Page:United States Statutes at Large Volume 81.djvu/890

 856 79 Stat. 313. 42 USC 1395X.

42 USC 1395CC. 42 USC 1395c1395i.

42 USC 1395f.

" R o u t i n e serv-

PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

1861 of such Act, but without regard to subsection (e) of such section) furnished by, or under arrangements (as defined in section 1861 (w) of such Act) with, a hospital if— (1) the hospital did not have an agreement in effect under section 1866 of such Act but would have been eligible for payment under part A of title X VIII of such Act with respect to such services if at the time such services were furnished the hospital had such an agreement in effect; (2) the hospital (A) meets the requirements of paragraphs (5) and (7) of section 1861(e) of such Act, (B) is not primarily engaged in providing the services described in section 1861(j) (1)(A) of such Act, and (C) is primarily engaged in providing, by or under the supervision of individuals referred to in paragraph (1) of section 1861(r) of such Act, to inpatients (i) diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or (ii) rehabilitation services for the rehabilitation of injured, disabled, or sick persons; (3) the hospital did not meet the requirements that must be met to permit payment to the hospital under part A of title X VIII of such Act; and (4) an application is filed (submitted in such form and manner and by such person, and containing and supported by such information, as the Secretary shall by regulations prescribe) for reimbursement before January 1, 1969. (b) Payments under this section may not be made for inpatient hospital services (as described in subsection (a)) furnished to an individual— (1) prior to July 1, 1966, (2) after December 31, 1967, unless furnished with respect to an admission to the hospital prior to January 1, 1968, and (3) for more than— (A) 90 days in any spell of illness, but only if (i) prior to January 1, 1969, the hospital furnishing such services entered into an agreement under section 1866 of the Social Security Act and (ii) the hospital's plan for utilization review, as provided for in section 1861(k) of such Act, has, in accordance with section 1814 of such Act, been applied to the services furnished such individual, or (B) 20 days in any spell of illness, if the hospital did not meet the conditions of clauses (i) and (ii) of subparagraph (A). . . . (c)(1) The amounts payable in accordance with subsection (a) with respect to inpatient hospital services shall, subject to paragraph (2) of this subsection, be paid from the Federal Hospital Insurance Trust Fund in amounts equal to 60 percent of the hospital's reasonable charges for routine services furnished in the accommodations occupied by the individual or in semi-private accommodations (as defined in section 1861(v)(4) of the Social Security Act) whichever is less, plus 80 percent of the hospital's reasonable charges for ancillary services. If separate charges for routine and ancillary services are not made by the hospital, reimbursement may be based on two-thirds of the hospital's reasonable charges for the services received but not to exceed the charges which would have been made if the patient had occupied semi-private accommodations (as so defined). For purposes of the preceding provisions of this paragraph, the term "routine services" shall mean the regular room, dietary, and nursing services, minor medical

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