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(z) Institutional planning.

An overall plan and budget of a hospital, skilled nursing facility, or home health agency shall be considered sufficient if it

(1) provides for an annual operating budget which includes all anticipated income and expenses related to items which would, under generally accepted accounting principles, be considered income and expense items (except that nothing in this paragraph shall require that there be prepared, in connection with any budget, an item-by-item identification of the components of each type of anticipated expenditure or income);

(2) provides for a capital expenditures plan for at least a 3-year period (including the year to which the operating budget described in subparagraph (1) is applicable) which includes and identifies in detail the anticipated sources of financing for, and the objectives of, each anticipated expenditure in excess of $100,000 related to the acquisition of land, the improvement of land, buildings, and equipment, and the replacement, modernization, and expansion of the buildings and equipment which would, under generally accepted accounting principles, be considered capital items;

(3) provides for review and updating at least annually; and

(4) is prepared, under the direction of the governing body of the institution or agency, by a committee consisting of representatives of the governing body, the administrative staff, and the medical staff (if any) of the institution or agency. (As amended Oct. 30, 1972, Pub. L. 92-603, title II, §§ 211(b), (c) (2), 221(c) (4), 223(a)–(d), (f), 227 (a), (c), (d) (1), (f), 234 (a)-(f), 237 (c), 244(c), 246 (b), 248, 249 (b), 251 (a) (1), (b) (1), (c), 252(a), 256(b), 264 (a), 265, 267, 273 (a), 276(a), 278(a) (4)-(15), (b)(6), (10), (11), 283 (a), 86 Stat. 1383, 1384, 1389, 1393, 1394, 1404-1407, 1412, 1413, 1416, 1423-1426, 1445-1447, 1449-1454, 1456.)

PAYMENT FOR SERVICE OF PHYSICIANS RENDERED IN A TEACHING HOSPITAL; STUDIES, REPORTS AND ANALYSIS TO CONGRESSIONAL COMMITTEES, EFFECTIVE DATES

Pub. L. 93-233, § 15(a) (1), (b)–(d), Dec. 31, 1973, 87 Stat. 965, provided:

"(a) (1) Notwithstanding any other provision of law, the provisions of section 1861(b) of the Social Security Act [subsec. (b) of this section], shall, subject to subsection (b) of this section, for the period with respect to which this paragraph is applicable, be administered as if paragraph (7) of such section [subsec. (b) (7) of this section] read as follows:

"'(7) physician where the hospital has a teaching program approved as specified in paragraph (6), if (A) the hospital elects to receive any payment due under this title [this subchapter] for reasonable costs of such services, and (B) all physicians in such hospital agree not to bill charges for professional services rendered in such hospital to individuals covered under the insurance program established by this title [this subchapter]'."

"(b) The provisions of subsection (a) [set out as italicized notes under this section and section 1395k of this title] shall not be deemed to render improper any determination of payment under title XVIII of the Social Security Act [this subchapter] for any service provided prior to the enactment of this Act [Dec. 31, 1973].

"(c) (1) The Secretary of Health, Education, and Welfare shall arrange for the conduct of a study or studies concerning (A) appropriate and equitable methods of reimbursement for physicians' services under titles [subchapters] XVIII and XIX of the Social Security Act [this chapter] in hospitals which have a teaching program approved as specified in section 1861 (b) (6) of such Act [subsec. (b) (6) of this section], (B) the extent to which funds expended under such titles [subchapters] are supporting the training of medical specialties which are in excess supply, (C) how such funds could be expended in ways which support more rational distribution of physician manpower both geographically and by specialty, (D) the extent to which such funds support or encourage teaching programs which tend to disproportionately attract foreign medical graduates, and (E) the existing and appropriate role that part of such funds which are expended to meet in whole or in part the cost of salaries of interns and residents in teaching programs approved as specified in section 1861(b) (6) of such Act [subsec. (b) (6) of this section].

"(2) The studies required by paragraph (1) shall be the subject of an interim report thereon submitted not later than December 1, 1974, and a final report not later than July 1, 1975. Such reports shall be submitted to the Secretary, the Committee on Finance of the Senate, and the Committee on Ways and Means of the House of Representatives, simultaneously.

