them to the level which they can attain. Neither must we indulge in the hope that the Indian, however hopeful his progress at the beginning, will very soon become as useful a citizen as the average of his neighbors; but we may certainly hope to see a large number of them gradually raise themselves to that position in a working and productive community which many Indians in the Indian Territory, in Indiana, Michigan, and other States have already reached. There are many among them who are now intelligent and useful citizens, many others rapidly qualifying themselves for citizenship, and there is no reason to doubt that this class may in the course of time be largely increased.

Experience has strengthened my conviction, which, this being my last report, I now feel at greater liberty to express, that while the guiding care of the government is necessary, that task should be intrusted to the


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Page:United States Statutes at Large Volume 100 Part 1.djvu/202

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 166

requirement of this section and the responsible physician in the hospital with respect to such a violation are each subject, under that section, to a civil money penalty of not more than $25,000 for each such violation. As used in the previous sentence, the term 'responsible physician' means, with respect to a hospital's violation of a requirement of this section, a physician who— "(A) is employed by, or under contract with, the participating hospital, and "(B) acting as such an employee or under such a contract, has professional responsibility for the provision of examinations or treatments for the individual, or transfers of the individual, with respect to which the violation occurred. xv.

"(3) CIVIL ENFORCEMENT.— "(A) PERSONAL HARM.—Any

J i

individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate.

State and local

"(B) FINANCIAL LOSS TO OTHER MEDICAL FACILITY.—Any

governments. "•r ' '•>•' ^-*

42 USC 1395CC.

medical facility that suffers a financial loss as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for financial loss, under the law of the State in which the hospital is located, and such equitable relief as is appropriate. "(C) LIMITATIONS ON ACTIONS.—No action may be brought

under this paragraph more than two years after the date of the violation with respect to which the action is brought. "(e) DEFINITIONS.—In this section: "(1) The term 'emergency medical condition' means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in— "(A) placing the patient's health in serious jeopardy, "(B) serious impairment to bodily functions, or "(C) serious dysfunction of any bodily organ or part. "(2) The term 'active labor' means labor at a time at which— "(A) delivery is imminent, "(B) there is inadequate time to effect safe transfer to another hospital prior to delivery, or "(C) a transfer may pose a threat of the health and safety of the patient or the unborn child. "(3) The term 'participating hospital' means hospital that has entered into a provider agreement under section 1866 and has, under the agreement, obligated itself to comply with the requirements of this section. "(4)(A) The term 'to stabilize' means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from the transfer of the individual from a facility.

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Page:United States Statutes at Large Volume 100 Part 1.djvu/203

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 167

"(B) The term 'stabilized' means, with respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from the transfer of the individual from a facility. "(5) The term 'transfer' means the movement (including the discharge) of a patient outside a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of a patient who (A) has been declared dead, or (B) leaves the facility without the permission of any such person. "(f) PREEMPTION.—The provisions of this section do not preempt State and local any State or local law requirement, except to the extent that the governments. requirement directly conflicts with a requirement of this section.". (c) EFFECTIVE DATE.—The amendments made by this section shall 42 USC 1395dd take effect on the first day of the first month that begins at least 90 note. days after the date of the enactment of this Act. (d) REPORT.—The Secretary of Health and Human Services shall, not later than 6 months after the effective date described in subsection (c), report to Congress on the methods to be used for monitoring and enforcing compliance with section 1867 of the Social Security Act. Ante, p. 164. SEC. 9122. REQUIREMENT FOR MEDICARE HOSPITALS TO PARTICIPATE IN CHAMPUS AND CHAMPVA PROGRAMS.

(a) IN GENERAL.—Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(l)) is amended— (1) by striking out "and" at the end of subparagraph (H), (2) by striking out the period at the end of subparagraph (I) and inserting in lieu thereof ", and", and (3) by inserting after subparagraph (I) the following new subparagraph: "(J) in the case of hospitals which provide inpatient hospital services for which payment may be made under this title, to be a participating provider of medical care under any health plan contracted for under section 1079 or 1086 of title 10, or under section 613 of title 38, United States Code, in accordance with admission practices, payment methodology, and amounts as prescribed under joint regulations issued by the Secretary and by the Secretaries of Defense and Transportation, in implementation of sections 1079 and 1086 of title 10, United States Code.". (b) EFFECTIVE DATE.—The amendments made by subsection (a) shall apply to agreements entered into or renewed on or after the date of the enactment of this Act, but shall apply only to inpatient hospital services provided pursuant to admissions to hospitals occurring on or after January 1, 1987. (c) REFERENCE TO STUDY REQUIRED.—For a study of the use by CHAMPUS of the medicare prospective payment system, see section 634 of the Department of Defense Authorization Act, 1985 (Public Law 98-525), the deadline for which is extended under section 2002 of this Act. (d) REPORT.—The Secretary of Health and Human Services shall report to Congress periodically on the number of hospitals that have terminated or failed to renew an agreement under section 1866 of the Social Security Act as a result of the additional conditions imposed under the amendments made by subsection (a).

