PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-81 (1) by inserting "(other than oxygen and oxygen equipment)" after "covered items", and (2) by inserting before the period at the end the following: "and to oxygen and oxygen equipment furnished on or after June 1, 1989". (i) EFFECTIVE DATE. —Except as otherwise provided, the amend- 42 USC 1395m ments made by this section shall apply to items furnished on or ^ote. after January 1, 1991. SEC. 4153. PROVISIONS RELATING TO ORTHOTICS AND PROSTHETICS. (a) PAYMENTS FOR PROSTHETIC DEVICES AND ORTHOTICS AND PROSTHETICS. — (1) MAINTAINING CURRENT PAYMENT METHODOLOGY.— Section 1834 (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: " (h) PAYMENT FOR PROSTHETIC DEVICES AND ORTHOTICS AND PROSTHETICS. — " (1) GENERAL RULE FOR PAYMENT. — "(A) IN GENERAL. —Payment under this subsection for prosthetic devices and orthotics and prosthetics shall be made in a lump-sum amount for the purchase of the item in an amount equal to 80 percent of the payment basis described in subparagraph (B). "(B) PAYMENT BASIS,—Except as provided in subparagraph (C), the payment basis described in this subparagraph is the lesser of— "(i) the actual charge for the item; or "(ii) the amount recognized under paragraph (2) as the purchase price for the item. "(C) EXCEPTION FOR CERTAIN PUBLIC HOME HEALTH AGEN- CIES. —Subparagraph (B)(i) shall not apply to an item furnished by a public home health agency (or by another home health agency which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low income) free of charge or at nominal charges to the public. "(D) EXCLUSIVE PAYMENT RULE.— This subsection shall constitute the exclusive provision of this title for payment for prosthetic devices, orthotics, and prosthetics under this part or under part A to a home health agency. "(2) PURCHASE PRICE RECOGNIZED. — For purposes of paragraph (1), the amount that is recognized under this paragraph as the purchase price for prosthetic devices, orthotics, and prosthetics' is the amount described in subparagraph (C) of this paragraph, determined as follows: "(A) COMPUTATION OF LOCAL PURCHASE PRICE.—Each carrier under section 1842 shall compute a base local purchase price for the item as follows: "(i) The carrier shall compute a base local purchase price for each item equal to the average reasonable charge in the locality for the purchase of the item for the 12-month period ending with June 1987. "(ii) The carrier shall compute a local purchase price, with respect to the furnishing of each particular item— "(I) in 1989 and 1990, equal to the base local purchase price computed under clause (i) increased by the percentage increase in the consumer price index for all urban consumers (United States city
�
