Page:United States Statutes at Large Volume 98 Part 1.djvu/1154

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1106 '

42 USC 1396b.

42 USC 1396b.

Post, p. 1109.

Ante, pp. 1066, 1105.

"(A) a physician certifies at the time of admission, or, if later, the time the individual applies for medical assistance under the State plan (and the physician, or a physician assistant or nurse practitioner under the supervision of a physician, recertifies, where such services are furnished over a period of time, in such cases, at least as often as required under section 1903(g)(6) (or, in the case of services that are intermediate care facility services provided in an institution for the mentally retarded, every year), and accompanied by such supporting material, appropriate to the case involved, as may be provided in regulations of the Secretary), that such services are or were required to be given on an inpatient basis because the individual needs or needed such services, and "(B) such services were furnished under a plan established and periodically reviewed and evaluated by a physician.". (2) Section 1903(g)(1) of such Act is amended— (A) in the matter preceding subparagraph (A), by striking out "care as an inpatient" and all that follows through "hospital for mental diseases on" and inserting in lieu thereof "inpatient hospital services or intermediate care facility services for 60 days, skilled nursing facility services for 30 days, or inpatient mental hospital services for", (B) in the matter before subparagraph (A), by striking out "which for purposes of this section means the four calendar quarters ending with June 30," and by striking out "in the same fiscal year", and (C) by striking out "(including tuberculosis hospitals)" and all that follows through the end of subparagraph (D) and inserting in lieu thereof ", skilled nursing facility services, or intermediate care facility services furnished beyond 60 days (or inpatient mental hospital services furnished beyond 90 days), such State has an effective program of medical review of the care of patients in mental hospitals, skilled nursing facilities, and intermediate care facilities pursuant to paragraphs (26) and (31) of section 1902(a) whereby the professional management of each case is reviewed and evaluated at least annually by independent professional review teams.". (4) Section 1903(g) of such Act is further amended by striking out paragraph (6) and inserting in lieu thereof the following: "(6)(A) Recertifications required under section 1902(a)(44) shall be conducted at least every 60 days in the case of inpatient hospital services. "(B) Such recertifications in the case of skilled nursing facility services shall be conducted at least— "(i) 30 days after the date of the initial certification, "(ii) 60 days after the date of the initial certification, "(iii) 90 days after the date of the initial certification, and "(iv) every 60 days thereafter. "(C) Such recertifications in the case of intermediate care facility services shall be conducted at least— "(i) 60 days after the date of the initial certification, "(ii) 180 days after the date of the initial certification, "(iii) 12 months after the date of the initial certification, "(iv) 18 months after the date of the initial certification, "(v) 24 months after the date of the initial certification, and

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