Page:United States Statutes at Large Volume 103 Part 3.djvu/203

 PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2271 (2) CLARIFICATION WITH RESPECT TO EMERGENCY TREATMENT. — Sections 1862(e)(l) and 1903(i)(2) of such Act (42 U.S.C. 1395y(e)(l), 1396b(i)(2)) are each amended by inserting ", not including items or services furnished in an emergency room of a hospital' after "emergency item or service". (3) CLARIFICATION OF EXCLUSION WITH RESPECT TO EMPLOYMENT BY HEALTH MAINTENANCE ORGANIZATIONS.— (A) Section 1876(i)(6)(A) of the Social Security Act (42 U.S.C. 1395mm(i)(6)(A)) is amended— (i) by striking "or" at the end of clause (v), (ii) by adding "or" at the end of clause (vi), and (iii) by inserting after clause (vi) the following new clause: "(vii) in the case of a risk-sharing contract, emplo3rs or con- tracts with any individual or entity that is excluded from participation under this title under section 1128 or 1128A for the provision of health care, utilization review, medical social work, or administrative services or employs or contracts with any entity for the provision (directly or indirectly) through such an excluded individual or entity of such services;'. (B) Section 1902(p)(2) of such Act (42 U.S.C. 1396a(p)(2)) is amended— v (i) by striking "or" at the end of subparagraph (A), (ii) by striking the period at the end of subparagraph (B) and inserting ", or", and (iii) by adding at the end the following new subparagraph: "(O employs or contracts with any individual or entity that is excluded from participation under this title under section 1128 or 1128A for the provision of health care, utilization review, medical social work, or administrative services or employs or contracts with any entity for the provision (directly or in- directly) through such an excluded individual or entity of such services.". (4) EFFECTIVE DATES. —The amendments made by paragraphs (1) and (2) shall take efTect on the date of the enactment of this Act. (B) The amendments made by paragraph (3) shall apply to employment and contracts as of 90 days after the date of the enactment of this Act. (e) SPOUSAL IMPOVERISHMENT.— (1) EQUAL TREATMENT OF TRANSFERS BY COMMUNITY SPOUSE BEFORE INSTITUTIONALIZATION.— Section 1917(c) of the Social Security Act (42 U.S.C. 1396p(c)) is amended— (A) in paragraph (1), by inserting "or whose spouse," after "an institutionalized individual (as defined in paragraph (3)) who,", and (B) in paragraph (2)(B)— (i) by amending clause (i) to read as follows: "(i) to or from (or to another for the sole benefit of) the individ- ual's spouse, or", and (ii) by striking ", or (iii)" and all that follows through "fair market vsdue". (2) CJLARIFYING APPLICATION TO "SECTION 209(B)" STATES.— Section 1902(f) of such Act (42 U.S.C. 1396a(f)) is amended by inserting "and section 1924" after "1619(b)(3)". (3) CLARIFICATION OF APPLICATION OF INCOME RULES TO REDETERMINATIONS.— Subsections (b)(2) and (d)(1) of section 1924 42 USC 1320a-7 note. 42 USC 1395mm note.

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