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 98 STAT. 1052 15 USC 80b-20. 26 USC 851.

Ante, p. 1050.

Ante, p. 577.

PUBLIC LAW 98-369—JULY 18, 1984 (Ill) registered under the Investment Company Act of 1940 as either a management company or a unit investment trust, and (ii) to which the provisions of part I of subchapter M of chapter 1 of the Internal Revenue Code of 1954 applied for its first taxable year beginning after November 8, 1983, for purposes of section 852(a)(3)(A) of such Code (as amended by paragraph (3)), the provisions of part I of subchapter M of chapter 1 of such Code shall be treated as applying to such investment company for its first taxable year ending after November 8, 1983. For purposes of the preceding sentence, all members of an affiliated group (as defined in section 1504(a) of such Code) filing a consolidated return shall be treated as 1 taxpayer. (b) SHORT-TERM OBLIGATIONS ISSUED ON A DISCOUNT BASIS.—

26 USC 852.

26 USC 852 note.

(1) IN GENERAL.—Paragraph (2) of section 852(b) (defining investment company taxable income) is amended by adding at the end thereof the following new subparagraph— "(F) The taxable income shall be computed without regard to section 454(b) (relating to short-term obligations issued on a discount basis) if the company so elects in a manner prescribed by the Secretary." (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to taxable years beginning after December 31, 1978. SEC. 1072. TECHNICAL MODIFICATIONS TO TIP REPORTING REQUIREMENTS. (a) LOWER ALLOCATION OF GROSS RECEIPTS.—Subparagraph (C) of

26 USC 6053.

Regulations. 26 USC 6053 note.

section 6053(c)(3) (relating to employee allocation of 8 percent of gross receipts) is amended— (1) by striking out "The Secretary" and inserting in lieu thereof "Upon the petition of the employer or the majority of employees of such employer, the Secretary", and (2) by striking out "5 percent" and inserting in lieu thereof "2 percent". Qa) RECORDKEEPING BY TIPPED EMPLOYEES.—The Secretary of the

Treasury shall prescribe by regulations within 1 year after the date of the enactment of this Act the applicable recordkeeping requirements for tipped employees. (c) 50 PERCENT OWNERS NOT TREATED AS EMPLOYEES FOR CERTAIN PURPOSES.—

26 USC 6053.

26 USC 6053 note.

(1) IN GENERAL.—Paragraph (4) of section 6053(c) (defining large food or beverage establishment) is amended by inserting before the period at the end of the last sentence the following: ", and an individual who owns 50 percent or more in value of the stock of the corporation operating the establishment shall not be treated as an employee'. (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to calendar years beginning after December 31, 1982. SEC. 1073. TIPS TREATED AS WAGES FOR PURPOSES OF FEDERAL UNEMPLOYMENT TAX.

97 Stat 123. 26 USC 3306.

(a) GENERAL RULE.—Section 3306 (relating to definitions for purposes of Federal unemployment tax) is amended by adding at the end thereof the following new subsection:

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98 STAT. 1053

"(s) TIPS TREATED AS WAGES.—For purposes of this chapter, the term 'wages' includes tips which are— "(1) received while performing services which constitute employment, and "(2) included in a written statement furnished to the employer pursuant to section 6053(a)." (b) EFFECTIVE DATE.— 26 USC 3306 (1) IN GENERAL.—Except as provided in paragraph (2), the note. amendment made by subsection (a) shall take effect on January 1, 1986. (2) EXCEPTION FOR CERTAIN STATES.—In the case of any State the legislature of which— (A) did not meet in a regular session which begins during 1984 and after the date of the enactment of this Act, and (B) did not meet in a session which began before the date of the enactment of this Act and remained in session for at least 25 calendar days after such date of enactment, the amendment made by subsection (a) shall take effect on January 1, 1987. SEC. 1074. EXCLUSION OF CERTAIN SERVICES FROM THE FEDERAL UNEMPLOYMENT TAX ACT.

Subsection (b) of section 822 of the Economic Recovery Tax Act of 1981 (26 U.S.C. 3306 note) is amended by striking out "and before January 1, 1983" and inserting in lieu thereof "and before January 1, 1985".

iH^rsv

SEC. 1075. TAXATION OF UNEMPLOYMENT COMPENSATION NOT TO APPLY TO COMPENSATION PAID FOR WEEKS OF UNEMPLOYMENT ENDING BEFORE DECEMBER 1, 1978.

(a) GENERAL RULE.—Subsection (d) of section 112 of the Revenue Act of 1978 (relating to taxation of unemployment compensation 26 USC 85 note benefits at certain income levels) is amended to read as follows: "(d) EFFECTIVE DATE.—The amendments made by this section shall apply to payments of unemployment compensation made after December 31, 1978, in taxable years ending after such date; except that such amendments shall not apply to payments made for weeks of unemployment ending before December 1, 1978." (b) WAIVER OF STATUTE OF LIMITATIONS.—If credit or refund of any 26 USC 85 note, overpayment of tax resulting from the amendment made by subsection (a) is barred on the date of the enactment of this Act or at any time during the 1-year period beginning on the date of the enactment of this Act by the operation of any law or rule of law (including res judicata), refund or credit of such overpayment (to the extent attributable to the amendment made by subsection (a)) may, nevertheless, be made or allowed if claim therefor is filed before the close of such 1-year period. SEC. 1076. EXCLUSION FROM GROSS INCOME OF CANCELLATIONS OF CERTAIN STUDENT LOANS. (a) IN GENERAL.—Section 108 (relating to income from discharge 26 USC 108. of indebtedness) is amended by adding at the end thereof the following new subsection: "(f) STUDENT LOANS.—

"(1) IN GENERAL.—In the case of an individual, gross income does not include any amount which (but for this subsection) would be includible in gross income by reason of the discharge

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


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 98 STAT. 1054

PUBLIC LAW 98-369—JULY 18, 1984

(in whole or in part) of any student loan if such discharge was pursuant to a provision of such loan under which all or part of the indebtedness of the individual would be discharged if the individual worked for a certain period of time in certain professions for any of a broad class of employers. "(2) STUDENT LOAN.—For purposes of this subsection, the term 'student loan' means any loan to an individual to assist the individual in attending an educational organization described in section 170(b)(l)(A)(ii) made by— "(A) the United States, or an instrumentality or agency thereof, "(B) a State, territory, or possession of the United States, or the District of Columbia, or any political subdivision thereof, or "(C) a public benefit corporation— "(i) which is exempt from taxation under section 501(c)(3), "(ii) which has assumed control over a State, county, or municipal hospital, and "(iii) whose employees have been deemed to be public employees under State law, or "(D) any educational organization so described pursuant to an agreement with any entity described in subparagraph (A), (B), or (C) under which the funds from which the loan was made were provided to such educational organization." 26 USC 108 note. (b) EFFECTIVE DATE.—The amendments made by this section shall apply to discharges of indebtedness made on or after January 1, 1983. SEC. 1077. MIGRATORY BIRD HUNTING STAMPS.

16 USC 7i8a-7i8d. lQu 718. -710 718f-718h,

(a) IN GENERAL.—Section 5 of the Act of March 16, 1934 (48 Stat. 451, Chapter 71; 16 U.S.C. 718e) is amended by adding at the end thereof the following new subsection: "(c) Notwithstanding the provisions of subsection Ob), or the prohibition in section 474 of title 18, United States Code, or other provisions of law, the Secretary of the Interior may authorize, with the concurrence of the Secretary of the Treasury, "(1) the color reproduction, or "(2) the black and white reproduction, of migratory bird hunting stamps authorized by sections 1 through 4 and 6 through 9 of this Act, which otherwise satisfies the requirements of clauses (ii) and (iii) of section 504(1) of title 18, United States Code. Any such reproduction shall be subject to those terms and conditions deemed necessary by the Secretary of the Interior by regulation or otherwise and any proceeds received by the Federal Government as a result of such reproduction shall be paid into the migratory bird conservation fund established under section 4 of this Act." (b) TECHNICAL AMENDMENTS.—

(1) Clause (i) of section 504(1)(D) of title 18, United States Code, is amended by inserting "and stamps issued under the Migratory Bird Hunting Stamp Act of 1934" after "foreign government". (2) Clause (ii) of such section is amended by inserting "and illustrations of stamps issued under the Migratory Bird Hunting Stamp Act of 1934 in color" after "postage stamps in color".

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98 STAT. 1055

(3) Subsection (b) of section 5 of the Act referred to in subsec- 16 USC 7l8e. tion (a) is amended by striking out "No person" and inserting in lieu thereof "Except as provided in clauses (i) and (ii) of section 504(1)(D) of title 18, United States Code, no person", (c) EFFECTIVE DATE.—The amendments made by this section shall 16 USC 7l8e take effect on the date of the enactment of this Act. note. SEC. 1078. EXCLUSION FROM GROSS INCOME OF PAYMENTS FROM THE UNITED STATES FOREST SERVICE AS A RESULT OF RESTRICTING MOTORIZED TRAFFIC IN THE BOUNDARY WATERS CANOE AREA.

