PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 377 (2) AREA MUST HAVE SHORTAGE OF HEALTH CARE PRACTITIONERS. —Section 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)), as amended by paragraph (1), is further amended in the second sentence, in the matter in clause (i) preceding subclause (I)— (A) by striking the comma after "personal health services"; and (B) by inserting "and in which there are insufficient numbers of needed health care practitioners (as determined by the Secretary)," after "Bureau of the Census)". (3) PREVIOUSLY QUALIFYING CLINICS GRANDFATHERED ONLY TO PREVENT SHORTAGE.— (A) IN GENERAL. —Section 1861(aa)(2) of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended in the third sentence by inserting before the period "if it is determined, in accordance with criteria established by the Secretary in regulations, to be essential to the delivery of primary care services that would otherwise be unavailable in the geographic area served by the clinic". (B) PAYMENT FOR CERTAIN PHYSICIAN ASSISTANT SERV- ICES. —Section 1842(b)(6)(C) (42 U.S.C. 1395u(b)(6)(C)) is amended to read as follows: "(C) in the case of services described in clause (i) of section 1861(s)(2)(K), payment shall be made to either (i) the employer of the physician assistant involved, or (ii) with respect to a physician assistant who was the owner of a rural health clinic (as described in section 1861(aa)(2)) for a continuous period beginning prior to the date of the enactment of the Balanced Budget Act of 1997 and ending on the date that the Secretary determines such rural health clinic no longer meets the requirements of section 1861(aa)(2), for such services provided before January 1, 2003, payment may be made directly to the physician assistant; and". (4) EFFECTIVE DATES; IMPLEMENTING REGULATIONS.— 42 USC i395x (A) IN GENERAL.— Except as otherwise provided, the note. amendments made by the preceding paragraphs take effect on the date of the enactment of this Act. (B) CURRENT RURAL HEALTH CLINICS.— The amendments made by the preceding paragraphs take effect, with respect to entities that are rural health clinics under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) on the date of enactment of this Act, on the date of the enactment of this Act. (C) GRANDFATHERED CLINICS.— (i) IN GENERAL.— The amendment made by paragraph (3)(A) shall take effect on the effective date of regulations issued by the Secretary under clause (ii). (ii) REGULATIONS. —The Secretary shall issue final regulations implementing paragraph (3)(A) that shall take effect no later than January 1, 1999. SEC. 4206. MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES. 42 USC 1395/ (a) IN GENERAL.— Not later than January 1, 1999, the Secretary ^°^^' of Health and Human Services shall make payments from the Federal Supplementary Medical Insurance Trust Fund under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) in accordance with the methodology described in subsection
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