Page:United States Statutes at Large Volume 100 Part 3.djvu/227

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 2035

(b) DETERMINATION OF PAYMENT AMOUNT.—Section 1842(b) of such Act (42 U.S.C. 1395u(b)), as amended by section 9333(b), is amended by adding at the end the following new paragraph: "(12)(A) With respect to services described in section 1861(s)(2)(K) (relating to a physician assistant acting under the supervision of a physician)— "(i) payment under this part may only be made on an assigne ment-related basis; and d (ii) the prevailing charges determined under paragraph (3) shall not exceed— r ( ^.. "(I) in the case of services performed as an assistant at surgery, 65 percent of the amount that would otherwise be recognized if performed by a physician who is serving as an if, i'- assistant at surgery, or !^i:: "(II) in other cases, the applicable percentage (as defined I ->a. in subparagraph (B)) of the prevailing charge rate determined for such services performed by physicians who are not specialists. "(B) In subparagraph (A)(ii)(II), the term 'applicable percentage' means— "(i) 75 percent in the case of services performed (other than as an assistant at surgery) in a hospital, and "(ii) 85 percent in the case of other services. "(C) Except for deductible and coinsurance amounts applicable under section 1833, 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 described in section 1861(s)(2)(K) in violation of subparagraph (A)(i) 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) PAYMENT TO EMPLOYER.—The first sentence of section 1842(b)(6) of such Act (42 U.S.C. 1395u(b)(6)) is amended— (1) by striking "except that payment may be made (A)(i)" and inserting "except that (A) payment may be made (i)"; i'(2) by striking "or (B)" and by inserting "(B) payment may be » made"; and (3) by inserting before the period at the end the following: ", a and (C) in the case of services described in section 1861(s)(2)(K) H payment shall be made to the employer of the physician assistant involved". (d) REDUCTION IN PAYMENT TO AVOID DUPLICATE PAYMENT.—Not-

42 USC 1395x.

Ante, p. 2014.

Ante, pp. 2003, 2008.

\ct-gl DBl) 'It

Health care facilities. 42 USC 1395x note.

withstanding any other provision of law, the Secretary of Health and Human Services may reduce the amount of payments otherwise made to hospitals and skilled nursing facilities under title XVIII of the Social Security Act, so as to eliminate estimated duplicate 42 USC 1395. payments for historical or current costs attributable to services described in section 1861(s)(2)(K) of such Act (for which payment may be made under the amendments made by this section). (e) STUDY OF PAYMENT RATES.—The Secretary shall report to Reports. Congress, by not later than April 1, 1988, concerning adjustments to 42 USC 1395x the amount of payment made, under part B of title XVIII of the note. Social Security Act, for services described in section 1861(s)(2)(K) of 42 USC 1395J. such Act, to ensure that the amount of such payments reflects the approximate cost of furnishing the services, taking into account

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