34 1 2 be less efficient to have the services furnished by the hospital (or by others under arrangement with them made by the 3 hospital) than to have them furnished by another party.". 4 (2) Section 1842 (b) (3A) of such Act, as added by 5 section 20 of this Act, is amended by adding: "(G) The charge for a physician's or other per son's services and items which are related to the income or receipts of a hospital or hospital subdivision shall not be considered in determining his customary charge to the extent that the charge exceeds an amount equal to the salary which would reasonably have been paid for the service (together with any additional costs that would have been incurred by the hospital) to the physi cian performing it if it had been performed in an employment relationship with the hospital plus the cost of other expenses (including a reasonable allowance for traveltime and other reasonable types of expense related to any differences in acceptable methods of organization for the provision of services) incurred by the physician, as the Secretary may determine to be appropriate.". (c) Section 1861 (v) of the Social Security Act is 22 amended by adding: 23 "(8) (A) Where physicians' services are furnished 24 under an arrangement (including an arrangement under 25 which the physician performing the services is compensated 39 1 son for administration. 2 ts right to make recommendations supervision of another physio the proposed relative value 3 (b) Subsection (a) shall apply yone other than those 8 SEC. 14. (a) Section 1870 (f) of the Social Security 9 Act is amended, in the matter following clause (2) thereof, 10 11 12 13 14 15 16 17 18 19 22 23 by (1) inserting "(A)" immediately after ", and only if", and (2) by inserting immediately before the period the following: ", or (B) the spouse or other legally designated representative of such individual requests (in such form and manner as the Secretary shall by regulations prescribe) that payment for such services without regard to clause (A)”. (b) Subsection (a) shall apply to payments made after 20 the month of enactment. 21 USE OF APPROVED RELATIVE VALUE SCHEDULE SEC. 15. (a) To provide common language describing 23 the various kinds and levels of medical services which may 24 be reimbursed under titles V, XVIII, and XIX, of the Social 25 Security Act, the Secretary of Health, Education, and Wel 12 (b) Upon development of a proposed system of proce13 dural terminology and its approval by the Secretary of 14 Health, Education, and Welfare, it shall be published in 15 the Federal Register. Interested parties shall have not less 16 than six months in which to comment on the proposed sys17 tem and to recommend relative values to the Secretary for 18 the procedures and services designated by the terms. Com19 ments and proposals shall be supported by information and 20 documentation specified by the Secretary. 21 (c) The good faith preparation of a relative value sched22 ule or its submission to the Secretary by an association of 23 health practitioners solely in response to a request of the 24 Secretary as authorized under this section shall not in itself 25 be considered a violation of any consent decree by which 39 1 an association has waived its right to make recommendations 2 concerning fees: Provided, That the proposed relative value 3 schedule shall not be disclosed to anyone other than those 4 persons actually preparing it or their counsel until it is made 5 public by the Secretary. 6 (d) The Health Care Financing Administration shall 7 review materials submitted under this section and shall 8 recommend that the Secretary adopt a specific terminology 9 system and its relative values for use by carriers in calculat10 ing reasonable charges under title XVIII of the Social 11 Security Act, but only after: (1) Interested parties have been given an opportunity to comment and any comments have been considered; (2) Statistical analyses have been conducted assessing the economic impact of the relative values on the physicians in various specialties, geographic areas and types of practice, and on the potential liability of the program established by part B of title XVIII of the Social Security Act; (3) It has been determined that the proposed terminology and related definitions are unambiguous, practical, and easy to evaluate in actual clinical situations and that the unit values assigned generally reflect the 92-202 O-77-4 36 1 apply to any physician unless he has entered into an 2 agreement with the Secretary under which he agrees to be 3 compensated for all such services on the basis of an assign4 ment the terms of which are described in section 1842 (b) 5 (3) (B) (ii).". 6 (e) The amendments made by this section shall, except 7 those made by subsection (d), apply to services furnished 8 in accounting periods of the hospital which begin after the 9 month following the month of enactment of this Act. The 10 amendment made by subsection (d) shall be effective July 11 1, 1978. 12 13 PAYMENT FOR CERTAIN ANTIGENS UNDER PART B OF MEDICARE 14 SEC. 13. (a) Section 1861 (s) (2) of the Social Security 15 Act is amended (C), and (1) by striking out "and" at the end of clause (2) by inserting "and" at the end of clause (D), (3) by adding after clause (D) the following new clause: "(E) antigens (subject to reasonable quantity limitations determined by the Secretary) prepared by an allergist for a particular patient. including antigens he prepares which are forwarded to another qualified per |