Page:United States Statutes at Large Volume 86.djvu/1457

 86

STAT.]

PUBLIC LAW 92-^03-OCT. 30, 1972

described in subparagraph (B) (ii) of paragraph (3)) the physician or other person who provided the service, except that payment may be made (A) to the employer of such physician or other person if such physician or other person is required as a condition of his employment to turn over his fee for such service to his employer, or (B) (where the service was provided in a hospital, clinic, or other facility) to the facility in which the service was provided if there is a contractual arrangement between such physician or other person and such facility under which such facility submits the bill for such service." (b) Section 1902(a) of such Act is amended— (1) by striking out "and" at the end of paragraph (30); (2) by striking out the period at the end of paragraph (31) and inserting in lieu thereof "; and"; and (3) by inserting after paragraph (31) the following new paragraph: "(32) provide that no payment under the plan for any care or service provided to an individual by a physician, dentist, or other individual practitioner shall be made to anyone other than such individual or such physician, dentist, or practitioner, except that payment may be made (A) to the employer of such physician, dentist, or practitioner if such physician, dentist, or practitioner is required as a condition of his employment to turn over his fee for such care or service to his employer, or (B) (where the care or service was provided in a hospital, clinic, or other facility) to the facility in which the care or service was provided if there is a contractual arrangement between such physician, dentist, or practitioner and such facility under which such facility submits the bill for such care or service." (c) The amendment made by subsection (a) shall apply with respect to bills submitted and requests for payments made after the date of the enactment of this Act. The amendments made by subsection (b) shall be effective January 1, 1973 (or earlier if the State plan so provides).

1415 Ante, p. 1384; Post, p. 1455.

42 USC 1396a.

Effective dates.

U T I L I Z A T I O N REVIEW REQUIREMENTS FOR H O S P I T A L S A N D SKILLED N U R S I N G H O M E S U N D E R MEDICAID A N D U N D E R M A T E R N A L A N D C H I L D H E A L T H PROGRAM

SEC. 237. (a)(1) Section 1903(i) of the Social Security Act (as added by section 224(c) and amended by sections 229(c) and 233(c) of this Act) is further amended by striking out the period at the end of paragraph (3) and inserting in lieu thereof "; or", and by adding after paragraph (3) the following new paragraph: "(4) with respect to any amount expended for care or services furnished under the plan by a hospital or skilled nursing home unless such hospital or skilled nursing home has in effect a utilization review plan which meets the requirements imposed by section 1861(k) for purposes of title X VIII; and if such hospital or skilled nursing home has in effect such a utilization review plan for purposes of title X VIII, such plan shall serve as the plan required by this subsection (with the same standards and procedures and the same review committee or group) as a condition of payment under this title; the Secretary is authorized to waive the requirements of this paragraph if the State agency demonstrates to his satisfaction that it has in operation utilization review procedures which are superior in their effectiveness to the procedures required under section 1861(k). " 82-081 O - 73 - 92

Ante, pp. 1395, 1410, 1411.

42 USC 1395X, 1395.

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