(a) GENERAL RULE.—At the election of the taxpayer, for purposes of the Internal Revenue Code of 1954, gross income does not include 26 USC l et seq. the excludable portion of payments received from the United States Forest Service as a result of restricting motorized traffic in the q,;.«i Boundary Waters Canoe Area, pursuant to section 19(a) of "An Act to designate the Boundary Waters Canoe Area Wilderness, to establish the Boundary Waters Canoe Area Mining Protection Area, and for other purposes", approved October 21, 1978 (Public Law 95-495; 92 Stat. 1649). 92 Stat. 1659. (b) EXCLUDABLE PORTION.—For purposes of this section, the term "excludable portion" means that portion (or all) of a payment made , svii\ to any taxpayer during the period after December 31, 1979, and before the later of the date which is 2 years after— (1) the date of the enactment of this Act, or (2) the date of such payment, which payment is reinvested within such period in depreciable property used in a trade or business of such taxpayer as authorized by the Act referred to in subsection (a). In determining whether reinvestment has occurred, no direct tracing is required. (c) ELECTION.—An election under subsection (a) shall identify such property for which such payment has been allocated. An election may be made at any time before the expiration of the period for making a claim for credit or refund of the tax imposed by chapter 1 26 USC i et seq. of such Code for the taxable year in which the reinvestment occurred, and shall be made in such manner as the Secretary of the Treasury or his delegate shall by regulations prescribe. (d) BASIS OF PROPERTY.—

(1) IN GENERAL.—The basis of any property, with respect to which an allocation of any payment has been elected, shall be reduced by the amount of such payment. (2) INCREASE DUE TO REPAYMENT.—The basis of any property t described in paragraph (1) shall be increased by the amount of any repayments made to the United States Forest Service upon ' the sale of such property. (e) DENIAL OF DOUBLE BENEFIT.—No deduction or credit shall be allowed under such Code with respect to any expenditure which is properly associated with any amount excluded from gross income under subsection (a). (f) EFFECTIVE DATE; SPECIAL RULE.— (1) EFFECTIVE DATE.—The amendments

made by this section shall apply to payments made in taxable years beginning after '-^- December 31, 1979. (2) ELECTIONS FOR PRIOR YEARS.—In the case of any taxable year ending before the date of the enactment of this Act—

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text: Author:Eugène Lagrange

title: Author:Eugène Lagrange


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 98 STAT. 1056

PUBLIC LAW 98-369—JULY 18, 1984 (A) the period for making the election under subsection (c) shall not expire before the date which is 1 year after the date of the enactment of this Act, and (B) if, after the application of subparagraph (A), refund or credit of any overpayment of tax resulting from the application of this section is prevented at any time before the close of such 1-year period by the operation of any law or rule of law (including res judicata), refund or credit of such overpayment (to the extent attributable the application of this section) may, nevertheless, be made or allowed if claim therefore is filed before the close of such 1-year period.

SEC. 1079. TAX EXEMPTION OF CORPORATIONS ORGANIZED UNDER ACTS OF CONGRESS.

Post, p. 1207.

Ante, p. 494.

Paragraph (1) of section 501(c) (relating to list of exempt organizations), as amended by section 2813 of the bill, is amended by striking out subparagraph (A) thereof and inserting in lieu thereof the following: "(A) is exempt from Federal income taxes— "(i) under such Act as amended and supplemented before the date of the enactment of the Tax Reform Act of 1984, or

"(ii) under this title without regard to any provision of law which is not contained in this title and which is not contained in a revenue Act, or".

Subtitle I—Studies SEC. 1081. STUDY OF ALTERNATIVE INCOME TAX SYSTEMS.

(a) IN GENERAL.—The Secretary of the Treasury or his delegate shall conduct a study covering the advisability of— (1) replacing only the Federal individual income tax, or (2) replacing both the Federal individual income tax and the Federal corporate income tax, with an alternative tax system. (b) CONTENTS OF STUDY.—Such study shall take into account the administrative complexity of the existing Federal income tax system and address the ramifications of replacing that system with an alternative tax system. Such study shall focus on (but not be limited to) the following factors: (1) protecting the economically disadvantaged, (2) increasing economic efficiency in both the private and public sectors of the economy, (3) reducing paperwork and auditing requirements, reducing taxpayer fraud and evasion, and expediting resolution of tax disputes between taxpayers and the Federal Government, (4) increasing economic incentives for capital formation and productivity, (5) removing economic disincentives to employment, (6) excluding certain items, such as social security benefits, from gross income, (7) equalizing the tax burden on taxpayers with equal ability to pay taxes, and (8) achieving the appropriate burden of taxes for each income class of taxpayers.

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98 STAT. 1057

Such study shall also identify the strengths and potential weaknesses of an alternative tax system and propose possible solutions for any such potential weakness. (c) ALTERNATIVE TAX SYSTEM.—For purposes of this section, the term "alternative tax system" means a system based on— (1) a simplified income tax based on gross income; (2) a consumption tax; (3) a consumption-based tax; or (4) the broadening of the base and lowering of the rates of the current income tax. (d) STUDY OF TAX SHELTERS TO B E INCLUDED.—The study conducted under subsection (a) shall include a study of the entire area of tax shelters and how they impact on the equity of the tax system. (e) REPORTING DATE.—The report of the study required by subsection (a) shall be submitted to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate not later than December 31, 1984.

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SEC. 1082. STUDY OF TAXATION BY FOREIGN COUNTRIES ON SERVICES PERFORMED IN THE UNITED STATES.

(a) STUDY.—The Secretary of the Treasury or his delegate shall conduct a study of the practices of foreign countries of taxing income on services performed within the United States, including, but not limited to— (1) the status of treaty negotiations with such foreign countries with respect to such practices, and (2) any options to alleviate the taxation of such income by more than 1 country without appropriate credit for taxes paid. (b) REPORT.—The Secretary of the Treasury or his delegate shall report to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives the results of the study conducted under subsection (a) no later than December 31, 1984. DIVISION B—SPENDING REDUCTION ACT OF 1984 SEC. 2001. This division may be cited as the "Spending Reduction Act of 1984". Title Title Title Title Title Title Title Title Title

TABLE OF CONTENTS I. General provisions. II. Civil Service and military retirement programs. III. Medicare, medicaid, and maternal and child health amendments. IV. Small business programs. V. Veterans' programs. VI. OASDI, SSI, AFDC, and other programs. VII. Competition in contracting. VIII. Federal Credit Union Act Amendments. IX. Miscellaneous provisions.

TITLE I—GENERAL PROVISIONS SENSE OF S E N A T E STATEMENT

SEC. 2101. It is the sense of the Senate that ceilings on fiscal year 1985 appropriation bills shall not exceed, in the aggregate, $139.8 billion for non-defense, discretionary accounts, and shall not exceed $299 billion for defense accounts. Further, it is the sense of the Senate that the allocations of these sums, normally done through

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 98 STAT. 1058 2 USC 633.

PUBLIC LAW 98-369—JULY 18, 1984

the section 302(b) process under the Congressional Budget and Impoundment Control Act of 1974, in the absence of a first concurrent budget resolution for fiscal year 1985 will be done by the Senate Appropriations Committee to guide its subcommittees in their separate deliberations on individual appropriation bills for fiscal year 1985. SENSE OF HOUSE STATEMENT

Ante, p. 494.

SEC. 2102. (a) It is the sense of the House that in fiscal years 1985, 1986, and 1987, Federal deficits be reduced by $182 billion as a result of the first concurrent resolution on the budget for fiscal year 1985 and the Deficit Reduction Act of 1984. Further, it is the sense of the House that these deficit reductions shall be divided among revenue increases, domestic spending reductions, and limits on the growth in military spending. (b) It is the sense of the House that in the absence of agreement on a first concurrent resolution on the budget for fiscal year 1985 that the House will continue to abide by House Concurrent Resolution 280, as passed the House. (c) It is the sense of the House that the Congress shall immediately adopt a conference report on the first concurrent resolution on the budget for fiscal year 1985 and that the Congress shall enforce the aggregate levels of revenue and spending provided in such resolution. RESCISSION

42 USC 5915 note. 93 Stat. 954.

SEC. 2103. Of the amounts provided in Public Law 96-126, the Department of the Interior and Related Agencies Appropriation Act, 1980, for the "Energy Security Reserve", $2,000,000,000 are rescinded, of which $1,154,950,000 is to be derived from the unused portion of the commitment of financial assistance previously awarded to The Oil Shale Company (Colony Shale Oil Project).

TITLE II—CIVIL SERVICE AND MILITARY RETIREMENT PROGRAMS COST-OF-LIVING ADJUSTMENTS UNDER GOVERNMENT RETIREMENT SYSTEMS

5 USC 8340 note.

SEC. 2201. (a) Notwithstanding any other provision of law, beginning with the monthly rate payable for December 1984, any annuity or retired or retirement pay payable under any retirement system for Government officers or employees which the President adjusts pursuant to section 8340(b) of title 5, United States Code, shall be paid no earlier than the first business day of the succeeding month, (b) Section 8340(c)(1) of title 5, United States Code, is amended— (1) in subparagraph (A), by striking out "computer" and inserting in lieu thereof "computed"; and (2) in subparagraph (B), by striking out "counting" and inserting in lieu thereof "not to exceed 12 months, counting". TECHNICAL AMENDMENT RELATING TO PREVAILING RATE EMPLOYEES

5 USC 5343 note.

SEC. 2202. (a) Notwithstanding any other provision of law, effective as of October 1, 1983, any adjustment in a wage schedule or rate—

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text: Author:Fernand Lagrange

title: Author:Fernand Lagrange


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98 STAT. 1059

1

(1) that applies— (A) to a prevailing rate employee described in section 5342(a)(2) of title 5, United States Code; (B) to an employee covered by section 5348 of such title; 5 USC 5348. or (C) to any other employee subject to section 202(b)(1) of the Omnibus Budget Reconciliation Act of 1983 (Public Law 5 USC 5343 note. 98-270; 98 Stat. 158); (2) that results from a wage survey; and (3) that first becomes effective during the fiscal year ending September 30, 1984; shall not take effect until the first day of the first applicable pay period beginning after the expiration of the 90-day period beginning on the date on which such adjustment would otherwise have taken effect. (b) The Office of Personnel Management shall take such actions as may be necessary to carry out the provisions of this section. DEDUCTION FROM CIVILIAN PAY FOR COST-OF-LIVING ADJUSTMENT OF RETIRED OR RETAINER PAY

S E C 2203. Subsection (d) of section 301 of the Omnibus Budget Reconciliation Act of 1982 (96 Stat. 791; 5 U.S.C. 5532 note) is repealed, effective with respect to pay periods beginning after the date of enactment of this Act. L E A V E FOR CERTAIN OVERSEAS EMPLOYEES

SEC. 2204. Subsection (a) of section 6 of the Defense Department Overseas Teachers Pay and Personnel Practices Act (73 Stat. 214; 20 U.S.C. 904(a)) is amended by striking out "except that—" and all that follows through the end of such subsection and inserting in lieu thereof "except that if the school year includes more than eight months, any such teacher who shall have served for the entire school year shall be entitled to ten days of cumulative leave with pay.".

