PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-31 Sec. 4161. Community health centers and rural health clinics. Sec. 4162. Partial hospitalization in community mental health centers. Sec. 4163. Coverage of screening mammography. Sec. 4164. Miscellaneous and technical provisions relating to part B. PART 3—PROVISIONS RELATING TO PARTS A AND B Sec. 4201. Provisions relating to end stage renal disease. Sec. 4202. Staff-assisted home dialysis demonstration project. Sec. 4203. Extension of secondary payor provisions. Sec. 4204. Health maintenance organizations. Sec. 4205. Peer review organizations. Sec. 4206. Medicare provider agreements assuring the implementation of a patient's right to participate in and direct health care decisions affecting the patient. Sec. 4207. Miscellaneous and technical provisions relating to parts A and B. PART 4—PROVISIONS RELATING TO PART B PREMIUM AND DEDUCTIBLE Sec. 4301. Part B premium. Sec. 4302. Part B deductible. PART 5—MEDICARE SUPPLEMENTAL INSURANCE POUCIES Sec. 4351. Simplification of medicare supplemental policies. Sec. 4352. Guaranteed renewability. Sec. 4353. Enforcement of standards. Sec. 4354. Preventing duplication. Sec. 4355. Loss ratios and refund of premiums. Sec. 4356. Clarification of treatment of plans offered by health maintenance organizations. Sec. 4357. Pre-existing condition limitations and limitation on medical underwriting. Sec. 4358. Medicare select policies. Sec. 4359. Health insurance advisory services for medicare beneficiaries. Sec. 4360. Health insurance information, counseling, and assistance grants. Sec. 4361. Medicare and medigap information by telephone. PART 1—PROVISIONS RELATING TO PART A SEC. 4001. PAYMENTS FOR CAPITAL-RELATED COSTS OF INPATIENT HOSPITAL SERVICES. (a) REDUCTION IN PAYMENTS FOR FISCAL YEAR 1991.— Section 1886(g)(3)(A)(v) (42 U.S.C. 1395ww(g)(3)(A)(v)) is amended by striking "September 30, 1990" and inserting "September 30, 1991". (b) IMPLEMENTATION OF PROSPECTIVE PAYMENT FOR CAPITAL- RELATED COSTS. —Section 1886(g)(1)(A) (42 U.S.C. 1395ww(g)(l)) is amended by adding at the end the following: "Aggregate payments made under subsection (d) and this subsection during fiscal years 1992 through 1995 shall be reduced in a manner that results in a reduction (as estimated by the Secretary) in the amount of such payments equal to a 10 percent reduction in the amount of pay- ments attributable to capital-related costs that would otherwise have been made during such fiscal year had the amount of such payments been based on reasonable costs (as defined in section 1861(v)). ". (c) EXEMPTION FOR RURAL PRIMARY CARE HOSPITALS. — Section 1886(g)(3)(B) is amended by striking "subsection (d)(5)(D)(iii))." and inserting "subsection (d)(5)(D)(iii) or a rural primary care hospital (as defined in section 1861(mm)(l))." SEC. 4002. PROSPECTIVE PAYMENT HOSPITALS. (a) CHANGES IN UPDATE FACTORS. — (1) IN GENERAL.—Section 1886(b)(-3XBXi) (42 U.S.C. 1395ww(bK3XBXi)) is amended— (A) by striking "and" at the end of subclause (V);
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