of payment, and for implementing on a gradual, selective, or other basis the establishment of a prospective payment system, in order to stimulate such providers through positive (or negative) financial incentives to use their facilities and personnel more efficiently and thereby to reduce the total costs of the health programs involved without adversely affecting the quality of services by containing or lowering the rate of increase in provider costs that has been and is being experienced under the existing system of retroactive cost reimbursement.

"(2) The experiments and demonstration projects developed under paragraph (1) shall be of sufficient scope and shall be carried out on a wide enough scale to permit a thorough evaluation of the alternative methods of prospective payment under consideration while giving assurance that the results derived from the experiments and projects will obtain generally in the operation of the programs involved (without committing such programs to the adoption of any prospective payment system either locally or nationally).

"(3) In the case of any experiment or demonstration project under paragraph (1), the Secretary may waive compliance with the requirements of titles XVIII, XIX, and V of the Social Security Act [this subchapter and subchapters XIX and V of this chapter] insofar as such requirements relate to methods of payment for services provided; and costs incurred in such experiment or project in excess of those which would otherwise be reimbursed or paid under such titles [subchapters] may be reimbursed or paid to the extent that such waiver applies to them (with such excess being borne by the Secretary). No experiment or demonstration project shall be developed or carried out under paragraph (1) until the Secretary obtains the advice and recommendations of specialists who are competent to evaluate the proposed experiment or project as to the soundness of its objectives, the possibilities of securing productive results, the adequacy of resources to conduct it, and its relationship to other similar experiments or projects already completed or in process; and no such experiment or project shall be actually placed in operation unless at least 30 days prior thereto a written report, prepared for purposes of notification and information only, containing a full and complete description thereof has been transmitted to the Committee on Ways and Means of the House of Representatives and to the Committee on Finance of the

Senate.

"(4) Grants, payments under contracts, and other expenditures made for experiments and demonstration projects under this subsection shall be made in appropriate part from the Federal Hospital Insurance Trust Fund (established by section 1817 of the Social Security Act [section 13951 of this title]) and the Federal Supplementary Medical Insurance Trust Fund (established by section 1841 of the Social Security Act [section 1395t of this title]) and from funds appropriated under titles V and XIX of such Act [subchapters V and XIX of this chapter.] Grants and payments under contracts may be made either in advance or by way of reimbursement, as may be determined by the Secretary, and shall be made in such installments and on such conditions as the Secretary finds necessary to carry out the purpose of this subsection. With respect to any such grant, payment, or other expenditure, the amount to be paid from each of such trust funds (and from funds appropriated under such titles V and XIX [subchapters V and XIX of this chapter]) shall be determined by the Secretary, giving due regard to the purposes of the experiment or project involved.

"(5) The Secretary shall submit to the Congress no later than July 1, 1974, a full report on the experiments and demonstration projects carried out under this subsection and on the experience of other programs with respect to prospective reimbursement together with any related data and materials which he may consider appropriate. Such report shall include detailed recommendations with respect to the specific methods which could be used in the full implementation of a system of prospective payment to providers of services under the programs involved."

SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in sections 13951, 1395mm of this title.

§ 1395h. Use of public agencies or private organizations to facilitate payment to providers of services. (a) If any group or association of providers of services wishes to have payments under this part to such providers made through a national, State, or other public or private agency or organization and nominates such agency or organization for this purpose, the Secretary is authorized to enter into an agreement with such agency or organization providing for the determination by such agency or organization (subject to the provisions of section 139500 of this title and to such review by the Secretary as may be provided for by the agreement) of the amount of the payments required pursuant to this part to be made to such providers, and for the making of such payments by such agency or organization to such providers. Such agreement may also include provision for the agency or organization to do all or any part of the following: (1) to provide consultative services to institutions or agencies to enable them to establish and maintain fiscal records necessary for purposes of this part and otherwise to qualify as hospitals, extended care facilities, or home health agencies, and (2) with respect to the providers of services which are to receive payments through it (A) to serve as a center for, and communicate to providers, any information or instructions furnished to it by the Secretary, and serve as a channel of communication from providers to the Secretary; (B) to make such audits of the records of providers as may be necessary to insure that proper payments are made under this part; and (C) to perform such other functions as are necessary to carry out this subsection.