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CIVIL SERVICE RETIREMENT DEPOSITS COVERING MILITARY SERVICE

-SEC. 2205. The first sentence of section 306(g) of the Omnibus Budget Reconciliation Act of 1982 (5 U.S.C. 8331 note) is amended by striking out "October 1, 1983" and inserting in lieu thereof "October 1, 1985".

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ELECTION OF RETIREMENT PLAN

SEC. 2206. (a) For the purposes of this section, the term "covered retirement system" shall have the same meaning as provided in section 203(a)(2) of the Federal Employees' Retirement Contribution Temporary Adjustment Act of 1983 (Public Law 98-168; 97 Stat. 5 USC 8331 note. 1107). (b)(1) Any individual who was entitled to make an election under section 208(a) of the Federal Employees' Retirement Contribution Temporary Adjustment Act of 1983 (97 Stat. 1111), but who did not 5 USC 8331 note. make such an election, may make an election under such section not later than September 15, 1984. (2)(A) Not later than September 15, 1984, any such individual who made an election under paragraph (1) of section 208(a) of the Federal

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 98 STAT. 1060

PUBLIC LAW 98-369—JULY 18, 1984

Employees' Retirement Contribution Temporary Adjustment Act of 1983 may— (i) make any other election which such individual was entitled to make under such section before January 1, 1984; or (ii) elect to become a participant in a covered retirement system (if such individual is otherwise eligible to participate in 97 Stat. 1106 such System), subject to sections 201 through 207 of such Act. 5 USC 8331 note. (B) Not later than September 15, 1984, any such individual who made an election under paragraph (2) of section 208(a) of the Federal Employees' Retirement Contribution Temporary Adjustment Act of 97 Stat. n i l. 1983 may— 5 USC 8331 note. ([) make any other election which such individual was entitled to make under such section before January 1, 1984; or (ii) elect to terminate participation in the covered retirement system with respect to which such individual made the election under such paragraph (2). (3) An election under this subsection shall be made by a written application submitted to the official by whom the electing individual is paid. (4) An election made as provided in this subsection shall take effect with respect to service performed on or after the first day of the first applicable pay period commencing after September 15, 1984. (c)(1) Section 8342(a)(4) of title 5, United States Code, does not apply for the purpose of determining an entitlement to a refund under section 208(c) of the Federal Employees' Retirement Contribution Temporary Adjustment Act of 1983 (97 Stat. H I D. (2) Paragraph (1) shall take effect with respect to any election made under section 208(a) of such Act or this Act before, on, or after January 1, 1984. (d) Nothing in this section or the Federal Employees' Retirement 97 Stat. 1106. Contribution Temporary Adjustment Act of 1983 affects any entitle5 USC 8331 note, ment to benefits accrued under a covered retirement system before January 1, 1984, except to the extent that any amount refunded under section 208(c) of such Act is not redeposited in the applicable retirement fund. SALARY ADJUSTMENTS FOR J U D G E S

28 USC 461 note.

SEC. 2207. Effective on the first day of the first applicable pay period commencing on or after January 1, 1984, each rate of pay subject to adjustment by section 461 of title 28, United States Code, shall be increased by an amount, rounded to the nearest multiple of $100 (or if midway between multiples of $100, to the next higher multiple of $100), equal to the overall percentage of the adjustment taking effect under section 5305 of title 5, United States Code, in the rates of pay under the General Schedule during fiscal year 1984. RETIREMENT B E N E F I T S FOR N A T IV E S OF THE PRIBILOF ISLANDS

97 Stat. 843.

SEC. 2208. (a) Section 8332(b) of title 5, United States Code, is amended by striking out the period at the end of the second paragraph (13) and inserting in lieu thereof the following: '*, and regardless of whether the Native who performs the service retires before, on, or after the effective date of this paragraph.".

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(b) Title II of Public Law 89-702, as amended by section 2 of Public Law 98-129, is amended by adding at the end thereof the following 16 USC 1161. new section: "SEC. 212. (a)(1) An annuity or survivor annuity based on the 16 USC ii69a. service of an employee or Member who performed service described in the second paragraph (13) of subsection (b) or subsection (1)(1)(C) of section 8332 of title 5, United States Code, as added by subsections (b) and (e), respectively, of section 209 of this Act, shall, upon 97 Stat. 843. application to the Office of Personnel Management, be recomputed in accordance with the second paragraph (13) of subsection (b) and subsection (1), respectively, of such section 8332, regardless of whether the employee or Member retires before, on, or after the effective date of this paragraph. "(2) Any recomputation of annuity under paragraph (1) of this subsection shall apply with respect to months beginning more than 30 days after the date on which application for such recomputation is received by the Office.". (c) The amendments made by this section shall take effect as of Effective date. 16 USC 1169a October 14, 1983. note.

AMENDMENT TO OMNIBUS BUDGET RECONCILIATION ACT OF 1981

SEC. 2209. Section 1722 of the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35; 95 Stat. 759) is amended by striking out "1984" and inserting in lieu thereof "1987".

39 USC 403 note.

TITLE III—MEDICARE, MEDICAID, AND MATERNAL AND CHILD HEALTH AMENDMENTS

Medicare and Medicaid Budget Reconciliation Amendments of 1984.

SHORT TITLE OF TITLE

SEC. 2300. This title may be cited as the "Medicare and Medicaid Budget Reconciliation Amendments of 1984". TABLE OF CONTENTS OF TITLE Subtitle A—Medicare Amendments PART I—REIMBURSEMENT AND BENEFIT CHANGES

Sec. Sec. Sec. Sec. Sec.

2301. 2302. 2303. 2304. 2305.

Sec. 2306. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec.

2307. 2308. 2309. 2310. 2311. 2312. 2313. 2314. 2315. 2316. 2317.

Sec. 2318.

Modification of working aged provision. Part B premium. Payment for clinical diagnostic laboratory tests. Pacemaker reimbursement review and reform. Elimination of special payment provisions for preadmission diagnostic testing. Limitation on physician fee prevailing and customary charge levels; participating physician incentives. Payment for services of teaching physicians. Lesser of cost or charges. Study of medicare part B payments. Limitation on increase in hospital costs per case. 3? Classification of certain rural hospitals. Payment for services of a nurse anesthetist. Prospective payment assessment commission. Revaluation of assets. Technical amendments relating to the DRG payment system. Prospective payment wage index. Deadline for report on including payment for physicians' services to hospital inpatients in DRG payment amounts. Emergency room services.

42 USC 1305 note.

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PUBLIC LAW 98-369—JULY 18, 1984

Sec. 2319. Skilled nursing facility reimbursement. Sec. 2320. Payment for costs of hospital-based mobile intensive care units. Sec. 2321. Cost sharing for durable medical equipment furnished as a home health benefit. Sec. 2322. Services of a clinical psychologist provided to members of an HMO. Sec. 2323. Coverage of administration of hepatitis B vaccine. Sec. 2324. Coverage of hemophilia clotting factor. Sec. 2325. Payment for debridement of mycotic toenails. Sec. 2326. Contracts for medicare claims processing. PART II—ADMINISTRATIVE AND MISCELLANEOUS CHANGES

ji

Sec. 2331. Repeal of exclusion of for-profit organizations from research and demonstration grants. Sec. 2332. Presidential appointment of and pay level for the administrator of the health care financing administration. Sec. 2333. Exclusion of certain entities owned or controlled by individuals convicted of medicare- or medicaid-related crimes. Sec. 2334. Provider representation in peer review organizations. Sec. 2335. Repeal of special tuberculosis treatment requirements under medicare and medicaid. Sec. 2336. Access to home health services. Sec. 2337. Normalization of trust fund transfers. Sec. 2338. Enrollment and premium penalty with respect to working aged provision. Sec. 2339. Indirect payment of supplementary medical insurance benefits. Sec. 2340. Certification of psychiatric hospitals. Sec. 2341. Included podiatrists in definition of "physician" for outpatient physical therapy services and including podiatrists and dentists in definition of "physician" for outpatient ambulatory surgery. Sec. 2342. Establishment by physical therapists of plans for physical therapy. Sec. 2343. Hospice contracting for core services. Sec. 2344. Medicare recovery against certain third parties. Sec. 2345. Confidentiality of accreditation surveys. Sec. 2346. Use of additional accrediting organizations under medicare. Sec. 2347. Funding for PSRO review. Sec. 2348. Payment for services following termination of participation agreements with home health agencies or hospice programs. Sec. 2349. Elimination of health insurance benefits advisory council. Sec. 2350. Health maintenance organizations and competitive medical plans. Sec. 2351. Judicial review of provider reimbursement review board decisions. Sec. 2352. Flexible sanctions for noncompliance with requirements for end stage renal disease facilities. Sec. 2353. Payments to promote closure and conversion of underutilized hospital facilities. Sec. 2354. Miscellaneous technical corrections relating to medicare. Sec. 2355. Waivers for social health maintenance organizations. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec. Sec.

Subtitle B—Medicaid and Maternal and Child Health Amendments 2361. Medicaid coverage for pregnant women and children. 2362. Clarification of medicaid entitlements for certain newborns. 2363. Recertification of SNF and ICF patients. 2364. Waiver of certain membership requirements for certain health maintenance organizations. 2365. Incresise in medicaid ceiling amount for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. 2366. Payment for psychiatric hospital services. 2367. Mandatory assignment of rights of payment by medicaid recipients. 2368. Requirements for medical review and independent professional review under medicaid. 2369. Flexibility in setting payment rates for hospitals furnishing long-term care services under medicaid. 2370. Authority of the Secretary to issue and enforce subpoenas under medicaid. 2371. Medicaid clinic administration. 2372. Increase in authorization for maternal and child health block grant. 2373. Miscellaneous and technical amendments.

