Page:United States Statutes at Large Volume 111 Part 1.djvu/479

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 455 "(B) outpatient physical therapy services (which includes outpatient speech-language pathology services) and outpatient occupational therapy services furnished— "(i) by a hospital to an outpatient or to a hospital inpatient who is entitled to benefits under part A but has exhausted benefits for inpatient hospital services during a spell of illness or is not so entitled to benefits under part A, or "(ii) by another entity under an arrangement with a hospital described in clause (i), the amounts described in section 1834(k); and "(9) in the case of services described in section 1832(a)(2)(E) that are not described in paragraph (8), the amounts described in section 1834(k). ". (2) PAYMENT RATES. —Section 1834 (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: "(k) PAYMENT FOR OUTPATIENT THERAPY SERVICES AND COM- PREHENSIVE OUTPATIENT REHABILITATION SERVICES.— "(1) IN GENERAL.—With respect to services described in section 1833(a)(8) or 1833(a)(9) for which payment is determined under this subsection, the payment basis shall be— "(A) for services furnished during 1998, the amount determined under paragraph (2); or "(B) for services furnished during a subsequent year, 80 percent of the lesser of— "(i) the actual charge for the services, or "(ii) the applicable fee schedule amount (as defined in paragraph (3)) for the services. "(2) PAYMENT IN 1998 BASED UPON ADJUSTED REASONABLE COSTS.—The amount under this paragraph for services is the lesser of— "(A) the charges imposed for the services, or "(B) the adjusted reasonable costs (as defined in paragraph (4)) for the services, less 20 percent of the amount of the charges imposed for such services. "(3) APPLICABLE FEE SCHEDULE AMOUNT.—In this subsection, the term 'applicable fee schedule amount' means, with respect to services furnished in a year, the amount determined under the fee schedule established under section 1848 for such services furnished during the year or, if there is no such fee schedule established for such services, the amount determined under the fee schedule established for such comparable services as the Secretary specifies. "(4) ADJUSTED REASONABLE COSTS.— In paragraph (2), the term 'adjusted reasonable costs' means, with respect to any services, reasonable costs determined for such services, reduced by 10 percent. The 10-percent reduction shall not apply to services described in section 1833(a)(8)(B) (relating to services provided by hospitals). "(5) UNIFORM CODING.— For claims for services submitted on or after April 1, 1998, for which the amount of payment is determined under this subsection, the claim shall include a code (or codes) under a uniform coding system specified by the Secretary that identifies the services furnished. "(6) RESTRAINT ON BILLING.— The provisions of subpara- Applicability, graphs (A) and (B) of section 1842(b)(18) shall apply to therapy

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