Page:United States Statutes at Large Volume 86.djvu/1438

 1396

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

LIMITS ON PAYMENT FOR SKILLED NURSING HOME x\ND INTERMEDIATE CARE FACILITY SERVICES

SEC. 225. Section 1903 of the Social Security Act is amended by adding at the end thereof (after the new subsection added by section 224 Ante. p. 1395. (c) of this Act) the following new subsection: " (j) Notwithstanding the preceding provisions of this section— "(1) in determining the amount payable to any State with respect to expenditures for skilled nursing home services furnished in any calendar quarter beginning after December 31, 1972, there shall not be included as expenditures under the State plan any amount in excess of the product of (A) the number of inpatient days of skilled nursing home services provided under the State plan in such quarter, and (B) 105 per centum of the average per diem cost of such services for the fourth calendar quarter preceding such calendar quarter; and "(2) in determining the amount payable to any State with respect to expenditures for intermediate care facility services furnished in any calendar quarter beginning after December 31, 1972, there shall not be included as expenditures under the State plan any amount in excess of the product of (A) the number of inpatient days of intermediate care facility services provided in such quarter under each of the plans of such State approved under 120^1 ^^^s^lssi 13961 ' ' average per diem cost of such services for the fourth calendar quarter preceding such calendar quarter. For purposes of determining the amount payable to any State with respect to any quarter under paragraphs (1) and (2), the Secretary may by regulation increase the percentage specified in clause (B) of each such paragraph to the extent necessary to take account of increases in per diem costs which result directly from increases in the Federal minimum wage, or which otherwise result directly from cost increases which the Secretary determines are attributable to the upgrading of services and facilities required by this Act or from provisions of Federal law enacted (or amendments to Federal law made) after the date of the enactment of the Social Security Amendments of 1972." PAYMENTS TO HEALTH MAINTENANCE ORGANIZATIONS
 * ^^^^ -'•' -^' ^^7' ^^^' ^^^ ^^^' ^".^ (-"^^ '^^^ P^^ centum of the

42 USC 1395.

S E C 226. (a) Title X VIII of the Social Security Act is amended by adding at the end thereof the following new section: " P A Y M E N T S TO HEALTH MAINTENANCE ORGANIZATIONS

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"SEC. 1876. (a)(1) I n lieu of amounts which would otherwise be Payable pursuant to sections 1814(b) and 1833(a), the Secretary is authorized to determine, by actuarial methods, as provided in this section, but only with respect to a health maintenance organization with which he has entered into a contract under subsection (i), a per capita rate of payment— " (A) for services provided under parts A and B for individuals enrolled with such organization pursuant to subsection (e) who are entitled to hospital insurance benefits under part A and enrolled for medical insurance benefits under part B, and " (B) for services provided under part B for individuals enrolled with such organization pursuant to subsection (e) who are not entitled to benefits under part A but who are enrolled for benefits under part B.

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