Subtitle C—Recovery of Hill-Burton Funds Sec. 2381. Recovery of Hill-Burton funds. '

_;•''•

-<:

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text:
Author:Samuel Laing (1812-1897)

Works

 * A Report on British and Foreign Railways (1844)
 * National distress; its causes and remedies, 1844 external link
 * India and China; England's Mission in the East (1863)
 * Pre-historic remains of Caithness. With Notes on the human remains with Thomas Henry Huxley (1866) external link
 * England's foreign policy, 1884 external link
 * Modern Science and Modern Thought (1885) external link
 * A Sporting Quixote (1886) vol 1, vol 2
 * A Modern Zoroastrian (1887) external link
 * Problems of the Future, and other Essays (1889) external link
 * The Antiquity of Man (1891)
 * Human Origins (1892) external link

title: Author:Samuel Laing (1812-1897)


text:
Page:United States Statutes at Large Volume 98 Part 1.djvu/1111

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1063

Subtitle D—Uncompensated Services Provided by Skilled Nursing Facilities and Intermediate Care Facilities Sec. 2391. Study.

Subtitle A—Medicare Amendments PART I—REIMBURSEMENT AND BENEFIT CHANGES

-.•cil'

MODIFICATION OF WORKING AGED PROVISION

SEC. 2301. (a) Section 18620b)(3)(A)(i) of the Social Security Act is amended by striking out "over 64 but" each place it appears. (b) Section 4(g)(1) of the Age Discrimination in Employment Act of 1967 is amended— (1) by inserting ", and any employee's spouse aged 65 through 69," after "aged 65 through 69"; and (2) by inserting ", and the spouse of such employee," after "same conditions as any employee". (c)(1) The amendment made by subsection (a) shall be effective with respect to items and services furnished on or after January 1, 1985. (2) The amendment made by subsection (b) shall become effective on January 1, 1985.

42 USC I395y. 29 USC 623.

Effective date, 42 USC I395y "°Effective date. 29 USC 623 note.

PART B PREMIUM

SEC. 2302. (a) Section 1839(e) of the Social Security Act is amended by striking out "1986" each place it appears and inserting in lieu thereof in each instance "1988". (h) Section 1839 of such Act is amended by adding at the end thereof the following new subsection: "(fKl) If no cost-of-living increase becomes effective under section 215(i) in December of 1985 or 1986, the monthly premium of each individual enrolled under this part for each month in the succeeding year shall (except as otherwise provided in subsection (b)) be the same as the monthly premium (disregarding subsection 0))) of the individual for such December. "(2) If paragraph (1) does not apply to the monthly premiums for 1986 or 1987, if an individual is entitled to monthly benefits under section 202 or 223 for November and for December in the preceding year, and if the monthly premium for that December and for the following January is deducted from those benefits under section 1840(a)(l), the monthly premium for that individual for that January and for each of the succeeding 11 months for which he is entitled to benefits under section 202 or 223 shall (except as otherwise provided in subsection (b)) be the greater of— "(A) the monthly premium amount determined under subsection (a)(2) for that January reduced by the amount (if any) necessary to make the monthly benefits under section 202 or 223 for that January after the deduction of the monthly premium (disregarding subsection (b)) for that January at least equal to the monthly benefits under section 202 or 223 for the preceding November after the deduction of the premium (disregarding subsection (b)) for that individual for that November, or "(B) the monthly premium (disregarding subsection (b)) for that individual for that December.

97 Stat. 170. 42 USC 1395r.

42 USC 415.

^-

42 USC 402,423. 42 USC 1395s. 42 USC 402, 423.

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text:
Page:United States Statutes at Large Volume 98 Part 1.djvu/1112

 98 STAT. 1064

42 USC 402, 423. Effective date. 42 USC 1395r note.

PUBLIC LAW 98-369—JULY 18, 1984

For purposes of this subsection, retroactive adjustments or payments and deductions on account of work shall not be taken into account in determining the monthly benefits to which an individual is entitled under section 202 or 223.". (c) The amendments made by this section shall apply to premiums for months beginning with January 1986. PAYMENT FOR CLINICAL DIAGNOSTIC LABORATORY TESTS

42 USC 1395Z.

42 USC 1395u. 42 USC 1395gg.

42 USC 1395CC.

SEC. 2303. (a) Section 1833(a)(1)(D) of the Social Security Act is amended to read as follows: "(D) with respect to clinical diagnostic laboratory tests for which payment is made under this part (i) on the basis of a fee schedule under subsection (h)(1), the amount paid shall be equal to 80 percent (or 100 percent, in the case of such tests for which payment is made on the basis of an assignment described in section 1842(b)(3)(B)(ii) or under the procedure described in section 1870(f)(1)) of the lesser of the amount determined under such fee schedule or the amount of the charges billed for the tests, or (ii) on the basis of a negotiated rate established under subsection (h)(6), the amount paid shall be equal to 100 percent of such negotiated rate,". (b) Section 1833(a)(2) of such Act is amended— (1) in subparagraph (B), by inserting "or (D)" after "subparagraph (C)"; (2) by striking out "and" at the end of subparagraph (B); (3) by adding "and" at the end of subparagraph {C); and (4) by adding at the end thereof the following new subparagraph: "(D) with respect to clinical diagnostic laboratory tests for which payment is made under this part (i) on the basis of a fee schedule determined under subsection (h)(1), the amount paid shall be equal to 80 percent (or 100 percent, in the case of such tests for which payment is made on the basis of an assignment described in section 1842(b)(3)(B)(ii), under the procedure described in section 1870(f)(1), or to a provider having an agreement under section 1866) of the lesser of the amount determined under such fee schedule or the amount of the charges billed for the tests, or (ii) on the basis of a negotiated rate established under subsection (h)(6), the amount paid shall be equal to 100 percent of such negotiated rate for such tests;". (c) Section 1833(b) of the Social Security Act is amended by striking out "and" at the end of clause (2) and by inserting before the period at the end of clause (3) the following: ", and (4) such deductible shall not apply with respect to clinical diagnostic laboratory tests for which payment is made under this part (A) under subsection (a)(l)(D)(i) or (a)(2)(D)(i) on the basis of an assignment described in section 1842(b)(3)(B)(ii), under the procedure described in section 1870(f)(1), or to a provider having an agreement under section 1866, or (B) on the basis of a negotiated rate determined under subsection (h)(6)". (d) Section 1833(h) of such Act is amended to read as follows: "(h)(1)(A) The Secretary shall establish fee schedules for clinical diagnostic laboratory tests for which payment is made under this part, other than such tests performed by a provider of services for an inpatient of such provider. "(B) In the case of clinical diagnostic laboratory tests performed by a physician or by a laboratory (other than tests performed by a

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1113

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1065

hospital laboratory for outpatients of such hospital), the fee schedules established under subparagraph (A) shall be established on a regional, statewide, or carrier service area basis (as the Secretary may determine to be appropriate) for tests furnished during the period beginning on July 1, 1984, and ending on June 30, 1987. For such tests furnished on or after July 1, 1987, the fee schedule shall be established on a nationwide basis. "(C) In the case of clinical diagnostic laboratory tests performed by a hospital laboratory for outpatients of such hospital, the fee schedules established under subparagraph (A) shall be established on a regional, statewide, or carrier service area basis (as the Secretary may determine to be appropriate) for tests furnished during the period beginning on July 1, 1984, and ending on June 30, 1987. For such tests furnished on or after July 1, 1987, the fee schedule under subparagraph (A) shall not apply with respect to clinical diagnostic laboratory tests performed by a hospital laboratory for outpatients of such hospital. "(2) Except as provided in paragraph (4), the Secretary shall set the fee schedules at 60 percent (or, in the case of a test performed by a hospital laboratory for outpatients of such hospital, 62 percent) of the prevailing charge level determined pursuant to the third and fourth sentences of section 1842(b)(3) for similar clinical diagnostic 42 USC I395u laboratory tests for the applicable region. State, or area (or, effective July 1, 1987, for the United States) for the 12-month period beginning July 1, 1984, adjusted annually by a percentage increase or decrease equal to the percentage increase or decrease in the Consumer Price Index for All Urban Consumers (United States city average), and subject to such other adjustments as the Secretary determines are justified by technological changes. The Secretary may make further adjustments or exceptions to the fee schedules to assure adequate reimbursement of (A) emergency laboratory tests needed for the provision of bona fide emergency services, and (B) certain low volume high-cost tests where highly sophisticated equipment or extremely skilled personnel are necessary to assure quality. "(3) In addition to the amounts provided under the fee schedules, the Secretary shall provide for and establish a nominal fee to cover the appropriate costs in collecting the sample on which a clinical diagnostic laboratory test was performed and for which payment is made under this part, except that not more than one such fee may be provided under this paragraph with respect to samples collected in the same encounter. "(4) In establishing any fee schedule under this subsection, the Secretary may provide for an adjustment to take into account, with respect to the portion of the expenses of clinical diagnostic laboratory tests attributable to wages, the relative difference between a region's or local area's wage rates and the wage rate presumed in the data on which the schedule is based. "(5)(A) In the case of a bill or request for payment for a clinical diagnostic laboratory test for which payment may otherwise be made under this part on the basis of an assignment described in section 1842(b)(3)(B)(ii), under the procedure described in section 42 USC 1395u. 1870(0(1), or under a provider agreement under section 1866, pay- 42 USC 1395gg, ment may be made only to the person or entity which performed or 1395CC. supervised the performance of such test; except that— "(i) if a physician performed or supervised the performance of such test, payment may be made to another physician with whom he shares his practice, and

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text: Author:Heinrich Gottfried Langen

title: Author:Heinrich Gottfried Langen


text:
Page:United States Statutes at Large Volume 98 Part 1.djvu/1114

 98 STAT. 1066

42 USC 1395u. Post, p. 1070. 42 USC 1395gg. 42 USC 1395CC.

42 USC 1395u. 42 USC 1395CC.

42 USC 1896a.

42 USC 1396b.

Ante, p. 1064. 42 USC 1395J. 42 USC 1395u note.

Report. 42 USC 1395/f note.