(As amended Oct. 30, 1972, Pub. L. 92-603, title II, § 243 (b), 86 Stat. 1422.)

AMENDMENTS

1972 Subsec. (a). Pub. L. 92-603 inserted reference to the provisions of section 139500 of this title.

EFFECTIVE DATE OF 1972 AMENDMENT Amendment by Pub. L. 92-603 applicable with respect to cost reports of providers of services for accounting periods ending on or after June 30, 1973, see section 243 (c) of Pub. L. 92-603, set out as a note under section 139500 of this title.

SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in sections 1320c-14, 1395mm, 139500 of this title.

§ 13951. Federal Hospital Insurance Trust Fund. (a) There is hereby created on the books of the Treasury of the United States a trust fund to be known as the "Federal Hospital Insurance Trust Fund" (hereinafter in this section referred to as the "Trust Fund"). The Trust Fund shall consist of such gifts and bequests as may be made as provided in section 401 (i) (1) of this title, and such amounts as may be deposited in, or appropriated to, such fund as provided in this part. There are hereby appropriated to the Trust Fund for the fiscal year ending

June 30, 1966, and for each fiscal year thereafter, out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 100 per centum of

(As amended Oct. 30, 1972, Pub. L. 92-603, title I, § 132(d), 86 Stat. 1361.)

AMENDMENTS

1972 Subsec. (a). Pub. L. 92-603 inserted "such gifts and bequests as may be made as provided in section 401 (1) (1) of this title, and" following "consist of" and preceding "such amounts" in the provisions preceding par. (1).

EFFECTIVE DATE OF 1972 AMENDMENT

Amendment by Pub. L. 92-603 applicable with respect to gifts and bequests received after Oct. 30, 1972, see section 132(f) of Pub. L. 92-603, set out as a note under section 401 of this title.

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1395b-1 of this title.

§ 13951-2. Hospital insurance benefits for uninsured individuals not otherwise eligible.

(a) Individuals eligible to enroll. Every individual who

(1) has attained the age of 65,

(2) is enrolled under part B of this subchapter, (3) is a resident of the United States, and is either (A) a citizen or (B) an alien lawfully admitted for permanent residence who has resided in the United States continuously during the 5 years immediately preceding the month in which he applies for enrollment under this section, and (4) is not otherwise entitled to benefits under this part,

shall be eligible to enroll in the insurance program established by this part.

(b) Time, manner, and form of enrollment.

An individual may enroll under this section only in such manner and form as may be prescribed in regulations, and only during an enrollment period prescribed in or under this section.

(c) Period of enrollment; scope of coverage.

The provisions of section 1395p of this title (except subsection (f) thereof), section 1395q of this title, subsection (c) of section 1395r of this title, and subsections (f) and (h) of section 1395s of this title shall apply to persons authorized to enroll under this section except that-

(1) individuals who meet the conditions of subsection (a) (1), (3), and (4) of this section on or before the last day of the seventh month after the month in which this section is enacted may enroll under this part and (if not already so enrolled) may also enroll under part B during an initial general enrollment period which shall begin on the first day of the second month which begins after the date on which this section is enacted and shall end on the last day of the tenth month after the month in which this Act is enacted;

(2) in the case of an individual who first meets the conditions of eligibility under this section on or after the first day of the eighth month after the month in which this section is enacted, the initial enrollment period shall begin on the first day of the third month before the month in which

he first becomes eligible and shall end 7 months later;

(3) in the case of an individual who enrolls pursuant to paragraph (1) of this subsection, entitlement to benefits shall begin on

(A) the first day of the second month after the month in which he enrolls,

(B) July 1, 1973, or

(C) the first day of the first month in which he meets the requirements of subsection (a) of this section,

whichever is the latest;

(4) termination of coverage under this section by the filing of notice that the individual no longer wishes to participate in the hospital insurance program shall take effect at the close of the month following the month in which such notice is filed;

(5) an individual's entitlement under this section shall terminate with the month before the first month in which he becomes eligible for hospital insurance benefits under section 426 of this title or section 426a of this title; and upon such termination, such individual shall be deemed, solely for purposes of hospital insurance entitlement, to have filed in such first month the application required to establish such entitlement; and (6) termination of coverage for supplementary medical insurance shall result in simultaneous termination of hospital insurance benefits for uninsured individals who are not otherwise entitled to benefits under this chapter.

