Page:United States Statutes at Large Volume 100 Part 3.djvu/207

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 2015

services has an employment or contractual relationship that provides for payment to be made under this part for such services to such hospital, physician, or group practice. "(B)(i) Payment for the services of a certified registered nurse anesthetist under this part may be made only on an assignmentrelated basis, and any such assignment agreed to by a certified registered nurse anesthetist shall be binding upon any other person presenting a claim or request for payment for such services. "(ii) Except for deductible and coinsurance amounts applicable under this section, any person who knowingly and willfully presents, or causes to be presented, to an individual enrolled under this part a bill or request for payment for services of a certified registered nurse anesthetist for which payment may be made under this part only on an assignment-related basis is subject to a civil monetary penalty of not to exceed $2,000 for each such bill or request. Such a penalty shall be imposed in the same manner as civil monetary penalties are imposed under section 1128A with respect to actions described in subsection (a) of that section. "(C) No hospital that presents a claim or request for payment for services of a certified nurse anesthetist under this part may treat any uncollected coinsurance amount imposed under this part with respect to such services as a bad debt of such hospital for purposes of this title. "(6)(A) If an adjustment under paragraph (3)(B) results in a reduction in the reasonable charge for a physicians' service and a nonparticipating physician furnishes the service to an individual entitled to benefits under this part (subject to subparagraph (D)), the physician may not charge the individual more than the limiting charge (as defined in subparagraph (B)) plus (for services furnished during the 12-month period beginning on the effective date of the reduction) Vi of the amount by which the physician's actual charges for the service for the previous 12-month period exceeds the limiting charge. "(B) In subparagraph (A), the term 'limiting charge' means, with respect to a service, 125 percent of the prevailing charge for the service after the reduction referred to in subparagraph (A). "(C) If a physician knowingly and willfully imposes charges in violation of subparagraph (A), the Secretary may apply sanctions against such physician in accordance with subsection (j)(2). "(D) This paragraph shall not apply to services furnished after the earlier of (i) December 31, 1990, or (ii) one-year after the date the Secretary reports to Congress, under section 1845(e)(3), on the development of the relative value scale under section 1845.". (3) Section 1842(j)(2) of such Act (42 U.S.C. 1395uO*X2)) is amended by striking "paragraph (1) or subsection (k)" and inserting "this paragraph".

V.''. Ante, pp. 2003, 2008. Claims.

Health care professionals.

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Health care professionals. Sanctions. Reports. Ante, p. 190.

(f) NOT TREATED AS PART OF INPATIENT HOSPITAL SERVICES.—

Section 1861(b)(4) of such Act (42 U.S.C. 1395x03X4)) is amended by inserting before the semicolon the following: ", anesthesia services provided by a certified certified registered nurse anesthetist". (g) CONFORMING AMENDMENTS TO HOSPITAL PAYMENTS.—(1) Section 1886(a)(4) of such Act (42 U.S.C. 1395ww(a)(4)) is amended by striking ", costs of anesthesia services provided by a certified registered nurse anesthetist,". (2) Section 1886(d)(5) of such Act (42 U.S.C. 1395ww(d)(5)) is amended by striking subparagraph (E).

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