PUBLIC LAW 98-369—JULY 18, 1984

"(ii) in the case of a test performed at the request of a laboratory by another laboratory, payment may be made to the referring laboratory. "(B) In the case of such a bill or request for payment for a clinical diagnostic laboratory test for which payment may otherwise be made under this part, and which is not described in subparagraph (A), payment may be made to the beneficiary only on the basis of the itemized bill of the person or entity which performed or supervised the performance of the test. "(C) Payment for a clinical diagnostic laboratory test performed by a laboratory which is independent of a physician's office or a rural health clinic may only be made on the basis of an assignment described in section 1842(b)(3)(B)(ii), in accordance with section 1842(b)(6)(B) under the procedure described in section 1870(f)(1), or to a provider of services with an agreement in effect under section 1866. "(6) In the case of any diagnostic laboratory test payment for which is not made on the basis of a fee schedule under paragraph (1), the Secretary may establish a payment rate which is acceptable to the person or entity performing the test and which would be considered the full charge for such tests. Such negotiated rate shall be limited to an amount not in excess of the total payment that would have been made for the services in the absence of such rate.". (e) Section 1842 of such Act is amended by striking out subsection (h) thereof. (f) The last sentence of section 1866(a)(2)(A) of such Act is amended by inserting "and with respect to clinical diagnostic laboratory tests" after "section 1861(s)(10)". (g)(1) Section 1902(a) of such Act is amended— (A) by inserting "and" at the end of paragraph (42); (B) by striking out paragraph (43); and (C) by redesignating paragraph (44) as paragraph (43). (2) Section 1903(i) of such Act is amended— (A) by striking out the period at the end of paragraph (6) and inserting in lieu thereof "; or ", and (B) by adding after paragraph (6) the following new paragraph: "(7) with respect to any amount expended for clinical diagnostic laboratory tests performed by a physician, independent laboratory, or hospital, to the extent such amount exceeds the amount that would be recognized under section 1833(h) for such tests performed for an individual enrolled under part B of title XVIIL". (h) The Secretary of Health and Human Services shall simplify the procedures under section 1842 of the Social Security Act with respect to claims and payments for clinical diagnostic laboratory tests so as to reduce unnecessary paperwork while assuring that sufficient information is supplied to identify instances of fraud and abuse. (i)(l) The Comptroller General shall report to the Congress on— (A) the appropriateness of the fee schedules under section 1833(h) of the Social Security Act and their impact on the volume and quality of clinical diagnostic laboratory tests; (B) the potential impact of the adoption of a national fee schedule; and

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1115

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1067

(C) the potential impact of applying a national fee schedule to clinical diagnostic laboratory tests provided by hospitals to their outpatients. (2) The Secretary of Health and Human Services shall report to the Congress with respect to the advisability and feasibility of a system of direct payment to any physician for all clinical diagnostic laboratory tests ordered by such physician. (3) The reports required by paragraphs (1) and (2) shall be submitted not later than January 1, 1987. (j)(l) Except as provided in paragraphs (2) and (3), the amendments made by this section shall apply to clinical diagnostic laboratory tests furnished on or after July 1, 1984. (2) The amendments made by subsection (g)(2) shall apply to payments for calendar quarters beginning on or after October 1, 1984. (3) The amendments made by this section shall not apply to clinical diagnostic laboratory tests furnished to inpatients of a provider operating under a waiver granted pursuant to section 602(k) of the Social Security Amendments of 1983. Payment for such services shall be made under part B of title XVIII of the Social Security Act at 80 percent (or 100 percent in the case of such tests for which payment is made on the basis of an assignment described in section 1842(b)(3)(B)(ii) of the Social Security Act or under the procedure described in section 1870(f)(1) of such Act) of the reasonable charge for such service. The deductible under section 1833(b) of such Act shall not apply to such tests if payment is made on the basis of such an assignment or procedure.

Report.

Effective dates. 42 USC 1395/ note.

97 Stat. 163. 42 USC 1395y note. 42 USC 1395J. 42 USC 1395u. 42 USC 1395gg. 42 USC 1395/.

PACEMAKER REIMBURSEMENT REVIEW AND REFORM

SEC. 2304. (a)(1) The Secretary of Health and Human Services 42 USC 1395/ shall issue revisions to the current guidelines for the payment under note. part B of title XVIII of the Social Security Act for the transtelephonic monitoring of cardiac pacemakers. Such revised guidelines shall include provisions regarding the specifications for and frequency of transtelephonic monitoring procedures which will be found to be reasonable and necessary. (2)(A) Except as provided in subparagraph (B), if the guidelines required by paragraph (1) have not been issued and put into effect by October 1, 1984, and until such guidelines have been issued and put into effect, payment may not be made under part B of title XVIII of the Social Security Act for transtelephonic monitoring procedures, with respect to a single-chamber cardiac pacemaker powered by lithium batteries, conducted more frequently than— (i) weekly during the first month after implantation, (ii) once every two months during the period representing 80 percent of the estimated life of the implanted device, and (iii) monthly thereafter. (B) Subparagraph (A) shall not apply in cases where the Secretary determines that special medical factors (including possible evidence of pacemaker or lead malfunction) justify more frequent transtelephonic monitoring procedures. (b)(1) The Secretary shall review, and report to the Committees on Report. Energy and Commerce and Ways and Means of the House of Representatives and the Committee on Finance of the Senate, regarding the appropriateness of the amounts recognized as reasonable under part B of title XVIII of the Social Security Act for physicians

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text:
Page:United States Statutes at Large Volume 98 Part 1.djvu/1116

 98 STAT. 1068

Report. 97 Stat. 152. 42 USC 1395WW.

42 USC 1395c.

42 USC 1395y.

PUBLIC LAW 98-369—JULY 18, 1984

services associated with implantation or replacement of pacemaker devices and pacemaker leads. Such review shall take into account the amounts recognized as reasonable with respect to such procedures and the time and difficulty of such procedures at the current time in comparison with such amounts and the time and difficulty of such procedures at the time the amounts for such procedures were first established under such part. (2) The Prospective Payment Assessment Commission, established under section 1886(e) of the Social Security Act, shall review and report to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate regarding the appropriateness of the payment amounts provided under section 1886(d) of such Act for inpatient hospital services associated with implantation or replacement of pacemaker devices and pacemaker leads. Such review shall take into account the time, difficulty, and costs associated with such procedures at the current time in comparison with the time, difficulty, and costs associated with such procedures upon which the payment rates for such procedures under part A of title XVIII of such Act are based. (3) The Secretary and the Commission shall each complete the review described in paragraph (1) or (2), respectively, of this subsection and report on such review not later than March 1, 1985. (c) Section 1862 of the Social Security Act is amended by adding at the end the following new subsection: "(h)(1)(A) The Secretary shall, through the Commissioner of the Food and Drug Administration, provide for a registry of all cardiac pacemaker devices and pacemaker leads for which payment was made under this title. "(B) Such registry shall include the manufacturer, model, and serial number of each such device or lead, the name of the recipient of such device or lead, the date and location of the implantation or removal of the device or lead, the name of the physician implanting or removing such device or lead, the name of the hospital or other provider billing for such procedure, any express or implied warranties associated with such device or lead under contract or State law, and such other information as the Secretary deems to be appropriate. "(C) Each physician and provider of services performing the implantation or replacement of pacemaker devices and leads for which payment is made or requested to be made under this title shall, in accordance with regulations of the Secretary, submit information respecting such implantation or replacement for the registry. "(D) Such registry shall be for the purposes of assisting the Secretary in determining when payments may properly be made under this title, in tracing the performance of cardiac pacemaker devices and leads, in determining when inspection by the manufacturer of such a device or lead may be necessary under paragraph (3), and in carrying out studies with respect to the use of such devices and leads. In carrying out any such study, the Secretary may not reveal any specific information which identifies any pacemaker device or lead recipient by name (or which would otherwise identify a specific recipient). "(E) Any person or organization may provide information to the registry with respect to cardiac pacemaker devices and leads other than those for which payment is made under this title. ,, - -

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1117

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1069

"(2) The Secretary may, by regulation, require each provider of services— "(A) to return, to the manufacturer of the device or lead for testing under paragraph (3), any cardiac pacemaker device or lead which is removed from a patient and payment for the implantation or replacement of which was made or requested by such provider under this title, and "(B) not to charge any beneficiary for replacement of such a device or lead if the device or lead has not been returned in accordance with subparagraph (A). "(3) The Secretary may, by regulation, require the manufacturer of a cardiac pacemaker device or lead (A) to test or analyze each pacemaker device or lead for which payment is made or requested under this title and which is returned to the manufacturer by a provider of services under paragraph (2), and (B) to provide the results of such test or analysis to that provider, together with information and documentation with respect to any warranties covering such device or lead. In any case where the Secretary has reason to believe, based upon information in the pacemaker registry or otherwise available to him, that replacement of a cardiac pacemaker device or lead for which payment is or may be requested under this title is related to the malfunction of a device or lead, the Secretary may require that personnel of the Food and Drug Administration be present at the testing of such device by the manufacturer, to determine whether such device was functioning properly. "(4) The Secretary may deny payment under this title, in whole or in part and for such period of time as the Secretary determines to be appropriate, with respect to the implantation or replacement of a pacemaker device or lead of a manufacturer performed by a physician and provider of services after the Secretary determines (in accordance with the procedures established under paragraphs (2) and (3) of subsection (d)) that— "(A) the physician or provider of services has failed to submit information to the registry as required under paragraph (1)(C), "(B) the provider of services has failed to return devices and leads as required under paragraph (2)(A) or has improperly charged beneficiaries as prohibited under paragraph (2)(B), or "(C) the manufacturer of the device or lead has failed to perform and to report on the testing of devices and leads returned to it as required under paragraph (3).". (d) The Secretary of Health and Human Services shall promulgate Regulations. final regulations to carry out this section and the amendment made 42 USC 1395y by this section prior to January 1, 1985, and the amendment made ^°^^by subsection (c) shall apply to pacemaker devices and leads implanted or removed on or after the effective date of such regulations. ELIMINATION OF SPECIAL PAYMENT PROVISIONS FOR PREADMISSION DIAGNOSTIC TESTING

SEC. 2305. (a) Section 1833(a)(1) of the Social Security Act is 42 USC 1395Z. amended by striking out "(F) with respect to" and all that follows through "(G)" and inserting in lieu thereof "and (F)". (b) Section 1833(a) of such Act is amended— (1) by adding "and" at the end of paragraph (3); (2) by striking out "; and" at the end of paragraph (4) and inserting in lieu thereof a period; and

