104 STAT. 1388-36 PUBLIC LAW 101-508—NOV. 5, 1990 42 USC 1395WW note. 42 USC 1395x note. 42 USC 1395x note. (4) EFFECTIVE DATE.— The amendment made by paragraph (1) shall apply to discharges occurring on or after October 1, 1990. (f) ELIMINATION OF HOSPITAL OFF-SET FOR SERVICES OF PHYSICIAN ASSISTANTS.— (1) IN GENERAL. — Section 9338 of the Omnibus Budget Reconciliation Act of 1986 is amended by striking subsection (d). (2) EFFECTIVE DATE.— The amendment made by paragraph (1) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986. (g) RESPONSIBILITIES AND REPORTING REQUIREMENTS OF PROSPEC- TIVE PAYMENT ASSESSMENT COMMISSION.— (1) EXPANSION OF RESPONSIBILTIES 3.— Section 1886(e)(2) (42 U.S.C. 1395ww(e)(2)) is amended— (A) by striking "(2)" and inserting "(2)(A)"; and (B) by adding at the end the following new subparagraphs: "(B) In order to promote the efficient and effective delivery of high-quality health care services, the Commission shall, in addition to carrying out its functions under subparagraph (A), study and make recommendations for each fiscal year regarding changes in each existing reimbursement policy under this title under which payments to an institution are based upon prospectively determined rates and the development of new institutional reimbursement policies under this title, including recommendations relating to pay- ments during such fiscal year under the prospective payment system established under this section for determining payments for the operating costs of inpatient hospital services, including changes in the number of diagnosis-related groups used to classify inpatient hospital discharges under subsection (d), adjustments to such groups to reflect severity of illness, and changes in the methods by which hospitals are reimbursed for capital-related costs, together with general recommendations on the effectiveness and quality of health care delivery systems in the United States and the effects on such systems of institutional reimbursements under this title. "(C) By not later than June 1 of each year, the Commission shall submit a report to Congress containing an examination of issues affecting health care delivery in the United States, including issues relating to— "(i) trends in health care costs; "(ii) the financial condition of hospitals and the effect of the level of payments made to hospitals under this title on such condition; "(iii) trends in the use of health care services; and "(iv) new methods used by employers, insurers, and others to constrain growth in health care costs.". (2) REPORTING REQUIREMENTS FOR COMMISSION AND SECRETARY; ELIMINATION OF OTA REPORTING REQUIREMENTS. — Section 1886 (42 U.S.C. 1395ww) is amended— (A) by striking subparagraph (D) of subsection (d)(4); (B) in the second sentence of subsection (e)(2)(A), as amended by paragraph (I)(A), by striking "In addition" and all that follows through "the Commission" and inserting "The Commission"; (C) in subsection (e)(3)(A)— (i) by striking "the Secretary" and inserting "Congress", and ' So in original. Probably should be "RESPONSIBIUTIES".