"(3) The Secretary shall request the National Academy of Sciences to conduct such studies under an arrangement under which the actual expenses incurred by such Academy in conducting such studies will be paid by the Secretary. If the National Academy of Sciences is willing to do so, the Secretary shall enter into such an arrangement with such Academy for the conduct of such studies.

"(4) If the National Academy of Sciences is unwilling to conduct the studies required under this section, under such an arrangement with the Secretary, then the Secretary shall enter into a similar arrangement with other appropriate nonprofit private groups or associations under which such groups or associations shall conduct such studies and prepare and submit the reports thereon as provided in paragraph (2).

"(5) The Social Security Administration shall study the interim report called for in paragraph (2) and shall submit its analysis of such interim report to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives not later than March 1, 1975. The Social Security Administration shall study and submit its analysis of the

final report to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives by October 1, 1975.

"(d) The provisions of subsection (a) [set out as italicized notes under this section and section 1395k of this title] shall apply with respect to cost accounting periods beginning after June 30, 1973, and prior to January 1, 1975, except that if the Secretary of Health, Education, and Welfare determines that additional time is required to prepare the report required by subsection (c), he may, by regulation, extend the applicability of the provisions of subsection (a) to cost accounting periods beginning after June 30, 1975." AMENDMENTS

1972 Subsec. (a) (2). Pub. L. 92-603, § 278(a) (4), substituted "skilled nursing facility" for "extended care facility" and "a" for "an".

Subsec. (b) (6). Pub. L. 92-603, §§ 227(a), 276(a), redesignated existing provisions as subsec. (b) (6) and in subsec. (b) (6) as so designated inserted reference to services in a hospital or osteopathic hospital by an intern or resident-in-training in the field of podiatry, approved by the Council on Podiatry Education of the American Podiatry Association.

Subsec. (b) (7). Pub. L. 92-603, § 227(a), added par. (7).

Subsec. (e). Pub. L. 92-603, § 211(b), inserted reference to section 1395f (f) of this title in the provisions preceding par. (1), inserted reference to sections 1395f (f) (2) of this title following "For purposes of sections 1395f (d) and 1395n (b) of this title (including determination of whether an individual received inpatient hospital services or diagnostic services for purposes of such sections),", and added provisions for accreditation by the Joint Commission on Accreditation of Hospitals.

Subsec. (e) (8). Pub. L. 92-603, § 234 (a) added subsec. (e) (8). Former par. (8) renumbered as par. (9).

Subsec. (e) (9). Pub. L. 92-603, §§ 234(a), 244(c), redesignated former subsec. (e) (8) as (e) (9) and struck out provisions requiring that other requirements not be higher than the comparable requirements prescribed for the accreditation of hospitals by the Joint Commission on Accreditation of Hospitals.

Subsec. (f) (2). Pub. L. 92-603, § 234 (b), added reference to par. (9) of subsec. (e) of this section.

Subsec. (g) (2). Pub. L. 92-603, § 234 (c), added reference to par. 9 of subsec. (e) of this section.

Subsec. (h). Pub. L. 92-603, § 278(a) (5), substituted "skilled nursing facility" for "extended care facility", "skilled nursing facilities" for "extended care facilities" and "a" for "an".

Subsec. (1). Pub. L. 92-603, §§ 248, 278 (a) (6), (b) (10), extended the class of persons qualifying to be deemed as having been an inpatient in a hospital immediately before transfer therefrom by designating as clause (A) the existing requirement that the person have been admitted to the skilled nursing facility within 14 days after discharge from such hospital and adding clauses (B) and (C) and substituted "skilled nursing facility" for "extended care facility".

Subsec. (j). Pub. L. 92-603, § 278 (a) (7), substituted "skilled nursing facility" for "extended care facility" in the provisions preceding par. (1).

Subsec. (j) (10). Pub. L. 92-603, § 234 (d), added par. (10). Former par. (10) was redesignated par. (11) by section 234 (d) (2) of Pub. L. 92-603 and again redesignated par. (15) by section 246(b)(2) of Pub. L. 92-603.

Subsec. (j) (11)-(13). Pub. L. 92-603, § 246(b) (3), added pars. (11)-(13).