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text:
Page:United States Statutes at Large Volume 98 Part 1.djvu/1118

 98 STAT. 1070 42 USC 1395Z.

42 USC 1395/ note. 42 USC 1395/ note. 42 USC 1395J.

PUBLIC LAW 98-369—JULY 18, 1984

(3) by striking out paragraph (5). (c) Section 1833(a)(2) of such Act is amended by striking out "and in paragraph (5) of this subsection". (d) Section 1833(b) and section 1833(i)(3) of such Act are each amended by striking out "subsection (a)(1)(G)" and inserting in lieu thereof "subsection (a)(1)(F)". (e) The amendments made by this section shall apply to services performed after the date of the enactment of this Act. (f) The amendments made by this section shall not be construed as prohibiting payment, subject to the applicable copayments, under part B of title XVIII of the Social Security Act for preadmission diagnostic testing performed in a physician's office to the extent such testing is otherwise reimbursable under regulations of the Secretary. LIMITATION ON PHYSICIAN FEE PREVAILING AND CUSTOMARY CHARGE L E V E L S; PARTICIPATING PHYSICIAN INCENTIVES

42 USC 1395U.

SEC. 2306. (a) Section 1842(b) of the Social Security Act is amended by redesignating paragraphs (4) through (6) as paragraphs (5) through (7), respectively, and by inserting after paragraph (3) the following new paragraph: "(4)(A) In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians' services furnished during the 15-month period beginning July 1, 1984, the Secretary shall not set any level higher than the same level as was set for the 12-month period beginning July 1, 1983. "(B) In determining the reasonable charge under paragraph (3) for physicians' services furnished during the 15-month period beginning July 1, 1984, the customary charges shall be the same customary charges as were recognized under this section for the 12-month period beginning July 1, 1983. "(C) In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians' services furnished during periods beginning after September 30, 1985, the Secretary shall treat the level as set under subparagraph (A) as having fully provided for the economic changes which would have been taken into account but for the limitations contained in subparagraph (A). "(D) In determining the customary charges for physicians' services furnished during the 12-month period beginning October 1, 1985, or October 1, 1986, by a physician who at no time for any services furnished during the 12-month period beginning October 1, 1984, was a participating physician (as defined in subsection (h)(1)), the Secretary shall not recognize increases in actual charges for services furnished during the 15-month period beginning on July 1, 1984, above the level of the physician's actual charges billed in the 3month period ending on June 30, 1984.". (b)(1) Section 1842(b)(3) of such Act is amended— (A) in subparagraph (F), by striking out "June 30" and inserting in lieu thereof "September 30"; (B) by striking out "July 1" each place it appears in the third and eighth sentences and inserting in lieu thereof in each instance "October 1"; and (C) in the third sentence thereof, by striking out "during the last preceding calendar year elapsing prior to" and inserting in

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text:
Page:United States Statutes at Large Volume 98 Part 1.djvu/1119

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1071

lieu thereof "during the 12-month period ending on the March 31 last preceding". (2) The amendments made by paragraph (1) shall apply to items and services furnished on or after October 1, 1985. (c) Section 1842 of such Act, as amended by section 2303(e) of this title, is amended by adding at the end thereof the following new subsections: "(h)(1) Any physician or supplier may voluntarily enter into an agreement with the Secretary to become a participating physician or supplier. For purposes of this section, the term 'participating physician or supplier' means a physician or supplier (excluding any provider of services) who, before October 1 of any year beginning with 1984, enters into an agreement with the Secretary which provides that such physician or supplier will accept payment under this part on the basis of an assignment described in subsection (b)(3)(B)(ii), in accordance with subsection (b)(6)(B), or under the procedure described in section 1870(0(1) for all items and services furnished to individuals enrolled under this part during the 12month period beginning on October 1 of such year. In the case of a newly licensed physician or a physician who begins a practice in a new area, or in the case of a new supplier who begins a new business, or in such similar cases as the Secretary may specify, such physician or supplier may enter into such an agreement after October 1 of a year, for items and services furnished during the remainder of the 12-month period beginning on such October 1. "(2) Each carrier having an agreement with the Secretary under subsection (a) shall maintain a toll-free telephone number or numbers at which individuals enrolled under this part may obtain the names, addresses, specialty, and telephone numbers of participating physicians and suppliers. "(3) In any case in which a carrier having an agreement with the Secretary under subsection (a) is able to develop a system for the electronic transmission to such carrier of bills for services, such carrier shall establish direct lines for the electronic receipt of claims from participating physicians and suppliers. "(i)(l) Each year the Secretary shall publish a list containing the name, address, specialty, and percent of claims submitted with respect to each physician and supplier during the preceding year that were paid on the basis of an assignment described in subsection (b)(3)(B)(ii), in accordance with subsection (b)(6)(B), or under the procedure described in section 1870(f)(1). The Secretary may limit such list to those physicians and suppliers who accepted such an assignment in a certain percentage of such physician's or supplier's billings or who provide at least a certain volume of services, as the Secretary may determine to be appropriate. Such list shall be organized by such geographical area as the Secretary determines, after consultation with carriers, would facilitate the use of such list by individuals enrolled under this part. "(2) At the beginning of each fiscal year the Secretary shall publish a directory containing the name, address, and specialty of all participating physicians and suppliers (as defined in subsection (h)(1)) for that fiscal year. The directory shall be organized to make the most useful presentation of the information (as determined by the Secretary) for individuals enrolled under this part. "(3) The Secretary shall promptly notify individuals enrolled under this part of the publication of such list and directory and shall make such list and directory available in each district and branch

Effective date. 42 USC I395u "°*^ Ante, p. 1066.

42 USC I395gg.

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text:
Page:United States Statutes at Large Volume 98 Part 1.djvu/1120

 98 STAT. 1072

42 USC 1395y.

42 USC

1320a-7a.

42 USC 1395J. Report.

PUBLIC LAW 98-369—JULY 18, 1984

office of the Social Security Administration, in the offices of carriers, and to senior citizen organizations. "(4) The Secretary shall provide that the list and directory shall be available for purchase by the public. "(j)(l) In the case of a physician who is not a participating physician, the Secretary shall monitor each such physician's actual charges to individuals enrolled under this part for physicians' services furnished during the 15-month period beginning July 1, 1984. If such physician knowingly and willfully bills individuals enrolled under this part for actual charges in excess of such physician's actual charges for the calendar quarter beginning on April 1, 1984, the Secretary may apply sanctions against such physician in accordance with paragraph (2). "(2) Subject to paragraph (3), the sanctions which the Secretary may apply under paragraph (1) are— "(A) barring a physician from participation under the program under this title for a period not to exceed 5 years, in accordance with the procedures of paragraphs (2) and (3) of section 1862(d), or "(B) the imposition of civil monetary penalties and assessments, in the same manner as such penalties are authorized under section 1128A(a), or both. No payment may be made under this title with respect to any item or service furnished by a physician during the period when he is barred from participation in the program under this title pursuant to this subsection. "(3)(A) The Secretary may not bar a physician pursuant to paragraph (2)(A) if such physician is a sole community physician or sole source of essential specialized services in a community. "(B) The Secretary shall take into account access of beneficiaries to physicians' services for which payment may be made under this part in determining whether to bar a physician from participation under paragraph (2)(A). "(4) The Secretary may, out of any civil monetary penalty or assessment collected from a physician pursuant to this subsection, make a payment to a beneficiary enrolled under this part in the nature of restitution for amounts paid by such beneficiary to such physician which was determined to be an excess charge under paragraph (1).". (d)(1) During the 15-month period beginning July 1, 1984, the Secretary of Health and Human Services shall monitor physicians' services in order to determine any changes in the per capita volume and mix of physicians' services provided to beneficiaries under part B of title XVIII of the Social Security Act, classified by participating and nonparticipating physicians, by assigned and nonassigned claims, by specialty, and by geographic area. (2) A report on changes monitored pursuant to paragraph (1) shall be provided to Congress prior to July 1, 1985. (3) Such report shall include recommendations in sufficient detail to serve as the basis for legislative action which Congress can take to assure that any burden of effectively constraining the growth of costs in the medicare part B program, which Congress intends to be borne by providers and physicians, is not transferred (in whole or in part) so as to become an additional burden on part B beneficiaries in the form of increased out-of-pocket costs, reduced services, or reduced access to needed physician care.

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Author:William Henry Larrabee

Articles in Popular Science Monthly

(as translator)

title: Author:William Henry Larrabee


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Page:United States Statutes at Large Volume 98 Part 1.djvu/1121

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1073

(e) In addition to any funds otherwise provided for fiscal years 1984 and 1985 for payment to carriers under contracts entered into under section 1842 of the Social Security Act, there are transferred 42 USC I395u. from the Federal Supplementary Medical Insurance Trust Fund, for payments to such carriers under such contracts to implement the amendments made by this section, not less than $8,000,000 for fiscal year 1984, and not less than $15,000,000 for fiscal year 1985. (f)(1) Section 1128A(a)(2) of the Social Security Act is amended by 42 USC inserting before the comma at the end thereof the following: ", or (C) 1320a-7a. an agreement to be a participating physician or supplier under section 1842(h)(1)". 42 USC 1395nn. (2) Section 1877(d) of such Act is amended— (A) by inserting "or agrees to be a participating physician or supplier under section 1842(h)(1)" after "1842(b)(3)(B)(ii)", and (B) by striking out "specified in subclause (I) of such section" and inserting in lieu thereof "or agreement". PAYMENT FOR SERVICES OF TEACHING PHYSICIANS

SEC. 2307. (a)(1) Subparagraph (A) of section 1842(b)(7)(A) of the Social Security Act (as redesignated by section 2306 of this title) is Ante, p. 1070 amended by adding at the end the following sentence: "If all the teaching physicians in a hospital agree to have payment made for all of their physicians' services under this part furnished patients in the hospital on the basis of an assignment described in paragraph (3)(B)(ii) or under the procedure described in section 1870(f)(1), not- 42 USC 1395gg. withstanding clause (ii) of this subparagraph, the carrier shall provide for payment in an amount equal to 90 percent of the prevailing charges paid for similar services in the same locality.". (2) Section 1842(b)(7)(B) of such Act is amended— (A) by striking out "physician who has a substantial practice outside the teaching setting" in clause (i) and inserting in lieu thereof "physician who is not a teaching physician (as defined by the Secretary)"; (B) by striking out "outside practice" in clause (i) and inserting in lieu thereof "practice outside the teaching setting"; (C) by striking out "In the case of a physician who does not have a practice described in clause (i)" in clause (ii) and inserting in lieu thereof "In the case of a teaching physician"; (D) by striking out "greater" in clause (ii) and inserting in lieu thereof "greatest"; (E) by striking out "or" at the end of subclause (I) of clause (ii); (F) by striking out the period at the end of subclause (II) of clause (ii) and inserting in lieu thereof ", or"; and (G) by adding at the end of clause (ii) the following new subclause: "(III) 85 percent of the prevailing charges paid for similar services in the same locality.". (3) The amendments made by this subsection shall apply to serv- Effective date. 42 USC 1395u ices furnished on or after July 1, 1984. (b)(1) Section 1886(d)(5)(B) of the Social Security Act is amended by note. adding at the end thereof the following new sentence: "In determin- 97 Stat. 152. ing such adjustment the Secretary shall not distinguish between 42 USC 1395WW. 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.".

