Page:United States Statutes at Large Volume 98 Part 1.djvu/1114

 98 STAT. 1066

42 USC 1395u. Post, p. 1070. 42 USC 1395gg. 42 USC 1395CC.

42 USC 1395u. 42 USC 1395CC.

42 USC 1896a.

42 USC 1396b.

Ante, p. 1064. 42 USC 1395J. 42 USC 1395u note.

Report. 42 USC 1395/f note.

PUBLIC LAW 98-369—JULY 18, 1984

"(ii) in the case of a test performed at the request of a laboratory by another laboratory, payment may be made to the referring laboratory. "(B) In the case of such a bill or request for payment for a clinical diagnostic laboratory test for which payment may otherwise be made under this part, and which is not described in subparagraph (A), payment may be made to the beneficiary only on the basis of the itemized bill of the person or entity which performed or supervised the performance of the test. "(C) Payment for a clinical diagnostic laboratory test performed by a laboratory which is independent of a physician's office or a rural health clinic may only be made on the basis of an assignment described in section 1842(b)(3)(B)(ii), in accordance with section 1842(b)(6)(B) under the procedure described in section 1870(f)(1), or to a provider of services with an agreement in effect under section 1866. "(6) In the case of any diagnostic laboratory test payment for which is not made on the basis of a fee schedule under paragraph (1), the Secretary may establish a payment rate which is acceptable to the person or entity performing the test and which would be considered the full charge for such tests. Such negotiated rate shall be limited to an amount not in excess of the total payment that would have been made for the services in the absence of such rate.". (e) Section 1842 of such Act is amended by striking out subsection (h) thereof. (f) The last sentence of section 1866(a)(2)(A) of such Act is amended by inserting "and with respect to clinical diagnostic laboratory tests" after "section 1861(s)(10)". (g)(1) Section 1902(a) of such Act is amended— (A) by inserting "and" at the end of paragraph (42); (B) by striking out paragraph (43); and (C) by redesignating paragraph (44) as paragraph (43). (2) Section 1903(i) of such Act is amended— (A) by striking out the period at the end of paragraph (6) and inserting in lieu thereof "; or ", and (B) by adding after paragraph (6) the following new paragraph: "(7) with respect to any amount expended for clinical diagnostic laboratory tests performed by a physician, independent laboratory, or hospital, to the extent such amount exceeds the amount that would be recognized under section 1833(h) for such tests performed for an individual enrolled under part B of title XVIIL". (h) The Secretary of Health and Human Services shall simplify the procedures under section 1842 of the Social Security Act with respect to claims and payments for clinical diagnostic laboratory tests so as to reduce unnecessary paperwork while assuring that sufficient information is supplied to identify instances of fraud and abuse. (i)(l) The Comptroller General shall report to the Congress on— (A) the appropriateness of the fee schedules under section 1833(h) of the Social Security Act and their impact on the volume and quality of clinical diagnostic laboratory tests; (B) the potential impact of the adoption of a national fee schedule; and

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