Subsec. (1) (15). Pub. L. 92-603, §§ 234 (d), 246 (b) (2), (4), 265, 267, redesignated former par. (10) as par. (11), amended par. (11) as thus redesignated by the addition of provisions that the Secretary shall not require as a condition of participation that medical social services be furnished in any such institution, redesignated such par. (11) as thus amended as par. (15), and added provision

that all information concerning skilled nursing facilities required to be filed with the Secretary be made available to Federal and state employees for purposes consistent with the effective administration of programs established under subchapters XVIII and XIX and added provision for the waiver of the registered nurse requirement in skilled nursing facilities in rural areas.

Subsec. (k). Pub. L. 92-603, §§ 237(c), 278 (a) (8), added provisions authorizing the Secretary to utilize the procedures established under subchapter XIX of this chapter if such procedures were determined to be superior in their effectiveness and substituted "skilled nursing facility" for "extended care facility", "skilled nursing facilities" for "extended care facilities", and "a" for "an".

Subsec. (1). Pub. L. 92-603, § 278(a) (9), substituted "skilled nursing facility" for "extended care facility" and "a" for "an".

Subsec. (m) (7). Pub. L. 92–603, § 278 (a) (10), substituted "skilled nursing facility" for "extended care facility".

Subsec. (n). Pub. L. 92-603, § 278 (a) (11), substituted "skilled nursing facility" for "extended care facility" and "a" for "an".

Subsec. (o). Pub. L. 92-603, § 234 (e), added par. (5), and redesignated former par. (5) as par. (6).

Subsec. (p). Pub. L. 92-603, §§ 251(a) (1), (b) (1), added provisions covering physical therapy services of a licensed physical therapist other than under an arrangement with and under the supervision of a provider of services, clinic, rehabilitation agency, or public health agency, added "In addition, such term includes physical therapy services which meet the requirements of the first sentence of this subsection except that they are furnished to an individual as an inpatient of a hospital or extended care facility", and extended the definition of "outpatient physical therapy services" to include outpatient speech pathology services.

Subsec. (q). Pub. L. 92-603, § 227(f), substituted "subsection (b) (6) of this section" for "the last sentence of subsection (b) of this section" in the parenthetical phrase.

Subsec. (r). Pub. L. 92–603, §§ 211(c) (2), 256(b), 264(a), 273(a), inserted "or (C) the certification required by section 1395x(a)(2)(E) of this title," added provision so as to include doctors in one of the specified arts legally authorized to practice such art in the country in which services inpatient hospital referred to in section 1395y (a) (4) are furnished, added clause (4) covering doctors of optometry who are legally authorized to practice optometry by the State in which they perform such functions, but only with respect to establishing the necessity for prosthetic lenses, and added clause (5) providing for the inclusion of chiropractor services.

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Subsec. (s) (8). Pub. L. 92–603, § 252(a), inserted (including colostomy bags and supplies directly related to colostomy care)" after "organ".

Subsec. (u). Pub. L. 92-603, §§ 227(d)(1), 278(a) (12). substituted "skilled nursing facility, or home health agency, or, for purposes of sections 1395 (g) and 1395n(e) of this title, a fund." for "extended care facility, or home health agency.".

Subsec. (v) (1). Pub. L. 92-603, §§ 223(a), (b), (c), (d), 227(c) (1), (2), (3), (4), 249(b), 278(b)(11), added definition of the costs of services, added provision that the regulation for the establishment of limits on the direct or indirect overall incurred costs or incurred costs of specific items or services or groups of items or services to be recognized as reasonably based on estimates of the costs necessary in the efficient delivery of needed health services to individuals covered by the insurance programs established under this subchapter, added parenthetical provisions covering exclusion of costs, substituted "the necessary costs of efficiently delivering covered services covered by the insurance programs" for "the costs with respect to individuals covered by the insurance programs", designated existing provisions as subpars. (A) and (B), and added subpars. (C), (D), and (E), and substituted "skilled nursing facilities" for "extended care facilities".

Subsec. (v) (3). Pub. L. 92-603, § 278(a) (13), substituted "skilled nursing facility" for "extended care facility".

Subsec. (v) (4). Pub. L. 92-603, § 223 (f), added subsec. (v) (4). Former subsec. redesignated (v) (6).

(v) (4)

subsec. Subsec. (v) (5). Pub. L. 92-603, § 251 (c), added subsec. (v) (5).

Subsec. (v) (6). Pub. L. 92-603, §§ 223(f), 251(c), redesignated former subsec. (v) (4) as (v) (6).