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1122

 98 STAT. 1074 Effective date. 42 USC 1395WW note. Study. 42 USC 1395u note. Ante, p. 1070. Report.

PUBLIC LAW 98-369—JULY 18, 1984

(2) The amendment made by paragraph (1) shall apply to cost reporting periods beginning on or after October 1, 1984. (c) The Comptroller General shall conduct a study of the amounts billed for physiciem services and paid by carriers under section 1842G)X7) of the Social Security Act to determine whether such payments have been made only where the physician satisfies the requirements of section 1842(b)(7)(A)(i) of such Act. The Comptroller General shall submit to the Committees on Ways and Means and on Energy and Commerce of the House of Representatives and to the Committee on Finance of the Senate a report on the results of such study not later than 18 months after the date of the enactment of this Act. LESSER OF COST OR CHARGES

Regulations. 42 USC 1395f note. 42 USC 1395. 42 USC 1395c, 1395J. Ante, p. 1064. 42 USC 1395f note. 42 USC 1395f, 1395Z.

42 USC 1395f.

42 USC 1395/.

SEC. 2308. (a) The Secretary of Health and Human Services shall issue regulations which require, for purposes of title XVIII of the Social Security Act, that providers of services calculate and report the lesser-of-cost-or-charges determinations separately with respect to payments for services under part A and services under part B of such title (other than clinical diagnostic laboratory tests paid under section 1833(h)), and that payment under such title be based upon such separate determinations. Such regulations shall apply to cost reporting periods beginning on or after October 1, 1984. (b)(l) For purposes of applying the nominality test under sections 181403X2) and 1833(a)(2)(B)(ii) of the Social Security Act, the Secretary shall, in addition to those rules for establishing nominality which the Secretary determines to be appropriate, provide that charges representing 60 percent or less of costs shall be considered nominal. The charges used in making such determinations shall be the charges actusdly billed to charge-paying patients who are not entitled to benefits under either part of such title. Such determination shall be made separately with respect to payments for services under part A and services under part B of such title (other than clinical diagnostic laboratory tests paid under section 1833(h)), or on the basis of inpatient and outpatient services, except that the determination need not be made separately for home health services if the Secretary finds that such separation is not appropriate. (2)(A) Section 18140)X2) of such Act is amended by inserting after "public provider of services" the following: ", or by another provider which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low-income (and requests that payment be made under this paragraph),". (B) Section 1833(a)(2)(B)(ii) of such Act is amended by inserting after "public provider of services" the following: ", or by another provider which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low-income (and requests that payment be made under this clause),". STUDY OF MEDICARE PART B PAYMENTS

Report. 42 USC 1395Z note.

42 USC 1395J.

SEC. 2309. (a)(1) The Director of the Office of Technology Assessment shall conduct a study of physician reimbursement under the medicare program and report to Congress on such study not later than December 31, 1985. The report shall include specific findings and recommendations on methods by which payment amounts and other program policies under part B of title XVIII of the Social Security Act may be modified— .

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1123

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1075

(A) to eliminate inequities in the relative amounts paid to physicians by type of service, locality, and specialty, with particular attention to any inequities between cognitive services and medical procedures; and (B) to increase incentives for physicians and other suppliers under such part to accept assignment for services covered under title XVIII of the Social Security Act. 42 USC 1395. The study shall also examine the influence of payment methodology and payment levels on the utilization of services. (2) In carrying out the study under paragraph (1)(A), the Director shall take into account the relative time, complexity, investment in professional training, and overhead expenses necessary to the provision of various medical services and procedures, as well as the influence of the changes in technology. (3) The report under paragraph (1)(A) shall include information on methodologies which could be applied in the development of fee schedules on a national or regional basis for payments under part B of title XVIII of the Social Security Act in a manner consistent with 42 USC 1395j. the findings of the study under this subsection. (4) In preparing the report and recommendations, the Director shall consult with the Secretary of Health and Human Services and, as appropriate, with national organizations of physicians and other interested associations and individuals. (b) In order to assist the Director in completing the study and to facilitate Congressional review, the Secretary of Health and Human Services shall compile a centralized medicare part B charge data base, utilizing information gathered by the medicare carriers for charges in 1983. Such data shall include information, by procedure, on— (1) utilization, (2) assignment rates of physicians and suppliers, (3) actual, customary, and prevailing charges, and (4) the differences in charges by physician specialty and locality. Such information shall be provided to the Director of the Office of Technolo^ Assessment. (c) The Secretary shall review the report submitted under subsection (a)(1) and shall report to the Congress his comments on the report and recommendations for legislative amendments. LIMITATION ON INCREASE IN HOSPITAL COSTS PER CASE

SEC. 2310. (a) Section 1886a))(3)(B) of the Social Security Act is amended— (1) by striking out "1 percentage point", and by inserting in lieu thereof "one-quarter of 1 percentage point", and (2) by adding at the end thereof the following: "In determining a percentage change under subsection (e)(4) with respect to discharges occurring in any cost reporting period or fiscal year beginning on or after October 1, 1985, and before October 1, 1986, the Secretary may not establish a percentage increase which exceeds the applicable percentage increase otherwise determined for that period or fiscal year under the preceding sentence.". (b) The amendments made by this section shall apply to cost reporting periods beginning in, and discharges occurring in, fiscal year 1985 and thereafter.

42 USC 1395WW.

Effective date. 42 USC 1395w^ note.

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1124

 98 STAT. 1076

PUBLIC LAW 98-369—JULY 18, 1984 CLASSIFICATION OF CERTAIN RURAL HOSPITALS

97 Stat. 152. SEC. 2311. (a) Section 1886(d)(5)(C)(i) of the Social Security Act is 42 USC 1395WW. amended by adding at the end thereof the following: "A hospital which is classified as a rural hospital may appeal to the Secretary to be classified as a rural referral center under this clause on the basis of criteria (established by the Secretary) which shall allow the hospital to demonstrate that it should be so reclassified by reason of certain of its operating characteristics being similar to those of a typical urban hospital located in the same census region. Such characteristics may include wages, scope of services, service area, and the mix of medical specialties. The Secretary shall publish the criteria not later than 30 days after the date of the enactment of this Act, for implementation by October 1, 1984. An appeal allowed under this clause must be submitted to the Secretary (in such form and manner as the Secretary may prescribe) during the quarter before the first quarter of the hospital's cost reporting period (or, in the case of a cost reporting period beginning during October 1984, during the first quarter of that period), and the Secretary must make a final determination with respect to such appeal within 60 days after the date the appeal was submitted. Any payment adjustments necessitated by a reclassification based upon the appeal shall be effective at the beginning of such cost reporting period.".

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(b) Section 1886(d)(2)(D) of such Act is amended by adding at the end thereof the following: "A hospital located in a Metropolitan Statistical Area shall be deemed to be located in the region in which the largest number of the hospitals in the same Metropolitan Statistical Area are located, or, at the option of the Secretary, the region in which the majority of the inpatient discharges (with respect to which payments are made under this title) from hospitals in the same Metropolitan Statistical Area are made.". (c) Section 1886(d) of such Act is amended by adding at the end thereof the following new paragraph: "(8) In the case of any hospital which is located in an area which is, at any time after April 20, 1983, reclassified from an urban to a rural area, payments to such hospital for the first two cost reporting periods for which such reclassification is effective shall be made as follows: "(A) For the first such cost reporting period, payment shall be equal to the amount payable to such hospital for such reporting period on the basis of the rural classification, plus an amount equal to two-thirds of the amount (if any) by which— "(i) the amount which would have been payable to such hospital for such reporting period on the basis of an urban classification, exceeds "(ii) the amount payable to such hospital for such reporting period on the basis of the rural classification. "(B) For the second such cost reporting period, payment shall be equal to the amount payable to such hospital for such reporting period on the basis of the rural classification, plus an amount equal to one-third of the amount (if any) by which— "(i) the amount which would have been payable to such hospital for such reporting period on the basis of an urban classification, exceeds "(ii) the amount payable to such hospital for such reporting period on the basis of the rural classification.". i«^..

