104 STAT. 1388-108 PUBLIC LAW 101-508—NOV. 5, 1990 the provisions of section 226A, or, if earlier, the first month in which the individual would have been entitled to benefits under such part under the provisions of section 226A if the individual had filed an application for such benefits; and" (B) in the matter following clause (ii), by adding at the end the following: "Effective for items and services furnished on or after February 1, 1991, and on or before
January 1, 1996, (with respect to periods beginning on or after February 1, 1990), clauses (i) and (ii) shall be applied by substituting '18-month' for '12-month' each place it appears. ". 42 USC 1395y (2) GAO STUDY OF EXTENSION OF SECONDARY PAYER PERIOD.— "°*®' (A) The Comptroller General shall conduct a study of the impact of the application of clause (iii) of section 1862(b)(1)(C) of the Social Security Act on individuals entitled to benefits under title XVIII of such Act by reason of section 226A of such Act, and shall include in such report information relating to— (i) the number (and geographic distribution) of such individuals for whom medicare is secondary; (ii) the amount of savings to the medicare program achieved annually by reason of the application of such clause; (iii) the effect on access to employment, and employmentbased health insurance, for such individuals and their family members (including coverage by employment-based health insurance of cost-sharing requirements under medicare after such employment-based insurance becomes secondary); (iv) the effect on the amount paid for each dialysis treatment under employment-based health insurance; (v) the effect on cost-sharing requirements under employ- ment-based health insurance (and on out-of-pocket expenses of such individuals) during the period for which medicare is secondary; (vi) the appropriateness of applying the provisions of section 1862(b)(1)(C) to all group health plans. (B) The Comptroller General shall submit a preliminary report on the study conducted under subparagraph (A) to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate not later than January 1, 1993, and a final report on such study not later than January 1, 1995. 26 USC 6103 ((J) EFFECTIVE DATE. — The amendments made this subsection shall " take effect on the date of the enactment of this Act and the amendment made by subsection (a)(2)(B) shall apply to requests made on or after such date. SEC. 4204. HEALTH MAINTENANCE ORGANIZATIONS. (a) REGULATION OF INCENTIVE PAYMENTS TO PHYSICIANS. — (1) IN GENERAL.— Section 1876(i) (42 U.S.C. 1395mm(i)) is amended by adding at the end the following new paragraph: "(8)(A) Each contract with an eligible organization under this section shall provide that the organization may not operate any physician incentive plan (as defined in subparagraph (B)) unless the following requirements are met: "(i) No specific payment is made directly or indirectly under the plan to a physician or physician group as an inducement to
�
