PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-215 (8) SUBSTITUTION OF "SPECIALIZED SERVICES" FOR "ACTIVE TREATMENT".— Sections 1919(b)(3)(F) and 1919(e)(7) (42 U.S.C. 1396r(b)(3)(F), 1396r(e)(7)) are each amended by striking "active treatment" and "ACTIVE TREATMENT" each place either appears and inserting "specialized services" and "SPECIALIZED SERVICES", respectively. (9) EFFECTIVE DATES.— (A) IN GENERAL.— Except as provided in subparagraph (B), the amendments made by this subsection shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987. (B) EXCEPTION.—The amendments made by paragraphs (4), (6), and (8) shall take effect on the date of the enactment of this Act, without regard to whether or not regulations to implement such amendments have been promulgated. (c) ENFORCEMENT PROCESS.— The Secretary of Health and Human Services shall not take (and shall not continue) any action against a State under section 1904 of the Social Security Act on the basis of the State's failure to meet the requirements of section 1919(h)(2) of such Act before the effective date of guidelines, issued by the Secretary, regarding the establishment of remedies by the State under such section, if the State demonstrates to the satisfaction of the Secretary that it has made a good faith effort to meet such requirements before such effective date. (d) SUPERVISION OF HEALTH CARE OF RESIDENTS OF NURSING FACILITIES BY NURSE PRACTITIONERS, CLINICAL NURSE SPECIAUSTS, AND PHYSICIAN ASSISTANTS ACTING IN COLLABORATION WITH PHYSI- CIANS. — (1) IN GENERAL.— Section 1919(b)(6)(A) (42 U.S.C. 1396r(b)(6)(A)) is amended by inserting "(or, at the option of a State, under the supervision of a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physician)" after "physician". (2) EFFECTIVE DATE. — The amendment made by paragraph (1) applies with respect to nursing facility services furnished on or after October 1, 1990, without regard to whether or not final regulations to carry out such amendment have been promulgated by such date. (e) OTHER AMENDMENTS.— (1) ASSURANCE OF APPROPRIATE PAYMENT AMOUNTS.— (A) IN GENERAL.— Section 1902(a)(13XA) (42 U.S.C. 1396a(a)(13XA)) is amended by inserting "(including the costs of services required to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident eligible for benefits under this title)" after "take into account the costs". (B) DETAILS IN PLAN AMENDMENT.—Section 4211(b)(2) of the Omnibus Budget Reconciliation Act of 1987 is amended by inserting after the first sentence the following: "Each such amendment shall include a detailed description of the specific methodology to be used in determining the appropriate adjustment in payment amounts for nursing facility services.'. (2) DISCLOSURE OF INFORMATION OF QUAUTY ASSESSMENT AND ASSURANCE COMMITTEES. — Section 1919(b)(l)(B) (42 U.S.C. 1396r(b)(l)(B)) is amended by adding at the end the following 42 USC 1396r note. 42 USC 13%r note. 42 USC 1396r note. 42 USC 1396a note.