Page:United States Statutes at Large Volume 86.djvu/1422

 1380

85*stat^809°^' 42 USC 1396a.

42 USC i395d.

Costdifferen-

tial

"eost.»» 42 USC 1396b. Effective date.

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

frequency as may be prescribed in regulations of the Secretary) by medical and other professional personnel who are not themselves directly responsible for the care of the patient and who are not employed by or financially interested in any such institution; and " (D) such State has an effective program of medical review of the care of patients in mental hospitals, skilled nursing homes, and intermediate care facilities pursuant to section 1902(a) (26) and ^^^^ whcreby the professional management of each case is revicwed aud evaluated at least annually by independent professional review teams. In determining the number of days on which an individual has received services described in this subsection, there shall not be counted any days with respect to which such individual is entitled to have payments made (in whole or in pail) on his behalf under section 1812, "(2) The Secretary shall, as part of his validation procedures under this subsection, conduct sample onsite surveys of private and public institutions in which recipients of medical assistance may receive care and services under a State plan approved under this title, and his findings with respect to such surveys (RS well as the showings of the State agency required under this subsection) shall be made available for public inspection. " (h)(1) If the Secretary determines for any calendar quarter beginning after June 30, 1973, with respect to any State that there does not exist a reasonable cost differential between the statewide average cost of skilled nursing home services and the statewide average cost of intermediate care facility services in such State, the Secretary may reduce the amount which would otherwise be considered as expenditures under the State plan by any amount which in his judgment is a reasonable equivalent of the difference between the amount of the expenditures by such State for intermediate care facility services and the amount that would have been expended by such State for such services if there had been a reasonable cost differential between the cost of skilled nursing home services and the cost of intermediate care facility services. "(2) In determining whether any such cost differential in any State is reasonable the Secretary shall take into consideration the range of such cost differentials in all States. "(3) For the purposes of this subsection, the term 'cost differential' for any State for any quarter means, as determined by the Secretary on the basis of the data for the most recent calendar quarter for which satisfactory data are available, the excess of— " (A) the average amount paid in such State (regardless of the source of payment) per inpatient day for skilled nursing home services, over " (B) the average amount paid in such State (regardless of the source of payment) per inpatient day for intermediate care facility services. "(4) For purposes of this subsection, the term 'cost' shall mean amounts reimbursable by the State under a State plan approved under this title." (2) Section 1903(a)(1) of such Act is amended by inserting ", subject to subsections (g) and (h) of this section" after "section 1905(b)". ^j^^ rpj^g amendments made by subsection (a) shall, except as otherwise provided therein, be effective July 1, 1973.

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