Page:United States Statutes at Large Volume 103 Part 3.djvu/182

 103 STAT. 2250 PUBLIC LAW 101-239—DEC. 19, 1989 42 USC 1395mm note. 42 USC 1395mm note. 42 USC 1395mm note. (b) LIMIT ON CHARGES POR EMERGENCY SERVICES AND OUT-OF-AREA COVERAGE.— (1) IN GENERAL.— Section 1876 of the Social Security Act (42 •* U.S.C. 1395mm) is emiended by adding at the end the following new subsection: "(JXIXA) In the case of physicians' services described in paragraph (2) which are furnished by a participating physician to an individual enrolled with an eligible organization under this section and en- rolled under part B, the participation agreement under section 1842(h)(l) is deemed to provide that the physician will accept as payment in full from the eligible organization the amount that would be payable to the physician under part B and from the individual under such part, if the individual were not enrolled with an eligible organization under this section. "(B) In the case of physicians' services described in paragraph (2) which are furnished by a nonparticipating physician, the limitations on actual charges for such services otherwise applicable under part B (to services furnished by individuals not enrolled with an eligible organization under this section) shall apply in the same manner as such limitations apply to services furnished to individuals not en- rolled with such an organization. "(2) The physicians' services described in this paragraph are physicians' services which— "(A) are emergency services or out-of-area coverage (described in clauses (iii) and (iv) of subsection (b)(2)(A)), and "(B) are furnished to an enrollee of an eligible organization under this section by a person who is not under a contract with the organization.". (2) EFFECTIVE DATE. —The amendment made by paragraph (1) shall apply to services furnished on or after April 1, 1990. (c) MAKING AUTHORITY FOR BENEFIT STABILIZATION FUND PERMA- NENT.— (1) REPEAL ON LIMITATION ON ESTABLISHMENT OF A FUND.— Section 2350(b) of the Deficit Reduction Act of 1984 (Public Law 98-369) is amended by striking paragraphs (3) and (4). (2) REPEAL ON LIMITING PERIOD OF USE.—Section 1876(g)(5) of the Social Security Act (42 U.S.C. 1395mm(g)(5)) is amended by striking "and during a period of not longer than four years'. (3) EFFECTIVE DATE. —"The amendments made by this subsec- tion shall take effect on the date of the enactment of this Act. SEC. 6213. RURAL HEALTH CLINIC SERVICES. (a) STAFFING REQUIREMENTS; INCLUSION OF NURSE-MIDWIFE SERV- ICES. —Section 1861(aaX2) of the Social Security Act (42 U.S.C. 1395x(aaX2)) is amended— (1) by striking "; and" at the end of subparagraph (I) and inserting a semicolon; (2) by redesignating subparagraph (J) as subparagraph (K); and (3) by inserting after subparagraph (I) the following new "(J) has a nurse practitioner, a physician assistant, or a certified nurse-midwife (as defined in subsection (gg)) available to furnish patient care services not less than 50 percent of the time the clinic operates; and". (b) COVERAGE OF SOCIAL WORKER SERVICES. —Section 1861(aaXl)(B) of such Act (42 U.S.C. 1395x(aaXlXB)) is amended—
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