Page:United States Statutes at Large Volume 100 Part 1.djvu/214

 100 STAT. 178

42 USC 1395.

42 USC 1395y note.

42 USC 1395y.

42 USC 1395h.

PUBLIC LAW 99-272—APR. 7, 1986

(b) COOPERATION IN STUDY.—The Secretary of Health and Human Services and the Comptroller General shall assist representatives of clinical laboratories in the industry's conduct of a study to determine whether methods exist which are better than competitive bidding for purposes of utilizing competitive market forces in setting payment levels for laboratory services under title XVIII of the Social Security Act. If such a study is conducted by the clinical laboratory industry, the Secretary and the Comptroller General shall comment on such study and submit such comments and the study to the Senate Committee on Finance and the House Committees on Ways and Means and Energy and Commerce. SEC. 9205. HOME HEALTH WAIVER OF LIABILITY.

The Secretary of Health and Human Services shall, for purposes of determining whether payments to a home health agency should be denied pursuant to section 1862(a)(1)(A) of the Social Security Act, apply a presumption of compliance (2.5 percent) in the same manner as under the regulations in effect as of July 1, 1985. Such presumption shall apply until 12 months after the date on which ten regional intermediaries have commenced operations to service home health agencies, as required under section 1816(e)(4) of the Social Security Act.

Subpart B—Other Provisions SEC. 9211. PROVISIONS RELATING TO HEALTH MAINTENANCE ORGANIZATIONS AND COMPETITIVE MEDICAL PLANS. (a) FINANCIAL RESPONSIBILITY FOR PATIENTS HOSPITALIZED ON THE EFFECTIVE DATE OF AN ENROLLMENT OR DISENROLLMENT.—(1) SubsecContracts. 42 USC 1395WW.

.aft:

tion (c) of section 1876 of the Social Security Act (42 U.S.C. 1395mm) is amended by adding at the end the following new paragraph: "(7) A risk-sharing contract under this section shall provide that in the case of an individual who is receiving inpatient hospital services from a subsection (d) hospital (as defined in section 1886(d)(1)(B)) as of the effective date of the individual's— "(A) enrollment with an eligible organization under this section— "(i) payment for such services until the date of the individual's discharge shall be made under this title as if the individual were not enrolled with the organization, "(ii) the organization shall not be financially responsible for payment for such services until the date after the date of the individual's discharge, and "(iii) the organization shall nonetheless be paid the full amount otherwise payable to the organization under this section; or "(B) termination of enrollment with an eligible organization under this section— "(i) the organization shall be financially responsible for payment for such services after such date and until the date of the individual's discharge, "(ii) payment for such services during the stay shall not be made under section 1886(d), and "(iii) the organization shall not receive any payment with respect to the individual under this section during the period the individual is not enrolled.".

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