(d) Monthly premiums.

(1) The monthly premium of each individual for each month in his coverage period before July 1974 shall be $33.

(2) The Secretary shall, during the last calendar quarter of each year, beginning in 1973, determine and promulgate the dollar amount (whether or not such dollar amount was applicable for premiums for any prior month) which shall be applicable for premiums for months occurring in the 12-month period commencing July 1 of the next year. Such amount shall be equal to $33, multiplied by the ratio of (A) the inpatient hospital deductible for such next year, as promulgated under section 1395e(b) (2) of this title, to (B) such deductible promulgated for 1973. Any amount determined under the preceding sentence which is not a multiple of $1 shall be rounded to the nearest multiple of $1, or if midway between multiples of $1 to the next higher multiple of $1. (e) Contract or other arrangement for payment of monthly premiums.

Payment of the monthly premiums on behalf of any individual who meets the conditions of subsection (a) of this section may be made by any public or private agency or organization under a contract or other arrangement entered into between it and the Secretary if the Secretary determines that payment of such premiums under such contract or arrangement is administratively feasible.

(f) Deposit of amounts into Treasury.

Amounts paid to the Secretary for coverage under this section shall be deposited in the Treasury to the credit of the Federal Hospital Insurance Trust Fund. (Aug. 14, 1935, ch. 531, title XVIII, § 1818, as added

Oct. 30, 1972, Pub. L. 92-603, title II, § 202, 86 Stat. 1374.)

REFERENCES IN TEXT

The month in which this section is enacted, referred to in the text, is October, 1972.

The month in which this Act is enacted, referred to in the text, probably means October, 1972.

The date on which this section is enacted, referred to in the text, is Oct. 30, 1972.

SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in sections 1395p, 1395ff, 1395gg of this title.

PART B-SUPPLEMENTARY MEDICAL INSURANCE BENEFITS FOR THE AGED AND DISABLED

PART REFERRED TO IN OTHER SECTIONS This part is referred to in sections 1395b-1, 13951-2, 1395mm, 1395pp, 1396a of this title; title 45 section 228s-3.

§ 1395j. Establishment of supplementary medical insurance program for the aged and disabled. There is hereby established a voluntary insurance program to provide medical insurance benefits in accordance with the provisions of this part for aged and disabled individuals who elect to enroll under such program, to be financed from premium payments by enrollees together with contributions from funds appropriated by the Federal Government. (As amended Oct. 30, 1972, Pub. L. 92-603, title II, § 201 (a) (3) (B), 86 Stat. 1371.)

AMENDMENTS

1972-Pub. L. 92-603 substituted "aged and disabled individuals" for "individuals 65 years of age or over".

§ 1395k. Scope of benefits; definitions.

(a) The benefits provided to an individual by the insurance program established by this part shall consist of—

(2) entitlement to have payment made on his behalf (subject to the provisions of this part) for

(B) medical and other health services furnished by a provider of services or by others under arrangement with them made by a provider of services, excluding

(i) physician services except where furnished by

(I) a resident or intern of a hospital, or (II) a physician to a patient in a hospital which has a teaching program approved as specified in paragraph (6) of section 1395x (b) of this title (including services in conjunction with the teaching programs of such hospital whether or not such patient is an inpatient of such hospital), unless either clause (A) or (B) of paragraph (7) of such section is met, and

(ii) services for which payment may be made pursuant to section 1395n (b) (2) of this title; and

(C) outpatient physical therapy services, other than services to which the next to last sentence of section 1395x (p) of this title applies.