Ante, p. 164.

42 USC 1395CC note.

98 Stat. 2544 42 USC 1395CC note.

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Page:United States Statutes at Large Volume 100 Part 1.djvu/204

 100 STAT. 168

PUBLIC LAW 99-272—APR. 7, 1986

SEC. 9123. EXTENSION AND PAYMENT FOR HOSPICE CAKE. 42 USC 1395c note.

(a) ELIMINATION OF SUNSET.—Section 122(h)(1) of the Tax Equity and Fiscal Responsibility Act of 1982 (P.L. 97-248, 96 Stat. 362), relating to the end of the effective date for hospice care, is amended— (1) in subparagraph (A)— (A) by striking out "(h)(1)(A) Subject to subparagraph (B), the" and inserting in lieu thereof "(h)(1) The", and (B) by striking out ", and before October 1, 1986", and (2) by striking out subparagraph (B). (b) INCREASE IN PAYMENT OF DAILY RATES FOR HOSPICE CARE.—(1)

Subparagraph (B) of section 1814(i)(l) of the Social Security Act (42 U.S.C. 1395f(i)(l)) is amended to read as follows: "(B) Notwithstanding subparagraph (A), for hospice care furnished on or after April 1, 1986, the daily rate of payment per day for routine home care shall be $63.17 and the daily rate of payment for other services included in hospice care shall be the daily rate of payment recognized under subparagraph (A) as of July 1, 1985, increased by $10.". (2) Subparagraph (C) of such section is amended by striking out "1985" and inserting in lieu thereof "1986". SEC. 9124. LIMITING THE PENALTY FOR LATE ENROLLMENT IN PART A. (a) LIMITING PENALTY TO 10 PERCENT AND TWICE THE PERIOD DURING WHICH NOT ENROLLED.—Section 1818(c) of the Social Secu-

42 USC 1395r.

42 USC 1395i-2 note.

rity Act (42 U.S.C. 1395i-2(c)) is amended— (1) by striking out "and" at the end of paragraph (5), (2) by striking out the period at the end of paragraph (6) and inserting in lieu thereof "; and", and (3) by adding at the end the following new paragraph: "(7) any percent increase effected under section 1839(b) in an individual's monthly premium may not exceed 10 percent and shall only apply to premiums paid during a period equal to twice the number of months in the full 12-month periods described in that section.". (b) EFFECTIVE DATE.—(1) The amendment made by subsection (a)(3) shall apply to premiums paid for months beginning with July 1986. (2) In applying that amendment, months (before, during, or after April 1986) in which an individual was required to pay a premium increased under the section that was so amended shall be taken into account in determining the month in which the premium will no longer be subject to an increase under that section as so amended. SEC. 9125. PROMULGATION OF INPATIENT HOSPITAL DEDUCTIBLE.

42 USC 1395e note.

(a) CHANGE IN DEADLINE.—Section 1813(b)(2) of the Social Security Act (42 U.S.C. 1395e(b)(2)) is amended by striking out "October 1" and inserting in lieu thereof "September 15". (b) EFFECTIVE DATE.—The amendment made by this section shall apply to calendar years after 1985. SEC. 9126. ACCESS TO SKILLED NURSING FACILITIES. (a) OPTIONAL PROSPECTIVE RATES FOR CERTAIN SKILLED NURSING

FACILITIES.—Section 1888 of the Social Security Act (42 U.S.C. 1395yy) is amended by adding at the end the following new subsection: .. _,

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Page:United States Statutes at Large Volume 100 Part 1.djvu/205

