PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-121 of the Social Security Act, the Secretary shall ensure that aggregate payments to home health agencies under title XVIII of such Act will be no greater or lesser than such payments would have been without regard to such update. (3) TRANSITION PROVISION.— Notwithstanding section 1861(v)(l)(L)(iii) of the Social Security Act, the Secretary of Health and Human Services shall, in determining the limits of reasonable costs under title XVIII of such Act with respect to services furnished by a home health agency, utilize a wage index equal to— (A) for cost reporting periods beginning on or after July 1, 1991, and on or before June 30, 1992, a combined area wage index consisting of— (i) 67 percent of the area wage index applicable under section 1861(v)(l)(L)(iii) of such Act to such home health agency, determined using the survey of the 1982 wages and wage-related costs of hospitals in the United States conducted under such section, and (ii) 33 percent of the area wage index applicable under section 1886(d)(3)(E) of such Act to hospitals located in the geographic area in which the home health agency is located, determined using the survey of the 1988 wages and wage-related costs of hospitals in the United States conducted under such section; and (B) for cost reporting periods beginning on or after July 1, 1992, and on or before June 30, 1993, a combined area wage index consisting of— (i) 33 percent of the area wage index applicable under section 1861(v)(l)(L)(iii) of such Act to such home health agency, determined using the survey of the 1982 wages and wage-related costs of hospitals in the United States conducted under such section, and (ii) 67 percent of the area wage index applicable under section 1886(d)(3)(E) of such Act to hospitals located in the geographic area in which the home health agency is located, determined using the survey of the 1988 wages and wage-related costs of hospitals in the United States conducted under such section. (3) EFFECTIVE DATE. — The amendment made by paragraph (1) shall apply with respect to home health agency cost reporting periods beginning on or after July 1, 1991. (e) CLARIFICATION OF DEFINITIONS AND REPORTING REQUIREMENTS RELATING TO PHYSICIAN OWNERSHIP AND REFERRAL. — (1) CLARIFYING DEFINITIONS. —Section 1877(h) of the Social Security Act (42 U.S.C. 1395nn(h)) is amended— (A) in paragraph (6)(A), by striking "in the case of and all that follows through "the service," and inserting "in the case of an item or service for which payment may be made under part B, the request by a physician for the item or service,"; (B) in paragraph (6)(B), by striking "in the case of another clinical laboratory service,", and (C) by redesignating paragraph (6) as paragraph (7) and by inserting after paragraph (5) the following new paragraph: 42 USC 1395x note. 42 USC 1395x note.
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