Subsec. (v) (7). Pub. L. 92-603, §§ 221 (c) (4), 223(b), 251 (c), added subsec. (v) (7).

Subsecs. (w), (y). Pub. L. 92-603, § 278(a) (14), (15), substituted "skilled nursing facility" for "extended care facility" and "a" for "an".

Subsec. (z). Pub. L. 92-603, §§ 234 (b), 278(b) (6), added subsec. (z) and in such subsec. (z) substituted "skilled nursing facility" for "extended care facility".

EFFECTIVE DATE OF 1972 AMENDMENT Amendment of subsecs. (e) and (r) of this section by section 211 (b) and (c) (2) of Pub. L. 92-603 applicable to services furnished with respect to admissions occurring after Dec. 31, 1972, see section 211(d) of Pub. L. 92-603, set out as a note under section 1395f of this title.

Section 223 (h) of Pub. L. 92-603 provided that: “The amendments made by this section [amending this section and section 1395cc of this title] shall be effective with respect to accounting periods beginning after December 31, 1972."

Section 227(g) of Pub. L. 92-603 provided that: "The amendments made by this section [amending this section and sections 1395f, 1395k, 1395n, 1395u, and 1395cc of this title] shall apply with respect to accounting periods beginning after June 30, 1973.”

Section 234 (1) of Pub. L. 92-603 provided that: "The amendments made by this section [amending this section and sections 1395f, 1395z, and 1395bb of this title] shall apply with respect to any provider of services for fiscal years (of such provider) beginning after the fifth month following the month in which this Act is enacted [Oct. 1972]."

Section 246 (c) of Pub. L. 92-603 provided that: "The amendments made by this section [adding pars. (11)-(13) of subsec. (j), redesignating former par. (11) of subsec. (j) as par. (15), and amending such par. (15), and section 1396(a) (28) of this title] shall be effective July 1, 1973."

Section 251(d) of Pub. L. 92-603, as amended by Pub. L. 93-233, § 17(a), Dec. 31, 1973, 87 Stat. 967, provided that:

"(1) The amendments made by subsection (a) [amending subsec. (p) of this section to cover physical therapy services of a licensed physical therapist other than under an arrangement with and under the supervision of a provider of services, clinic, rehabilitation agency, or public health agency, and amending sections 1395 and 1395k (a) (2) (C) of this title] shall apply with respect to services furnished on or after July 1, 1973.

"(2) The amendments made by subsection (b) [amending subsec. (p) of this section by adding provision for the inclusion of physical therapy services which meet the requirements of the first sentence except that they are furnished to an individual as an inpatient of a hospital or extended care facility, and amending section 1395n (a) (2) (C) of this title] shall apply with respect to services furnished on or after the date of enactment of this Act [Oct. 30, 1972].

"(3) The amendments made by subsection (c) [enacting par (5) of subsec. (v) of this section] shall be effective with respect to accounting periods beginning after the month in which there are promulgated, by the Secretary of Health, Education, and Welfare, final regulations implementing the provisions of section 1861 (v) (5) of the Social Security Act [subsec. (v) (5) of this section]."

Section 252 (b) of Pub. L. 92-603 provided that: "The amendment made by subsection (a) [amending subsec. (s) (8) of this section] shall apply only with respect to items furnished on or after the date of the enactment of this Act [Oct. 30, 1972]."

Amendment of subsec. (r) of this section by section 256(b) of Pub. L. 92-603 applicable with respect to admissions occurring after the second month following the month of enactment of Pub. L. 92-603 which was approved on Oct. 30, 1972, see section 256 (d) of Pub. L. 92-603, set out as a note under section 1395f of this title.

Section 264 (b) of Pub. L. 92-603 provided that: "The amendment made by subsection (a) [adding cl. (4) to subsec. (r) of this section] shall apply only with respect to services performed on or after the date of the enactment of this Act [Oct. 30, 1972]."

Section 273 (b) of Pub. L. 92-603 provided that: "The amendments made by this section [adding cl. (5) to subsec. (r) of this section] shall be effective with respect to services furnished after June 30, 1973."

Section 276 (b) of Pub. L. 92-603 provided that: "The amendment made by this section [amending subsec. (b) (6) of this section] shall apply with respect to accounting periods beginning after December 31, 1972." Amendment of subsec. (p) of this section by section 283 (a) of Pub. L. 92-603 to apply with respect to services rendered after Dec. 31, 1972, see section 283 (c) of Pub. L. 92-603, set out as a note under section 1395n of this title. PAYMENT FOR DURABLE MEDICAL EQUIPMENT Section 245 (a)-(c) of Pub. L. 92-603 provided that: "(a) The Secretary is authorized to conduct reimbursement experiments designed to eliminate unreasonable expenses resulting from prolonged rentals of durable medical equipment described in section 1861 (s) (6) of the Social Security Act [subsec. (s) (6) of this section].

"(b) Such experiment may be conducted in one or more geographic areas, as the Secretary deems appropriate, and may, pursuant to agreements with suppliers, provide for reimbursement for such equipment on a lump-sum basis whenever it is determined (in accordance with guidelines established by the Secretary) that a lump-sum payment would be more economical than the anticipated period of rental payments. Such experiments may also provide for incentives to beneficiaries (including waiver of the 20 percent coinsurance amount applicable under section 1833 of the Social Security Act [section 13957 of this title]) to purchase used equipment whenever the purchase price is at least 25 percent less than the reasonable charge for new equipment.

"(c) The Secretary is authorized, at such time as he deems appropriate, to implement on a nationwide basis any such reimbursement procedures which he finds to be workable, desirable and economical and consistent with the purposes of this section."

PHYSICAL THERAPY SERVICES REQUIREMENTS; EFFECTIVE

DATE POSTPONEMENT

Section 17(a) of Pub. L. 93-233, Dec. 31, 1973, 87 Stat. 967, provided that: "In the administration of title XVIII of the Social Security Act [this subchapter], the amount payable thereunder with respect to physical therapy and other services referred to in section 1861 (v) (5) (A) of such Act (as added by section 151 (c) [should read 251 (c)] of the Social Security Amendments of 1972) [subsec. (v) (5) (A) of this section] shall be determined (for the period with respect to which the amendment made by such section 151 (c) [251(c)] would, except for the provisions of this section, be applicable) in like manner as if the 'December 31, 1972', which appears in such subsection (d) (3) of such section 151 [251, set out as Effective Date of 1972 Amendment note hereunder], read the month in which there are promulgated, by the Secretary of Health, Education, and Welfare, final regulations implementing the provisions of section 1861 (v) (5) of the Social Security Act [subsec. (v) (5) of this section]'."

SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in sections 705, 706, 1395mm, 1395nn, 1396a, 1396b, 1396d of this title.

§ 1395y. Exclusions from coverage.

(a) Notwithstanding any other provision of this subchapter, no payment may be made under part A or part B for any expenses incurred for items or services

(4) which are not provided within the United States (except for inpatient hospital services furnished outside the United States under the conditions described in section 1395f (f) of this title and,

subject to such conditions, limitations, and requirements as are provided under or pursuant to this subchapter, physicians services and ambulance service furnished an individual in conjunction with such inpatient hospital services but only for the period during which such inpatient hospital services were furnished);

*

(12) where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status, requires hospitalization in connection with the provision of such services; or

(c) No payment may be made under this subchapter with respect to any item or service furnished to or on behalf of any individual on or after January 1, 1975, if such item or service is covered under a health benefits plan in which such individual is enrolled under chapter 89 of Title 5 unless prior to the date on which such item or service is so furnished the Secretary shall have determined and certified that such plan or the Federal employees health benefits program under chapter 89 of such Title 5 has been modified so as to assure that

(1) there is available to each Federal employee or annuitant enrolled in such plan, upon becoming entitled to benefits under part A or B, or both parts A and B of this subchapter, in addition to the health benefits plans available before he becomes so entitled, one or more health benefits plans which offer protection supplementing the protection he has under this subchapter, and

(2) the Government or such plan will make available to such Federal employee or annuitant a contribution in an amount at least equal to the contribution which the Government makes toward the health insurance of any employee or annuitant enrolled for high option coverage under the Government-wide plans established under chapter 89 of such Title 5, with such contribution being in the form of (A) a contribution toward the supplementary protection referred to in paragraph (1), (B) a payment to or on behalf of such employee or annuitant to offset the cost to him of his coverage under this subchapter or (C) a combination of such contribution and such payment.