(As amended Oct. 30, 1972, Pub. L. 92-603, title II, §§ 227(e) (1), 251(a) (4), 86 Stat. 1406, 1445.) PAYMENT FOR SERVICES OF PHYSICIANS RENDERED IN A TEACHING HOSPITAL; STUDIES, REPORTS, AND ANALYSIS TO CONGRESSIONAL COMMITTEES; EFFECTIVE DATES

Pub. L. 93-233, § 15(a) (2), Dec. 31, 1973, 87 Stat. 966, provided:

"Notwithstanding any other provision of law, the provisions of section 1832 (a) (2) (B) (i) of the Social Security Act [subsec. (a) (2) (B) (i) of this section] shall, subject to subsection (b) of this section [set out in italicized note under section 1395x of this title], for the period with respect to which this paragraph is applicable, be administered as if subclause II of such section reads as follows:

“'(II) a physician to a patient in a hospital which has a teaching program approved as specified in paragraph (6) of section 1861 (b) [section 1395x(b)(6) of this title] (including services in conjunction with the teaching programs of such hospital whether or not such patient is an inpatient of such hospital), where the conditions specified in paragraph (7) of such section [section 1395x(b) (7) of this title] are met and"."

For provisions respecting studies, reports, and analysis to congressional committees, and effective dates, see section 15(b)-(d) of Pub. L. 93-233, set out in italicized note under section 1395x of this title.

AMENDMENTS

1972 Subsec. (a)(2)(B). Pub. L. 92-603, § 227(e) (1), added provisions relating to medical and other health services performed by a physician to a patient in a hospital which has an approved teaching program.

Subsec. (a) (2) (C). Pub. L. 92-603, § 251 (a) (4), added ", other than services to which the next to last sentence of section 1395x (p) of this title applies".

EFFECTIVE DATE OF 1972 AMENDMENT Amendment by section 251(a) (4) of Pub. L. 92-603 applicable with respect to services furnished on or after July 1, 1973, see section 251 (d) (1) of Pub. L. 92-603, set out as a note under section 1395x of this title.

Amendment of section by section 227 (e) (1) of Pub. L. 92-603 applicable with respect to accounting periods beginning after June 30, 1973, see section 227 (g) of Pub. L. 92-603, set out as a note under section 1395x of this title. SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1395mm of this title.

§ 13951. Payment of benefits. (a) Amounts.

Except as provided in section 1395mm of this title, and subject to the succeeding provisions of this section, there shall be paid from the Federal Supplementary Medical Insurance Trust Fund, in the case of each individual who is covered under the insurance program established by this part and incurs expenses for services with respect to which benefits are payable under this part, amounts equal to

(1) in the case of services described in section 1395k (a) (1) of this title-80 percent of the reasonable charges for the services; except that (A) an organization which provides medical and other

health services (or arranges for their availability) on a prepayment basis may elect to be paid 80 percent of the reasonable cost of services for which payment may be made under this part on behalf of individuals enrolled in such organization in lieu of 80 percent of the reasonable charges for such services if the organization undertakes to charge such individuals no more than 20 percent of such reasonable cost plus any amounts payable by them as a result of subsection (b) of this section, (B) with respect to expenses incurred for radiological or pathological services for which payment may be made under this part, furnished to an inpatient of a hospital by a physician in the field of radiology or pathology, the amounts paid shall be equal to 100 percent of the reasonable charges for such services, (C) with respect to expenses incurred for those physicians' services for which payment may be made under this part that are described in section 1395y (a) (4) of this title, the amounts paid shall be subject to such limitations as may be prescribed by regulations, and (D) with respect to diagnostic tests performed in a laboratory for which payment is made under this part to the laboratory, the amounts paid shall be equal to 100 percent of the negotiated rate for such tests (as determined pursuant to subsection (g) of this section); and

(2) in the case of services described in section 1395k (a) (2) of this title-with respect to home health services, 100 percent, and with respect to other services, 80 percent of—

(A) the lesser of (i) the reasonable cost of such services, as determined under section 1395x(v) of this title, or (ii) the customary charges with respect to such services; or

(B) if such services are furnished by a public provider of services free of charge or at nominal charges to the public, the amount determined in accordance with section 1395f (b) (2) of this title; or

(C) if such services are services to which the next to last sentence of section 1395x(p) of this title applies, the reasonable charges for such services.

(b) Deductible provision.

