Page:United States Statutes at Large Volume 100 Part 3.djvu/205

 PUBLIC LAW 99-509—OCT. 21, 1986 •p

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100 STAT. 2013

(1) the number of disabled medicare beneficiaries for whom medicare has become secondary, either through their employment or the employment of a family member; (2) the amount of savings to the medicare program achieved annually through this provision; and (3) the effect on employment, and employment-based health coverage, of disabled individuals and family members.

(- (f) EFFECTIVE DATES.—

42 USC l395y

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(1) Except as provided in paragraph (2), the amendments made by this section shall apply to items and services furnished on or after January 1, 1987. (2) The amendments made by subsection (c) shall apply to enrollments occurring on or after January 1, 1987.

SEC. 9320. PAYMENT FOR SERVICES OF CERTIFIED REGISTERED NURSE ANESTHETISTS. (a) EXTENSION OF PASS-THROUGH FOR COSTS OF CERTIFIED REGIS-

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TERED NURSE ANESTHETISTS.—Section 2312(c) of the Deficit Reduction Act of 1984 is amended by striking "October 1, 1987." and inserting 42 USC I395ww "January 1, 1989. In the case of a cost reporting period that begins ^°^before January 1, 1989, but end after such date, additional pa3mients
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under the amendment made by subsection (a) shall be proportionately reduced to reflect the portion of the period occurring after such date.". (b) COVERAGE OF SERVICES OF A CERTIFIED REGISTERED NURSE

ANESTHETIST UNDER PART B.—Section 1861(s) of the Social Security

Act (42 U.S.C. 1395x(s)) is amended— (1) by redesignating paragraphs (11) through (14) as paragraphs (12) through (15), respectively; I (2) by striking "and" at the end of paragraph (9); (3) by striking the period at the end of paragraph (10) and inserting "; and"; and i (4) by inserting after paragraph (10) the following new paragraph: t "(11) services of a certified registered nurse anesthetist (as - defined in subsection (bb)).". (c) DEFINITION OF SERVICES OF A CERTIFIED REGISTERED NURSE

ANESTHETIST.—Section 1861 of such Act is amended by inserting after subsection (aa) the following new subsection: "SERVICES OF A CERTIFIED REGISTERED NURSE ANESTHETIST

"(bbXD The term 'services of a certified registered nurse anesthetist' means anesthesia services and related care furnished by a certified registered nurse anesthetist (as defined in paragraph (2)) which the nurse anesthetist is legally authorized to perform as such by the State in which the services are furnished. "(2) The term 'certified registered nurse anesthetist' means a certified registered nurse anesthetist licensed by the State who meets such education, training, and other requirements relating to anesthesia services and related care as the Secretary may prescribe. In prescribing such requirements the Secretary may use the same requirements as those established by a national organization for the certification of nurse anesthetists.". (d) DIRECT PAYMENT FOR SERVICES.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 1395k(a)(2)(B)) is amended— (1) by striking "and" at the end of clause (i),

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