(d) (1) No payment may be made under this subchapter with respect to any item or services furnished to an individual by a person.where the Secretary determines under this subsection that such person

(A) has knowingly and willfully made, or caused to be made, any false statement or representation of a material fact for use in an application for payment under this subchapter or for use in determining the right to a payment under this subchapter;

(B) has submitted or caused to be submitted (except in the case of a provider of services), bills

or requests for payment under this subchapter containing charges (or in applicable cases requests for payment of costs to such person) for services rendered which the Secretary finds, with the concurrence of the appropriate program review team appointed pursuant to paragraph (4), to be substantially in excess of such person's customary charges (or in applicable cases substantially in excess of such person's costs) for such services, unless the Secretary finds there is good cause for such bills or requests containing such charges (or in applicable cases, such costs); or

(C) has furnished services or supplies which are determined by the Secretary, with the concurrence of the members of the appropriate program review team appointed pursuant to paragraph (4) who are physicians or other professional personnel in the health care field, to be substantially in excess of the needs of individuals or to be harmful to individuals or to be of a grossly inferior quality.

(2) A determination made by the Secretary under this subsection shall be effective at such time and upon such reasonable notice to the public and to the person furnishing the services involved as may be specified in regulations. Such determination shall be effective with respect to services furnished to an individual on or after the effective date of such determination (except that in the case of inpatient hospital services, posthospital extended care services, and home health services such determination shall be effective in the manner provided in section 1395cc (b) (3) and (4) of this title with respect to terminations of agreements), and shall remain in effect until the Secretary finds and gives reasonable notice to the public that the basis for such determination has been removed and that there is reasonable assurance that it will not recur.

(3) Any person furnishing services described in paragraph (1) who is dissatisfied with a determination made by the Secretary under this subsection shall be entitled to reasonable notice and opportunity for a hearing thereon by the Secretary to the same extent as is provided in section 405 (b) of this title, and to judicial review of the Secretary's final decision after such hearing as is provided in section 405 (g) of this title.

(4) For the purposes of paragraph (1) (B) and (C) of this subsection, and clause (F) of section 1395cc (b) (2) of this title, the Secretary shall, after consultation with appropriate State and local professional societies, the appropriate carriers and intermediaries utilized in the administration of this subchapter, and consumer representatives familiar with the health needs of residents of the State, appoint one or more program review teams (composed of physicians, other professional personnel in the health care field, and consumer representatives) in each State which shall, among other things—

(A) undertake to review such statistical data on program utilization as may be submitted by the Secretary,

(B) submit to the Secretary periodically, as may be prescribed in regulations, a report on the results of such review, together with recommendations with respect thereto,

(C) undertake to review particular cases where there is a likelihood that the person or persons furnishing services and supplies to individuals may come within the provisions of paragraph (1) (B) and (C) of this subsection or clause (F) of section 1395cc (b) (2) of this title, and

(D) submit to the Secretary periodically, as may be prescribed in regulations, a report of cases reviewed pursuant to subparagraph (C) along with an analysis of, and recommendations with respect to, such cases.

(As amended Oct. 30, 1972, Pub. L. 92-603, title II, §§ 210, 211 (c) (1), 229(a), 256 (c), 86 Stat. 1382, 1384, 1408, 1447; Dec. 31, 1973, Pub. L. 93-233, § 18(k) (3), 87 Stat. 970.)

AMENDMENTS

1973-Subsec. (a) (12). Pub. L. 93-233 substituted "the provision of such dental services if the individual, because of his underlying medical condition and clinical status, requires hospitalization in connection with the provision of such services" for "a dental procedure where the individual suffers from impairments of such severity as to require hospitalization".

1972 Subsec. (a) (4). Pub. L. 92-603, § 211(c) (1), inserted reference to physicians' services and ambulance services furnished an individual in conjunction with emergency inpatient hospital services.

Subsec. (a) (12). Pub. L. 92-603, § 256(c), authorized payment under part A in the case of inpatient hospital services in connection with a dental procedure where the individual suffers from impairments of such severity as to require hospitalization.

Subsec. (c). Pub. L. 92-603, § 210, added subsec. (c). Subsec. (d). Pub. L. 92-603, § 229(a), added subsec. (d). EFFECTIVE DATE OF 1973 AMENDMENT

Amendment by Pub. L. 93-233 effective with respect to admissions subject to the provisions of section 1395(a) (2) of this title which occur after Dec. 31, 1973, see section 18(z-3) (2) of Pub. L. 93-233, set out as a note under section 1395f of this title.

