Page:United States Statutes at Large Volume 104 Part 2.djvu/499

 PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-91 Social Security Act to) a hospital because of alleged overpayments to such hospital under such title due to a determination that costs which were reported by the hospital on its medicare cost reports for cost reporting periods beginning on or after October 1, 1983, and before October 1, 1990, relating to approved nursing and allied health education programs did not meet the requirements for allowable nursing and allied health education costs (as developed by the Secretary pursuant to section 1861(v) of such Act). (B) REFUND OF AMOUNTS RECOUPED. —I f, prior to the date of the enactment of this Act, the Secretary has recouped payments from (or otherwise reduced or adjusted payments under part B of title XVIII of the Social Security Act to) a hospital because of overpayments described in subparagraph (A), the Secretary shall refund the amount recouped, reduced, or adjusted from the hospital. (4) SPECIAL AUDIT TO DETERMINE COSTS.— In determining the amount of costs incurred by, claimed by, and reimbursed to, a hospital for purposes of this subsection, the Secretary shall conduct a special audit (or use such other appropriate mechanism) to ensure the accuracy of such past claims and payments. (5) EFFECTIVE DATE. —Except as provided in paragraph (3), the provisions of this subsection shall apply to cost reporting periods beginning on or after October 1, 1990. SEC. 4160. CERTIFIED REGISTERED NURSE ANESTHETISTS. Section 1833(1) (42 U.S.C. 13951) is amended— (1) in paragraph (1)— (A) by inserting "(A)" after "(1)"; and (B) by adding at the end the following: "(B) In establishing the fee schedule under this paragraph the Secretary may utilize a system of time units, a system of base and time units, or any appropriate methodology. "(C) The provisions of this subsection shall not apply to certain services furnished in certain hospitals in rural areas under the provisions of section 9320(k) of the Omnibus Budget Reconciliation Act of 1986, as amended by section 6132 of the Omnibus Budget Reconciliation Act of 1989."; (2) by striking the second sentence of paragraph (2); and (3) by striking paragraph (4) and inserting the following: "(4)(A) Except as provided in subparagraphs (C) and (D), in determining the amount paid under the fee schedule under this subsection for services furnished on or after January 1, 1991, by a certified registered nurse anesthetist who is not medically directed— "(i) the conversion factor shall be— "(I) for services furnished in 1991, $15.50, "(II) for services furnished in 1992, $15.75, "(III) for services furnished in 1993, $16.00, "(IV) for services furnished in 1994, $16.25, "(V) for services furnished in 1995, $16.50, "(VI) for services furnished in 1996, $16.75, and "(VII) for services furnished in calendar years after 1996, the previous year's conversion factor increased by the update determined under section 1848(d)(3) for physician anesthesia services for that year; "(ii) the payment areas to be used shall be the fee schedule areas used under section 1848 (or, in the case of services fur-

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