PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 475 in which the number of home health visits, furnished under title XVIII of the Social Security Act pursuant to a prescription or certification of the physician, significantly exceeds such threshold (or thresholds) as the Secretary specifies. The Secretary may adjust such threshold to reflect demonstrated differences in the need for home health services among different beneficiaries. (c) EFFECTIVE DATE. —The amendments made by this section 42 USC I395y apply to services furnished on or after October 1, 1997. i^ote. SEC. 4615. NO HOME HEALTH BENEFITS BASED SOLELY ON DRAWING BLOOD. (a) IN GENERAL. —Sections 1814(a)(2)(C) and 1835(a)(2)(A) (42 U.S.C. 1395f[a)(2)(C), 1395n(a)(2)(A)) are each amended by inserting "(other than solely venipuncture for the purpose of obtaining a blood sample)" after "skilled nursing care". (b) EFFECTIVE DATE.—The amendments made by subsection 42 USC I395f (a) apply to home health services furnished after the 6-month "ote. period beginning after the date of enactment of this Act. SEC. 4616. REPORTS TO CONGRESS REGARDING HOME HEALTH COST 42 USC 1395y CONTAINMENT. note. (a) ESTIMATE.— Not later than October 1, 1997, the Secretary of Health and Human Services shall submit to the Committees on Commerce and Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report that includes an estimate of the outlays that will be made under parts A and B of title XVIII of the Social Security Act for the provision of home health services during each of fiscal years 1998 through 2002. (b) ANNUAL REPORT.— Not later than the end of each of years 1999 through 2002, the Secretary shall submit to such Committees a report that compares the actual outlays under such parts for such services during the fiscal year ending in the year, to the outlays estimated under subsection (a) for such fiscal year. If the Secretary finds that such actual outlays were greater than such estimated outlays for the fiscal year, the Secretary shall include in the report recommendations regarding beneficiary copayments for home health services provided under the medicare program or such other methods as will reduce the growth in outlays for home health services under the medicare program. CHAPTER 2—GRADUATE MEDICAL EDUCATION Subchapter A—Indirect Medical Education SEC. 4621. INDIRECT GRADUATE MEDICAL EDUCATION PAYMENTS. (a) MuLTiYEAR TRANSITION REGARDING PERCENTAGES. — (1) IN GENERAL.— Section 1886(d)(5)(B)(ii) (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended to read as follows: " (ii) For purposes of clause (i)(II), the indirect teaching adjustment factor is equal to c x (((1+r) to the nth power) - 1), where 'r' is the ratio of the hospital's full-time equivalent interns and residents to beds and 'n' equals.405. For discharges occurring— "(I) on or after October 1, 1988, and before October 1, 1997, 'c' is equal to 1.89; "(II) during fiscal year 1998, V is equal to 1.72; "(III) during fiscal year 1999, 'c' is equal to 1.6;
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