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1125

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1077

(d)(1) Except as provided in paragraph (2), the amendments made Effective date. by subsections (b) and (c) shall be effective with respect to cost 42 USC 1395WW reporting periods beginning on or after October 1, 1983, and the note. amendment made by subsection (a) shall be effective with respect to cost reporting periods beginning on or after October 1, 1984. (2) The amendment made by subsection (b) shall not apply so as to reduce any payment under section 1886(d) of the Social Security Act 97 Stat. 152. to a hospital the region of which is deemed to be changed pursuant 42 USC 1395WW. to such amendment for discharges occurring in any cost reporting period beginning before October 1, 1984. (e) The Secretary of Health and Human Services shall conduct a Study. study of the distinction between urban and rural hospitals for purposes of the DRG payment provisions under section 1886(d) of the Social Security Act, and the effect which such distinction may have on rural hospitals in the case of those DRG's which have high fixed nonlabor components which do not vary significantly between urban and rural areas (such as those DRG's which involve expensive medical devices). The Secretary also shall conduct a study of the advisability and feasibility of varying by DRG the proportions of the labor and nonlabor components of the Federal payment amount instead of applying the average proportion of those components to all DRG's. The Secretary shall report the results of such studies to Report the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives within six months after the date of the enactment of this Act. (f) The Secretary of Health and Human Services shall conduct a Study. study of further refinements which may be appropriate in the inpatient hospital prospective payment provisions of title XVIII of the Social Security Act, in order to address the problems of differ- 42 USC 1395. ences in payment amounts to specific hospitals. The study shall include (but shall not be limited to) the degree of variation in inpatient hospital costs per discharge within each diagnosis-related group. The Secretary shall also present alternative methods of computing the amount of such payments. The study shall include a discussion of the relative merits of a method of payment under which a percentage of the payment amount (for discharges classified within a diagnosis-related group) could be determined on a regional basis. The Secretary shall report the result of the study, and any Report, recommended changes in the prospective payment system, to the Congress prior to September 1, 1984. PAYMENT FOR SERVICES OF A NURSE ANESTHETIST

SEC. 2312. (a) Section 1886(d)(5) of the Social Security Act is amended by adding at the end thereof the following new subparagraph: "(E) The Secretary shall provide for an additional payment amount for any subsection (d) hospital equal to the reasonable costs incurred by such hospital for anesthesia services provided by a certified registered nurse anesthetist. Payment under this subparagraph shall be the only payment made to such hospital with respect to such services.". (b) The second sentence of section 1886(a)(4) of such Act is amended by inserting ", costs of anesthesia services provided by a certified registered nurse anesthetist" after "approved educational activities".

97 Stat. 152. 42 USC I395ww.

97 Stat. 149. 42 USC I395ww.

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1126

 98 STAT. 1078 Effective date. 42 USC 1395WW note. Study. 42 USC 1395. Report.

PUBLIC LAW 98-369—JULY 18, 1984

(c) The amendments made by subsections (a) and (b) shall apply to cost reporting periods beginning on or after October 1, 1984, and before October 1, 1987. (d) The Secretary of Health and Human Services shall conduct a study of possible methods of reimbursement under title XVIII of the Social Security Act which would not discourage the use of certified registered nurse anesthetists by hospitals. The Secretary shall report the results of such study to the Congress as soon as is practicable. PROSPECTIVE PAYMENT ASSESSMENT COMMISSION

97 Stat. 152.

SEC. 2313. (a) Section 1886(e)(2) of the Social Security Act is amended by inserting "(without regard to the provisions of title 5, 42 USC I395ww. United States Code, governing appointments in the competitive service)" after "appointed by the Director". (b)(1) Section 1886(e)(6)(C)(i) of such Act is amended to read as follows: "(i) employ and fix the compensation of an Executive Director (subject to the approval of the Director of the Office) and such other personnel (not to exceed 25) as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service);". (2) Section 1886(e)(6)(C)(iii) of such Act is amended by inserting "(without regard to section 3709 of the Revised Statutes (41 U.S.C. 5))" after "Commission". (3) Section 1886(e)(6)(C) of such Act is amended by adding at the end the following: "Section 10(a)(1) of the Federal Advisory Commit5 USC app. tee Act shall not apply to any portion of a Commission meeting if the Commission, by majority vote, determines that such portion of such meeting should be closed.". (4) Section 1886(e)(6)(D) of such Act is amended by adding at the end thereof the following sentence: "Physicians serving as personnel of the Commission may be provided a physician comparability alloMv ance by the Commission in the same manner as Government physi cians may be provided such an allowance by an agency under section 5948 of title 5, United States Code, and for such purpose subsection (i) of such section shall apply to the Commission in the same manner as it applies to the Tennessee Valley Authority.". Ante, p. 1068. (c) Section 1862 of such Act, as amended by section 2304(c) of this title, is amended by adding at the end the following new subsection, "(i) In order to supplement the activities of the Prospective PaySupra, ment Assessment Commission under section 1886(e) in assessing the safety, efficacy, and cost-effectiveness of new and existing medical procedures, the Secretary may carry out, or award grants or contracts for, original research and experimentation of the type described in clause (ii) of section 1886(e)(6)(E) with respect to such a procedure if the Secretary finds that— "(1) such procedure is not of sufficient commercial value to justify research and experimentation by a commercial organization; "(2) research and experimentation with respect to such procedure is not of a type that may appropriately be carried out by an institute, division, or bureau of the National Institutes of Health; and -

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1127

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1079

"(3) such procedure has the potential to be more cost-effective in the treatment of a condition than procedures currently in use with respect to such condition.". (d) Section 1886(e)(6) of such Act is amended by adding at the end the following new subparagraph: "(J) The Commission shall submit requests for appropriations in the same manner as the Office submits requests for appropriations, but amounts appropriated for the Commission shall be separate from amounts appropriated for the Office.". (e) The amendments made by this section shall become effective on the date of the enactment of this Act.

97 Stat. 152. 42 USC 1395WW.

Effective date. 42 USC 1395y note.

REVALUATION OF ASSETS

SEC. 2314. (a) Section 1861(v)(l) of the Social Security Act is amended by adding at the end thereof the following new subparagraph: "(O)(i) In establishing an appropriate allowance for depreciation and for interest on capital indebtedness and (if applicable) a return on equity capital with respect to an asset of a hospital or skilled nursing facility which has undergone a change of ownership, such regulations shall provide that the valuation of the asset after such change of ownership shall be the lesser of the allowable acquisition cost of such asset to the owner of record as of the date of the enactment of this subparagraph (or, in the case of an asset not in existence as of such date, the first owner of record of the asset after such date), or the acquisition cost of such asset to the new owner. "(ii) Such regulations shall provide for recapture of depreciation in the same manner as provided under the regulations in effect on June 1, 1984. "(iii) Such regulations shall not recognize, as reasonable in the provision of health care services, costs (including legal fees, accounting and administrative costs, travel costs, and the costs of feasibility studies) attributable to the negotiation or settlement of the sale or purchase of any capital asset (by acquisition or merger) for which any payment has previously been made under this title.". (b) Section 1902(a)(13) of such Act is amended— (1) by striking out "and" at the end of subparagraph (A), (2) by redesignating subparagraph (B) as subparagraph (C), and (3) by inserting after subparagraph (A) the following new subparagraph: "(B) that the State shall provide assurances satisfactory to the Secretary that the payment methodology utilized by the State for payments to hospitals, skilled nursing facilities, and intermediate care facilities can reasonably be expected not to increase such payments, solely as a result of a change of ownership, in excess of the increase which would result from the application of section 1861(v)(l)(O); and". IcXD Clause (i) of section 1861(v)(l)(O) of the Social Security Act shall not apply to changes of ownership of gissets pursuant to an enforceable agreement entered into before the date of the enactment of this Act. (2) Clause (iii) of section 1861(v)(l)(O) of such Act shall apply to costs incurred on or after the date of the enactment of this Act.

42 USC I395x.

42 USC I396a.

Supra. 42 USC I395x note.

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Page:United States Statutes at Large Volume 98 Part 1.djvu/1128

 98 STAT. 1080 Effective date. 42 USC 1396a note. 42 USC 1396.

PUBLIC LAW 98-369—JULY 18, 1984

(3)(A) Except as provided in subparagraph (B), the amendments made by subsection (b) shall apply to medical assistance furnished on or after October 1, 1984. (B) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. TECHNICAL AMENDMENTS RELATING TO THE DRG PAYMENT SYSTEM

97 Stat. 149. 42 USC 1395WW. 97 Stat. 152. 42 USC 1395WW.

97 Stat. 168. 42 USC 1395CC. 97 Stat. 170. 42 USC 1395i-2. 97 Stat. 168. 42 USC 1395WW note.

Federal Register, publication. 42 USC 1395WW note. 42 USC 1395WW.

Effective date. 42 USC 1395WW note. 97 Stat. 65. 42 USC 1395WW note.

42 USC 1395c. Ante, p. 1076.

SEC. 2315. (a) Section 1886(c)(4)(A) of the Social Security Act is amended by striking out "and (D)" and inserting in lieu thereof "(D), and (E)". (b) Section 1886(d)(2)(D) of such Act is amended by striking out "Standard". (c) Section 1886(e)(5) of such Act is amended— (1) by striking out "for public comment" in the matter before subparagraph (A), and (2) by inserting "for public comment" in subparagraph (A) after "that fiscal year". (d) Section 1866(a)(1)(F) of such Act (as added by section 602(f)(1)(C) of the Social Security Amendments of 1983) is amended by striking out "(c) or (d)" and inserting in lieu thereof "(b), (c), or (d)". (e) Section 1818(c) of such Act is amended by striking out "subsection (a) of section 1839" and inserting in lieu thereof "subsection (b) of section 1839". (f)(1) Section 604(c)(3) of the Social Security Amendments of 1983 (Public Law 98-21) is amended by striking out "to implement subsection (d) of section 1886 of the Social Security Act (as so amended)" and inserting in lieu thereof "to implement the amendments made by this title". (2) Notwithstanding section 604(c) of the Social Security Amendments of 1983, the Secretary of Health and Human Services shall cause to be published in the Federal Register proposed regulations to carry out subsection (c) of section 1886 of the Social Security Act not later than July 1, 1984, and allow for a period of 45 days for public comment thereon. After consideration of the comments received, the Secretary shall cause to be published in the Federal Register final regulations to carry out such subsection not later than October 1, 1984. (g) The amendments made by this section shall be effective as though they had been included in the enactment of the Social Security Amendments of 1983 (Public Law 98-21). (h) The Secretary of Health and Human Services shall, prior to December 31, 1984— (1) develop and publish a definition of "hospitals that serve a significantly disproportionate number of patients who have low income or are entitled to benefits under part A" of title XVIII of the Social Security Act for purposes of section 1886(d)(5)(C)(i) of that Act, and

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