EFFECTIVE DATE OF 1972 AMENDMENT Amendment of subsec. (a) (4) of this section by section 211(c)(1) of Pub. L. 92-603 applicable to services furnished with respect to admissions occurring after Dec. 31, 1972, see section 211(d) of Pub. L. 92-603, set out as a note under section 1395f of this title.

Amendment of subsec. (a) (12) of this section by section 256(c) of Pub. L. 92-603 applicable with respect to admissions occurring after the second month following the month of enactment of Pub. L. 92-603 which was approved on Oct. 30, 1972, see section 256(d) of Pub. L. 92-603, set out as a note under section 1395f of this title. SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 706, 1320c-6, 13951-2, 13951, 1395u, 1395x, 1395cc, 1395gg, 1395mm, 139500, 1395pp, 1396b of this title.

§ 1395z. Consultation with State agencies and other organizations to develop conditions of participation for providers of services.

In carrying out his functions, relating to determination of conditions of participation by providers of services, under subsections (e) (9), (f) (4), (g) (4), (j) (11), and (o) (6) of section 1395x of this title, the Secretary shall consult with the Health Insurance Benefits Advisory Council established by section 1395dd of this title, appropriate State agencies, and recognized national listing or accrediting bodies, and may consult with appropriate local agencies. Such conditions prescribed under any of such subsections may be varied for different areas or different classes of institutions or agencies and may, at the request of a State, provide higher requirements for

such State than for other States; except that, in the case of any State or political subdivision of a State which imposes higher requirements on institutions as a condition to the purchase of services (or of certain specified services) in such institutions under a State plan approved under subchapter I, XVI, or XIX of this chapter, the Secretary shall impose like requirements as a condition to the payment for services (or for the services specified by the State or subdivision) in such institutions in such State or subdivision. (As amended Oct. 30, 1972, Pub. L. 92-603, title II, § 234(g) (2), 86 Stat. 1413.)

AMENDMENTS

1972-Pub. L. 92-603 substituted "subsections (e) (9), (f) (4), (g) (4), (j) (11), and (o) (6) of section 1395x of this title" for "subsections (e) (8), (f) (4), (g) (4), (j) (10), and (o) (5) of section 1395x of this title".

EFFECTIVE DATE OF 1972 AMENDMENT

Amendment by Pub. L. 92-603 applicable with respect to providers of services for fiscal years beginning after the fifth month following October 1972, see section 234 (1) of Pub. L. 92-603, set out as a note under section 1395x of this title.

§ 1395aa. Use of State agencies to determine compliance by providers of services with conditions of participation.

(a) The Secretary shall make an agreement with any State which is able and willing to do so under which the services of the State health agency or other appropriate State agency (or the appropriate local agencies) will be utilized by him for the purpose of determining whether an institution therein is a hospital or skilled nursing facility, or whether an agency therein is a home health agency, or whether a laboratory meets the requirements of paragraphs (10) and (11) of section 1395x(s) of this title, or whether a clinic, rehabilitation agency, or public health agency meets the requirements of subparagraph (A) or (B), as the case may be, of section 1395x(p) (4) of this title. To the extent that the Secretary finds it appropriate, an institution or agency which such a State (or local) agency certifies is a hospital, skilled nursing facility, or home health agency (as those terms are defined in section 1395x of this title) may be treated as such by the Secretary. Any State agency which has such an agreement may (subject to approval of the Secretary) furnish to a skilled nursing facility, after proper request by such facility, such specialized consultative services (which such agency is able and willing to furnish in a manner satisfactory to the Secretary) as such facility may need to meet one or more of the conditions specified in section 1395x(j) of this title. Any such services furnished by a State agency shall be deemed to have been furnished pursuant to such agreement. Within 90 days following the completion of each survey of any health care facility, laboratory, clinic, agency, or organization by the appropriate State or local agency described in the first sentence of this subsection, the Secretary shall make public in readily available form and place the pertinent findings of each such survey relating to the c pliance of each such health care facility, labora clinic, agency, or organization with (1) the s tory conditions of participation imposed under subchapter and (2) the major addition!

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