Page:United States Statutes at Large Volume 104 Part 2.djvu/503

 PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-95 (8) EFFECTIVE DATE. —(A) Subject to subparagraphs (B) and (C), the amendments made by this section shall apply to services furnished on or after October 1, 1991. (B) In the case of a Federally qualified health care center that has elected, as of January 1, 1990, under part B of title XVIII of the Social Security Act, to have the amount of payments for services under such part determined on a reasonable-charge basis, the amendment made by paragraph (3)(A) shall only apply on and after such date (not earlier than October 1, 1991) as the center may elect. (C) The amendment made by paragraph (6) shall apply to cost reports for periods beginning on or after October 1, 1991. (b) RURAL HEALTH CLINIC SERVICES.— (1) EXPEDITED CERTIFICATION. —Section 1861(aa)(2) of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended by adding at the end the following: "If a State agency has determined under section 1864(a) that a facility is a rural health clinic and the facility has applied to the Secretary for certification as such a clinic, the Secretary shall notify the facility of the the Secretary's approval or disapproval of the certification not later than 60 days after the date of the State agency determination or the application (whichever is later).". (2) TEMPORARY WAIVER OF STAFFING REQUIREMENTS. —Section 1861(aa) of such Act, as amended by subsection (a), is further amended by adding at the end the following new paragraph: "(7)(A) The Secretary shall waive for a 1-year period the requirements of paragraph (2) that a rural health clinic employ a physician assistant, nurse practitioner or certified nurse midwife or that such clinic require such providers to furnish services at least 50 percent of the time that the clinic operates for any facility that requests such waiver if the facility demonstrates that the facility has been unable, despite reasonable efforts, to hire a physician assistant, nurse practitioner, or certified nurse-midwife in the previous 90-day period. "(B) The Secretary may not grant such a waiver under subparagraph (A) to a facility if the request for the waiver is made less than 6 months after the date of the expiration of any previous such waiver for the facility. "(C) A waiver which is requested under this paragraph shall be deemed granted unless such request is denied by the Secretary within 60 days after the date such request is received.". (3) PRODUCTIVITY SCREENS. — In employing any screening guideline in determining the productivity of physicians, physician assistants, nurse practitioners, and certified nurse-midwives in a rural health clinic, the Secretary of Health and Human Services shall provide that the guideline shall take into account the combined services of such staff (and not merely the service within each class of practitioner). (4) PRRB REVIEW OF COST REPORTS FOR RURAL HEALTH CEN- TERS. —Section 18780') of the Social Security Act (42 U.S.C. 1395oo(j)), as added by subsection (a)(6), is amended by inserting "a rural health clinic and" after "includes". (5) EFFECTIVE DATE. — T his subsection shall take effect on October 1, 1991, except that the amendment made by paragraph (4) shall apply to cost reports for periods beginning on or after October 1, 1991. 42 USC 1395k note. 42 USC 1395x note. 42 USC 1395x note.

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