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on and after the first day of the first calendar month which

2 begins more than thirty days after the date of enactment of

33 this Act.

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4 (b) Except as otherwise specified in this Actor 5 in a provision of law which is enacted or amended by

this Act, any regulation of the Secretary of Health, Educa

tion, and Welfare (hereinafter in this section referred to as 8 the “Secretary”), which is necessary or appropriate to inn9 plement any provision of this Act or any other provision of 10

law which is enacted or modified by this Act, shall, subject 11 to paragraph (2), be promulgated so as to become effective

12 not later than the first day of the thirteenth month following

13 the month in which this Act is enacted.

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REPEAL OF SECTION 1867

15 SEC. 33. Section 1867 of the Social Security Act is 16 hereby repealed.

17 PROCEDURES FOR DETERMINING REASONABLE COST AND

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REASONABLE CILARGE

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SI('. 40. (a) (1) In determining the amount of

any

20 payment under title XVIII, under a program established 21 under title V, or under a State plan approved under title 22 XIX, when the payment is based upon the reasonable cost

23 or reasonable charge, no element comprising any part of 24 the cost or charge shall be considered to be reasonable if, and 25 to the extent that, that element is

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(A) a commission, finder's fee, or for a similar

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(B) an amount payable for any facility (or part

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or activity thereof) under any rental or lease arrange

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6 which is, directly or indirectly, determined, wholly or in 7 part as a percentage, fraction, or portion of the charge or 8 cost attributed to any health service (other than the ele9 ment) or any health service including, but not limited to,

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SEC. 41. (a) Section 1861 (s) (7) of the Social Security 13 Act is amended by inserting: 14

(Including ambulance service to the nearest hos15 pital which is: (a) adequately equipped and (b) has 16 medical personnel qualified to deal with, and available

17

for the treatment of, the individual's illness, injury, or

18 condition)” immediately after “ambulance service”. 19 (b) The amendment made by subsection (a) shall 20 apply to services furnished on and after the first day of the 21 first calendar month which begins after the date of enact

22 ment of this Act.

23

GRANTS TO REGIONAL PEDIATRIC PULMONARY CENTERS

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Sec. 42. (a) Section 511 of the Social Security Act is

25 amended

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(1) by inserting “(a)” immediately after “Sec.

2

511.", and

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(2) by adding at the end of the section:

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4 “(b) (1) From the sums available under paragraph 5 (2), the Secretary is authorized to make grants to public

or nonprofit private regional pediatric respiratory centers, 7 which are a part of (or are affiliated with) an institution of 8 bigher learning, to assist them in carrying out a prograin for 9 the training and instruction (through demonstrations and 10 otherwise) of health care personnel in the prevention, diag11 nosis and treatment of respiratory diseases in children and 12 young adults, and in providing (through such program) 13 needed health care services to children and young adults 14 suffering from such diseases.

“(2) For the purpose of making grants under this sub16 section, there is authorized to be appropriated, for the fiscal 17

year ending September 30, 1978, and each of the next four 18

succeeding fiscal years, such sums (not in excess of $5,19 000,000 for any fiscal year') as may be necessary. Sums 20 authorized to be appropriated for any

fiscal

year under this 21 subsection for making grants for the purposes referred to in 22

paragraph (1) shall be in addition to any sums authorized 23 to be appropriated for such fiscal year for similar purposes 24 under other provisions of this title.”. 25

(1) Section 502 (2) of such Act is amended by insert26 ing “(a)” immediately after "511".

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WAIVER OF HUMAN EXPERIMENTATION PROVISION

2

FOR MEDICARE AND MEDICAID

3 SEC. 43. Any requirements of title II of Public Law 4 93-348 otherwise beld applicable are hereby waived with

5 respect to programs established under titles XVIII and XIX

6 of the Social Security Act.

7

DISCLOSURE OF AGGREGATE PAYMENTS TO L'ITYSCIANS

8

SEC. 44. Section 1106 of the Social Security Act is

9 amended by adding:

10 “(f) The Secretary shall not make available, nor shall 11 the State title XIX agency be required to make available 12 to the public information relating to the amounts that have 13 been paid to individual doctors of medicine or osteopathy 14 by or on behalf of beneficiaries of the health programs estab15 lished by titles XVIII or XIX, as the case may be, except

16 as may be necessary to carry out the purposes of those titles

17

or as may be specifically required by the provisions of other

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22 SEC. 45. Section 1904 of the Social Security Act is 23 amended by adding the following sentence: "The Secretary 24 shall not find that a State has failed to comply with the re

25 quirements of this title solely because it denies medical as

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1 sistance to an individual who would be ineligible for such 2 assistance if, in determining whether he is eligible for bene3 fits under title XVI of this Act, there were included in his

4 resources any property owned by him within the preceding

5 twelve months to the extent that he gave or sold that prop

6 erty to a relative for less than its fair market value.".

7

RATE OF RETURN ON NET EQUITY FOR FOR-PROFIT

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9 SEC. 46. (a) Section 1861 (1) (1) (B) of the Social 10 Security Act is amended

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(1) in the first sentence thereof, by inserting "hospital or” immediately after “Such regulations in the case of",

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(2) in the second sentence thereof, by striking

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out "one and one-half times" and inserting in lieu

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thereof “the percentages, specified in the next sentence,

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(3) by inserting after the last sentence of subparagraph (13) the following sentence: “For hospital and skilled nursing facility fiscal periods beginning before

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the month following the month of enactment of the

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Medicare-Medicaid Administrative and Reimbursement

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Reform Act, the percentage referred to in the previous sentence is 150 per cent and for subsequent fiscal years,

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the percentage is 200 per cent: Provided, howerer,

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