Before applying subsection (a) of this section with respect to expenses incurred by an individual during any calendar year, the total amount of the expenses incurred by such individual during such year (which would, except for this subsection, constitute incurred expenses from which benefits payable under subsection (a) of this section are determinable) shall be reduced by a deductible of $60; except that (1) the amount of the deductible for such calendar year as so determined shall first be reduced by the amount of any expenses incurred by such individual in the last three months of the preceding calendar year and applied toward such individual's deductible under this section for such preceding year, and (2) such total amount shall not include expenses incurred for radiological or pathological services furnished to such individual as an inpatient of a hospital by a physician in the field of radiology or pathology. The total amount of the expenses incurred by an individual as determined under the

preceding sentence shall, after the reduction specified in such sentence, be further reduced by an amount equal to the expenses incurred for the first three pints of whole blood (or equivalent quantities of packed red blood cells, as defined under regulations) furnished to the individual during the calendar year, except that such deductible for such blood shall in accordance with regulations be appropriately reduced to the extent that there has been a replacement of such blood (or equivalent quantities of packed red blood cells, as so defined); and for such purposes blood (or equivalent quantities of packed red blood cells, as so defined) furnished such individual shall be deemed replaced when the institution or other person furnishing such blood (or such equivalent quantities of packed red blood cells, as so defined) is given one pint of blood for each pint of blood (or equivalent quantities of packed red blood cells, as so defined) furnished such individual with respect to which a deduction is made under this sentence.

(f) Payment for purchase and rental of durable medical equipment.

(1) In the case of the purchase of durable medical equipment included under section 1395x(s) (6) of this title, by or on behalf of an individual, payment shall be made in such amounts as the Secretary determines to be equivalent to payments that would have been made under this part had such equipment been rented and over such period of time as the Secretary finds such equipment would be used for such individual's medical treatment, except that (A) payment may be made in a lump sum if the Secretary finds that such method of payment is less costly or more practical than periodic payments, and (B) with respect to purchases of used equipment the Secretary is authorized to waive the 20 percent coinsurance amount applicable under subsection (a) of this section whenever the purchase price of such equipment is at least 25 percent less than the reasonable charge for comparable new equipment.

(2) In the case of rental of durable medical equipment, the Secretary may, pursuant to agreements made with suppliers of such equipment, establish any reimbursement procedures (including payment on a lump-sum basis in lieu of prolonged rental payments) which he finds to be equitable, economical, and feasible.

(g) Physical therapy services.

In the case of services described in the next to last sentence of section 1395x(p) of this title, with respect to expenses incurred in any calendar year, no more than $100 shall be considered as incurred expenses for purposes of subsections (a) and (b) of this section.

(h) Direct laboratory billing of patients.

With respect to diagnostic tests performed in a laboratory for which payment is made under this part to the laboratory, the Secretary is authorized to establish a payment rate which is acceptable to the laboratory and which would be considered the full charge for such tests. Such negotiated rate shall be limited to an amount not in excess of the total payment that would have been made for the services in

the absence of such a rate. (As amended Oct. 30, 1972, Pub. L. 92-603, title II, §§ 204(a), 211(c) (4), 226(c) (2), 233(b), 245(d), 251(a) (2), (3), 279, 299K (a), 86 Stat. 1377, 1384, 1404, 1411, 1424, 1445, 1454, 1464.)

AMENDMENTS

1972 Subsec. (a). Pub. L. 92-603, § 226(c)(2), added reference to section 1395mm of this title in provisions preceding par. (1).

Subsec. (a) (1). Pub. L. 92-603, §§ 211 (c) (4), 279 (a), added cls. (C) and (D).

Subsec. (a) (2). Pub. L. 92-603, §§ 233(b), 251(a)(3), 299K (a), substituted subpars. (A) and (B) for provisions relating to the amount payable by reference to section 1395x(v) of this title, added subpar. (C), and in provisions preceding subpar. (A), added “with respect to home health services, 100 percent, and with respect to other services," preceding "80 percent".

Subsec. (b). Pub. L. 92-603, § 204 (a), substituted "$60" for "$50".

Subsec. (f). Pub. L. 92–603, § 245(d), designated existing provisions as par. (1) (A) and added par. (1)(B) and (2).

Subsec. (g). Pub. L. 92-603, § 251(a)(2), added subsec. (g).

Subsec. (h). Pub. L. 92-603, § 279 (b), added subsec. (h). Subsec. was in the original (g) and was changed to accommodate subsec. (g) as added by section 251 (a) (2) of Pub. L. 92-603.

