Page:United States Statutes at Large Volume 100 Part 3.djvu/189

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 1997

but only if the hospital was being paid for inpatient hospital services on such a periodic interim payment basis as of June 30, 1987, and continues to meet the requirements (in effect as of October 1, 1986) applicable to payment on such a basis. "(2) The Secretary shall provide (or continue to provide) for payment on a periodic interim payment basis (under the standards established under section 405.454(j) of title 42, Code of Federal Regulations, as in effect on October 1, 1986) with respect to— "(A) inpatient hospital services of a hospital that is not a subsection (d) hospital (as defined in section 1886(d)(1)(B)); "(B) a hospital which is receiving payment under a State hospital reimbursement system under section 1814(b)(3) or 1886(c), if payment on a periodic interim payment basis is an integral part of such reimbursement system; "(C) extended care services; "(D) home health services; and "(E) hospice care; if the provider of such services elects to receive, and qualifies for, such payments. "(3) In the case of a subsection (d) hospital or a subsection (d) Puerto Rico hospital (as defined for purposes of section 1886) which has significant cash flow problems resulting from operations of its intermediary or from unusual circumstances of the hospital's operation, the Secretary may make available appropriate accelerated payments.". (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to claims received on or after July 1, 1987. (3) TRANSITION.—Upon the request of a hospital which— J (A) as of June 30, 1987, is receiving payments under part A of title XVIII of such Act for inpatient hospital services I: on a periodic interim payment basis, (B) requests continuation of payment on such basis, and (C) is paid through an agency or organization with an agreement under section 1816 of such Act, the Secretary of Health and Human Services shall continue I payment on such a basis until not earlier than the end of the first period of three consecutive calendar months (beginning no earlier than April 1987) during all of which the agency or organization has met the requirements of section 1816(c)(2) of such Act (relating to prompt payment of claims). (b) PROMPT PAYMENT OF CLAIMS UNDER PART A.—Section 1816(c) of the Social Security Act (42 U.S.C. 1395h(c)) is amended— (1) by inserting "(1)" after "(c)", and (2) by adding at the end the following new paragraph: "(2)(A) Each agreement under this section shall provide that payment shall be issued, mailed, or otherwise transmitted with respect to not less than 95 percent of all claims submitted under this title— - . "(i) which are clean claims, and "(ii) for which payment is not made on a periodic interim payment basis, within the applicable number of calendar days after the date on which the claim is received. "(B) In this paragraph: J. "(i) The term 'clean claim' means a claim that has no defect or impropriety (including any lack of any required substantiat^ ing documentation) or particular circumstance requiring special

42 USC 1395WW. State and local governments. 42 USC 1395f.

Puerto Rico.

Claims. 42 USC 1395g note. 42 USC 1395g note. 42 USC 1395c. Claims. 42 USC 1395h.

Claims.

