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1 sultations, the required interpretation of the significance of

2 any material or data derived from a human being, the aspira

3 tion or removal of marrow or other materials, and the ad

4 ministration of test materials or isotopes. Such professional 5 services shall not include professional services such as: the 6 performance of autopsies; and services performed in carrying 7 out responsibilities for supervision, quality control, and for 8 various other aspects of a clinical laboratory's operations 9 that are customarily performed by nonphysician personnel. 10 (3) Section 1861 (b) of such Act is amended

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(A) by striking out “or” at the end of paragraph

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(B) by striking out the period at the end of paragraph (7) and inserting"; or”, and

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(C) by adding at the end the following paragraph:

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“(8) a physician, if the services provided are not physicians' services (within the meaning of subsection

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(9)).”.

19 (b) (1) Section 1861 (s) of the Social Security Act 20 is amended by adding at the end: "The term 'medical and

21 other health services' shall not include services described in

22 paragraphs (2) (A) and (3) if furnished to inpatients of a 23 provider of services unless the Secretary finds that, because 24 of the size of the hospital and the part-time nature of the 25 services or for some other reason acceptable to him, it would

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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.”.

(2) Section 1842 (b) (3A) of such Act, as added by 5 section 20 of this Act, is amended by adding:

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“(G) The charge for a physician's or other per

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son's services and items which are related to the income

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or receipts of a hospital or hospital subdivision shall not

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be considered in determining his customary charge to

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the extent that the charge exceeds an amount equal to

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the salary which would reasonably have been paid for the service (together with any additional costs that

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would have been incurred by the hospital) to the physician performing it if it had been performed in an employ

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ment relationship with the hospital plus the cost of other

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expenses (including a reasonable allowance for travel

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time and other reasonable types of expense related to

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18 any differences in acceptable methods of organization

for the provision of services) incurred by the physician, 20

as the Secretary may determine to be appropriate.”. 21

(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

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on a basis related to the amount of the income or receipts of the hospital or any department or other subdivision) with a hospital or medical school, the amount included in any

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4 payment to the hospital under this title as the reasonable

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cost of the services (as furnished under the arrangement)

6 shall not exceed an amount equal to the salary which would 7 reasonably have been paid for the services (together with 8 any additional costs that would have been incurred by the 9 hospital) to the physician performing them if they had 10 been performed in an employment relationship with the 11 hospital (rather than under such arrangement) plus the

12 cost of other expenses (including a reasonable allowance for

13 traveltime and other reasonable types of expense related to

14 any differences in acceptable methods of organization for the 15 provision of the services) incurred by the physician, as the 16 Secretary may determine to be appropriate.”.

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(d) (1) Section 1833 (a) (1) (B) of the Social Secu

18 rity Act is amended by inserting “ (except as provided in 19 subsection (h) )” immediately after “amounts paid shall”. 20 (2) Section 1833 (b) (2) of such Act is amended by 21 inserting“ (except as otherwise provided in subsection 22 (h))"immediately after "amount paid shall”. 23 (3) Section 1833 of such Act is amended by adding:

“(h) The provisions of subsection (a) (1) (B) and

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25 clause (2) of the first sentence of subsection (1) shall not

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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 assign

4 ment the terms of which are described in section 1842 (b) 5 (3) (B) (ii).".

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(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.

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PAYMENT FOR CERTAIN ANTIGENS UNDER PART BOF

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MEDICARE

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SEC. 13. (a) Section 1861 (s) (2) of the Social Security

15 Act is amended

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(1) by striking out "and" at the end of clause

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(2) by inserting “and” at the end of clause (D),

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(3) by adding after clause (D) the following new

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“ (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

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son for administration to the patient by or under the
supervision of another physician;".
(b) Subsection (a) shall apply to items furnished after

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8 SEC. 14. (a) Section 1870 () of the Social Security 9 Act is amended, in the matter following clause (2) thereof, 10 by

(1) inserting “(A)” immediately after “, and only

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(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

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regard to clause (A)”.

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(b) Subsection (a) shall apply to payments made after

20 the month of enactment.

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USE OF APPROVED RELATIVE VALUE SCHEDULE

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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

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