EFFECTIVE DATE OF 1972 AMENDMENT

Section 204 (c) of Pub. 92-603 provided that: "The amendments made by this section [amending subsec. (b) of this section and section 1395n (c) of this title] shall be effective with respect to calendar years after 1972 (except that, for purposes of applying clause (1) of the first sentence of section 1833 (b) of the Social Security Act [subsec. (b) of this section], such amendments shall be deemed to have taken effect on January 1, 1972)."

Amendment of subsec. (a)(1) of this section by section 211 (c) (4) of Pub. L. 92-603 applicable to services furnished with respect to admissions occurring after Dec. 31, 1972, see section 211(d) of Pub. L. 92-603, set out as a note under section 1395f of this title.

Amendment of section by section 226(c) (2) of Pub. L. 92-603 effective with respect to services provided on or after July 1, 1973, see section 226(f) of Pub. L. 92-603, set out as a note under section 1395mm of this title.

Amendment of subsec. (a) (2) by section 233 (b) of Pub. L. 92-603 applicable to services furnished by hospitals, extended care facilities, and home health agencies in accounting periods beginning after Dec. 31, 1972, see section 233 (f) of Pub. L. 92-603, set out as a note under section 1395f of this title. See, also, Pub. L. 93-233, § 16, Dec. 31, 1973, 87 Stat. 967, set out as a note under section 1395f of this title.

Amendment by section 251(a)(2), (3) of Pub. L. 92-603 applicable with respect to services furnished on or after July 1, 1973, see section 251(d)(1) of Pub. L. 92-603, set out as a note under section 1395x of this title.

Section 299K (b) provided that: "The amendment made by subsection (a) [amending subsec. (a) (2) of this section] shall apply to services furnished by home health agencies in accounting periods beginning after December 31, 1972."

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1395mm of this title.

§ 1395n. Procedure for payment of claims of providers of services.

(a) Except as provided in subsections (b), (c), and (e) of this section, payment for services described in section 1395k (a) (2) of this title furnished an individual may be made only to providers of services which are eligible therefor under section 1395cc (a) of this title, and only if

(1) written request, signed by such individual, except in cases in which the Secretary finds it im

practicable for the individual to do so, is filed for such payment in such form, in such manner and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the period of 3 calendar years following the year in which such services are furnished (deeming any services furnished in the last 3 calendar months of any calendar year to have been furnished in the succeeding calendar year) except that, where the Secretary deems that efficient administration so requires, such period may be reduced to not less than 1 calendar year; and

(2) a physician certifies (and recertifies, where such services are furnished over a period of time, in such cases, with such frequency, and accompanied by such supporting material, appropriate to the case involved, as may be provided by regulations) that

(C) in the case of outpatient physical therapy services, (i) such services are or were required because the individual needed physical therapy services, (ii) a plan for furnishing such services has been established, and is periodically reviewed, by a physician, and (iii) such services are or were furnished while the individual is or was under the care of a physician; and

(D) in the case of outpatient speech pathology services, (i) such services are or were required because the individual needed speech pathology services, (ii) a plan for furnishing such services has been established and is periodically reviewed by a physician, and (iii) such services are or were furnished while the individual is or was under the care of a physician.

(c) Notwithstanding the provisions of this section and sections 1395k, 13957, and 1395cc (a) (1) (A) of this title, a hospital may, subject to such limitations as may be prescribed by regulations, collect from an individual the customary charges for services specified in section 1395x (s) of this title and furnished to him by such hospital as an outpatient, but only if such charges for such services do not exceed the applicable supplementary medical insurance deductible, and such customary charges shall be regarded as expenses incurred by such individual with respect to which benefits are payable in accordance with section 13957 (a)(1) of this title. Payments under this subchapter to hospitals which have elected to make collections from individuals in accordance with the preceding sentence shall be adjusted periodically to place the hospital in the same position it would have been had it instead been reimbursed in accordance with section 13957(a)(2) of this title.

*

(e) For purposes of services (1) which are inpatient hospital services by reason of paragraph (7) of section 1395x (b) of this title or for which entitlement exists by reason of clause (II) of section 1395k (a) (2) (B) (i) of this title, and (2) for which the reasonable cost thereof is determined under section 1395x(v) (1) (D) of this title, payment under this part shall be made to such fund as may be designated by the organized medical staff of the