Page:United States Statutes at Large Volume 94 Part 2.djvu/1348

 94 STAT. 2626

Publication in Federal Register. 42 USC 1395u note. Report to Congress. 42 USC 1395u note. 42 USC 1395.

Ante, p. 2625.

42 USC 1395Z.

42 USC 1396a.

42 USC 1396a note.

PUBLIC LAW 96-499—DEC. 5, 1980

"(B) the amount the laboratory charged the physician for the test, plus a nominal fee (where the physician bills for such a service) to cover the physician's costs in collecting and handling the sample on which the test was performed (less the applicable deductible and coinsurance amounts). "(3) If the bill or request for payment (A) does not indicate who performed the test, or (B) indicates that the test was performed by a laboratory but does not identify the laboratory or include the amount charged by the laboratory, payment shall be the lowest charged at which the carrier estimates the test could have been secured by a physician from a laboratory serving the locality (less the applicable deductible and coinsurance amounts).". (2) The amendment made by paragraph (1) shall apply to bills submitted and requests for payment made on or after such date (not later than April 1, 1981) as the Secretary of Health and Human Services prescribes by a notice published in the Federal Register. (3) Not later than 24 months after the effective date specified in paragraph (2), the Secretary shall report to the Congress— (A) the proportion of bills and requests for payment submitted (during the 18-month period beginning on such effective date) under title XVIII of the Social Security Act for laboratory tests which did not identify who performed the tests, (B) the proportion of bills and requests for payment submitted during such period for laboratory tests with respect to which the amount paid under such title was less than the amount that would otherwise have been payable in the absence of section 1842(h) of such Act, (C) with respect to requests for payment described in subparagraph (B) which were submitted by patients, the average additional cost per laboratory test to patients resulting from reductions in payment that would otherwise have been made for such tests in the absence of such section 1842(h), and (D) with respect to bills described in subparagraph (B) which were submitted by physicians, the average reduction in payment per laboratory test to physicians resulting from the application of such section 1842(h). (4) Section 1833(a)(1)(D) of the Social Security Act is amended by striking out "subsection (g)" and inserting in lieu thereof "subsection (h)". (b)(1) Section 1902(a) of the Social Security Act (as amended by section 914(b)(1) of this Act) is further amended— (A) by striking out "and" at the end of paragraph (41); (B) by striking out the period at the end of paragraph (42) and inserting in lieu thereof"; and"; and (C) by adding after paragraph (42) the following new paragraph: "(43) if the State plan makes provision for payment to a physician for laboratory services the performance of which such physician (or any other physician with whom he shares his practice) did not personally perform or supervise, include provision to insure that payment under the State plan for such laboratory services not exceed the payment authorized for such services by section 1842(h).". (2)(A) The amendments made by paragraph (1) shall (except as otherwise provided in subparagraph (B)) apply to medical assistance provided, under a State plan approved under title XIX of the Social

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