Ill STAT. 474 PUBLIC LAW 105-33 —AUG. 5, 1997 42 USC 1395d note. 42 USC 1395x note. 42 USC 1395x note. 42 USC 1395y note. (vi) For 2003, %. (B) No IMPACT ON GOVERNMENT CONTRIBUTION.— Subparagraph (A) does not apply in determining the amount of the Government contribution under section 1844 of the Social Security Act (42 U.S.C. 1395w). (f) EFFECTIVE DATE. —The amendments made by this section apply to services furnished on or after January 1, 1998. For purpose of applying such amendments, any home health spell of illness that began, but not did not end, before such date shall be considered to have begun as of such date. SEC. 4612. CLARIFICATION OF PART-TIME OR INTERMITTENT NURSING CARE. (a) IN GENERAL.— Section 1861(m) (42 U.S.C. 1395x(m)) is amended by adding at the end the following: "For purposes of paragraphs (1) and (4), the term 'part-time or intermittent services' means skilled nursing and home health aide services furnished any number of days per week as long as they are furnished (combined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-by-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours per week). For purposes of sections 1814(a)(2)(C) and 1835(a)(2)(A), 'intermittent' means skilled nursing care that is either provided or needed on fewer than 7 days each week, or less than 8 hours of each day for periods of 21 days or less (with extensions in exceptional circumstances when the need for additional care is finite and predictable).". (b) EFFECTIVE DATE. — The amendment made by subsection (a) applies to services furnished on or after October 1, 1997. SEC. 4613. STUDY ON DEFINITION OF HOMEBOUND. (a) STUDY.— The Secretary of Health and Human Services shall conduct a study of the criteria that should be applied, and the method of applying such criteria, in the determination of whether an individual is homebound for purposes of qualifying for receipt of benefits for home health services under the medicare program. Such criteria shall include the extent and circumstances under which a person may be absent from the home but nonetheless qualify. (b) REPORT. —Not later than October 1, 1998, the Secretary shall submit a report to Congress on the study conducted under subsection (a). The report shall include specific recommendations on such criteria and methods. SEC. 4614. NORMATIVE STANDARDS FOR HOME HEALTH CLAIMS DENIALS. (a) IN GENERAL. —Section 1862(a)(1) (42 U.S.C. 1395y(a)(l)) (as amended by section 4104(c)) is amended— (1) by striking "and" at the end of subparagraph (G), (2) by striking the semicolon at the end of subparagraph (H) and inserting ", and", and (3) by inserting after subparagraph (H) the following new subparagraph: "(I) the frequency and duration of home health services which are in excess of normative guidelines that the Secretary shall establish by regulation;". (b) NOTIFICATION. — The Secretary of Health and Human Services may establish a process for notifying a physician in cases
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