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 169

"(d)(1) Any skilled nursing facility may choose to be paid under this subsection on the basis of a prospective payment for all routine service costs (and capital-related costs) of extended care services provided in a fiscal year if such facility had, in the preceding fiscal year, fewer than 1,500 patient days with respect to which payments were made under this title. Such prospective payment shall be in lieu of payments which would otherwise be made for routine service costs pursuant to section 1861(v) and subsections (a) through (c) of this section and capital-related costs pursuant to section 1861(v). This subsection shall not apply to a facility for any fiscal year immediately following a fiscal year in which such facility had 1,500 or more patient days with respect to which payments were made under this title, without regard to whether payments were made under this subsection during such preceding fiscal year. "(2)(A) The amount of the payment under this section shall be determined on a per diem basis. "(B) Subject to the limitations of subparagraph (C), for skilled nursing facilities located— "(i) in an urban area, the amount shall be equal to 105 percent of the mean of the per diem reasonable routine service and capital-related costs of extended care services for skilled nursing facilities in urban areas within the same region, determined without regard to the limitations of subsection (a) and adjusted for different area wage levels, and "(ii) in a rural area the amount shall be equal to 105 percent of the mean of the per diem reasonable routine service and capital-related costs of extended care services for skilled nursing facilities in rural areas within the same region, determined without regard to the limitations of subsection (a) and adjusted for different area wage levels. "(C) The per diem amounts determined under subparagraph (B) shall not exceed the limit on routine service costs determined under subsection (a) with respect to the facility, adjusted to take into account average capital-related costs with respect to the type and location of the facility. "(3) For purposes of this subsection, urban and rural areas shall be determined in the same manner as for purposes of subsection (a), and the term 'region' shall have the same meaning as under section 1886(d)(2)(D). "(4) The Secretary shall establish the prospective payment amounts for each fiscal year at least 90 days prior to the beginning of such fiscal year, on the basis of the most recent data available for a 12-month period. A skilled nursing facility must notify the Secretary of its intention to be paid pursuant to this subsection for a fiscal year within 60 days after the Secretary establishes the final prospective payment amounts for such fiscal year. "(5) The Secretary shall provide for a simplified cost report to be filed by facilities being paid pursuant to this subsection, which shall require only the cost information necessary for determining prospective payment amounts pursuant to paragraph (2) and reasonable costs of ancillary services. "(6) In lieu of payment on a cost basis for ancillary services provided by a facility which is being paid pursuant to this subsection, the Secretary may pay for such ancillary services on a reasonable charge basis if the Secretary determines that such payment basis will provide an equitable level of reimbursement and will ease the reporting burden of the facility.".

42 USC I395x.

Urban areas, Rural areas,

•tU 1

Reports,

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Page:United States Statutes at Large Volume 100 Part 1.djvu/206

 100 STAT. 170

PUBLIC LAW 99-272—APR. 7, 1986 (b) PUBLICATION OF DATA RELATING TO ADJUSTMENTS TO S N F

42 USC 1395yy.

42 USC 1395y note.

42 USC 1395y.

42 USC 1395yy note.

LIMITS.—Section 1888(c) of such Act is amended by adding at the end thereof the following: "The Secretary shall publish the data and criteria to be used for purposes of this subsection on an annual basis.". (c) REINSTATEMENT OF WAIVER OF LIABILITY PRESUMPTION.—The

Secretary of Health and Human Services shall, for purposes of determining whether payments to a skilled nursing facility should be denied pursuant to section 1862(a)(1)(A) of the Social Security Act, apply the same presumption of compliance (5 percent) as in effect under regulations as of July 1, 1985. Such presumption shall apply for the 30-month period beginning with the first month beginning after the date of the enactment of this Act. (d) EFFECTIVE DATES.—(1) The amendment made by subsection (a) shall apply to fiscal years beginning on or after October 1, 1986. (2) The amendment made by subsection (b) shall become effective on the date of the enactment of this Act. SEC. 9127. ADDITIONAL MEMBERS OF PROSPECTIVE PAYMENT ASSESSMENT COMMISSION.

42 USC 1395WW note.

(a) EXPANSION OF MEMBERSHIP.—Section 1886(e)(6)(A) of the Social Security Act (42 U.S.C. 1395ww(e)(6)(A)) is amended by striking out "15 individuals" and inserting in lieu thereof "17 individuals". (b) APPOINTMENTS.—The Director of the Congressional Office of Technology Assessment shall appoint the two additional members of the Prospective Payment Assessment Commission, as required by the amendment made by subsection (a), no later than 60 days after the date of the enactment of this Act, for terms of three years. SEC. 9128. SENSE OF THE SENATE WITH RESPECT TO INPATIENT HOSPITAL DEDUCTIBLE.

In view of the $92 Medicare hospital deductible increase that went into effect January 1, 1986, it is the sense of the Senate that the Committee on Finance should report legislation which will reform calculation of the annual increase in such deductible so that it is more consistent with annual increases in Medicare payments to hospitals. SEC. 9129. MEDICARE COVERAGE OF STATE AND LOCAL EMPLOYEES.

For provision providing for medicare coverage of certain State and local employees, see section 13205 of this Act.

PART 2—PROVISIONS RELATING TO PARTS A AND B OF MEDICARE

Subpart A—Payment-Related Provisions SEC. 9201. EXTENSION OF WORKING AGED PROVISION. (a) EXTENSION OF SECONDARY PAYOR STATUS BEYOND AGE 69.—

Section 1862(b)(3)(A) of the Social Security Act (42 U.S.C. 1395y(b)(3)(A)) is amended— (1) in clause (i), by striking out "who is under 70 years of age during any part of such month" and ", if the spouse is under 70 years of age during any part of such month", and

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