104 STAT. 1388-172 PUBLIC LAW 101-508 —NOV. 5, 1990 42 USC 1396a, 1396d. 42 USC 1396a note. 42 USC 1396a note. (b) MINIMUM PAYMENT RATES BY HEALTH MAINTENANCE ORGANIZATIONS.— (1) Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)) is amended— (A) by striking "and" at the end of clause (vii), (B) by striking the period at the end of clause (viii) and inserting ", and", and (C) by adding at the end the following new clause: (ix) such contract provides, in the case of an entity that has entered into a contract for the provision of services of such center with a federally qualified health center, that (I) rates of prepayment from the State are adjusted to reflect fully the rates of payment specified in section 1902(a)(13)(E), and (II) at the election of such center payments made by the entity to such a center for services described in 1905(a)(2)(C) are made at the rates of payment specified in section 1902(a)(13)(E). ". (2) Section 1903(m)(2)(B) (42 U.S.C. 1396b(m)(2)(A)) is amended by striking "(A)" and inserting "(A) except with respect to clause (ix) of subparagraph (A),". (3) Section 1915(b) (42 U.S.C. 1396n(b)) is amended by inserting after "section 1902" "(other than sections 1902(a)(13XE) and 1902(a)(10)(A) insofar as it requires provision of the care and services described in section 1905(a)(2)(C))". (c) CLARIFICATION IN TREATMENT OF OUTPATIENTS.— Section 1905(1)(2) (42 U.S.C. 1396d(l)(2)) is amended— (1) in subparagraph (A), by striking "outpatient" and inserting "patient", (2) in subparagraph (B), by striking "facility" and inserting "entity", and (3) by redesignating clause (ii) as clause (iii) and by inserting after clause (i) the following new clause: "(iiXD is receiving funding from such a grant under a contract with the recipient of such a grant, and "(II) meets the requirements to receive a grant under section 329, 330, or 340 of such Act;". (d) TREATMENT OF INDIAN TRIBES.—The first sentence of section 1905(1)(2)(B) (42 U.S.C. 1396d(l)(2)(B)) is amended— (1) by striking the period at the end and inserting a comma, and (2) by adding, after and below clause (ii), the following: "and includes an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act (Public Law 93-638).". (e) TECHNICAL CORRECTION. —Section 6402 of the Omnibus Budget Reconciliation Act of 1989 is amended— (1) by striking subsection (c), and (2) by amending subsection (d) to read as follows: "(c) EFFECTIVE DATE.— The amendments made by this section (except as otherwise provided in such amendments) shall take effect on the date of the enactment of this Act.". (f) EFFECTIVE DATE.The amendments made by this section shall be effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989. SEC. 4705. HOSPICE PAYMENTS. (a) IN GENERAL. amended— -Section 1905(o)(3) (42 U.S.C. 1396d(o)(3)) is
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