# Omnibus Budget Reconciliation Act of 1990/Title IV
## TITLE IV — MEDICARE, MEDICAID, AND OTHER HEALTH-RELATED PROGRAMS

    Subtitle A — Medicare
       Sec. 4000. References in Subtitle; Table of Contents.
       Part 1 — Provisions Relating to PART A
          Sec. 4001. Payments for Capital-Related Costs of Inpatient Hospital Services.
          Sec. 4002. Prospective Payment Hospitals.
          Sec. 4003. Expansion of DRG Payment Window.
          Sec. 4004. Payments for Medical Education costs.
          Sec. 4005. PPS-Exempt Hospitals.
          Sec. 4006. Hospice Benefit Extension.
          Sec. 4007. Freeze in Payments Under PART A Through December 31.
          Sec. 4008. Miscellaneous and technical provisions relating to PART A.
       Part 2 — Provisions Relating to PART B
          Subpart A — Payment for Physicians' Services
             Sec. 4101. Certain Overvalued Procedures.
             Sec. 4102. Radiology Services.
             Sec. 4103. Anesthesia Services.
             Sec. 4104. Physician Pathology Sservices.
             Sec. 4105. Update for Physicians' Services.
             Sec. 4106. New Physicians and Other New Health Care Practitioners.
             Sec. 4107. Assistants at Surgery.
             Sec. 4108. Technical Components of Certain Diagnostic Tests.
             Sec. 4109. Interpretation of Electrocardiograms.
             Sec. 4110. Reciprocal Billing Arrangements.
             Sec. 4111. Study of Prepayment Medical Review Screens.
             Sec. 4112. Practicing Physicians Advisory Council.
             Sec. 4113. Study of Aggregation Rule for Claims for Similar Physicians' Services.
             Sec. 4114. Utilization Screens for Physician Visits in Rehabilitation Hospitals.
             Sec. 4115. Study of Regional Variations in Impact of Medicare Physician Payment Reform.
             Sec. 4116. Limitation on Beneficiary Liability.
             Sec. 4117. Statewide Fee Schedule Areas for Physicians' Services.
             Sec. 4118. Technical Corrections.
          Subpart B — Other Items and Services
             Sec. 4151. Payments for Hospital Outpatient Sservices.
             Sec. 4152. Durable Medical Equipment.
             Sec. 4153. Provisions Relating to Orthotics and Prosthetics.
             Sec. 4154. Clinical Diagnostic Laboratory Tests.
             Sec. 4155. Coverage of Nurse Practitioners in Rural Areas.
             Sec. 4156. Coverage of Injectable Drugs for Treatment of Osteoporosis.
             Sec. 4157. Separate Payment Under PART B for Services of Certain Health Practitioners.
             Sec. 4158. Reduction in Payments Under PART B During Final 2 Months of 1990.
             Sec. 4159. Payments for Medical Education Costs.
             Sec. 4160. Certified Registered Nurse Anesthetists.
             Sec. 4161. Community Health Centers and Rural Health Clinics.
             Sec. 4162. Partial Hospitalization in Community Mental Health Centers.
             Sec. 4163. Coverage of Screening Mammography.
             Sec. 4164. Miscellaneous and Technical Provisions Relating to PART B.
       Part 3 — Provisions Relating to PARTs A and B
          Sec. 4201. Provisions Relating to End Stage Renal Disease.
          Sec. 4202. Staff-Assisted Home Dialysis Demonstration Project.
          Sec. 4203. Extension of Secondary Payor Provisions.
          Sec. 4204. Health Maintenance Organizations.
          Sec. 4205. Peer Review Organizations.
          Sec. 4206. Medicare Provider Agreements Assuring the Implementation of a Patient's Right to Participate in and Direct Health Care Decisions Affecting the Patient.
          Sec. 4207. Miscellaneous and Technical Provisions Relating to PARTS A and B.
       Part 4 — Provisions Relating to PART B Premium and Deductible
          Sec. 4301. PART B Premium.
          Sec. 4302. PART B Deductible.
       Part 5 — Medicare Supplemental Insurance Policies
          Sec. 4351. Simplification of Medicare Supplemental Policies.
          Sec. 4352. Guaranteed Renewability.
          Sec. 4353. Enforcement of Standards.
          Sec. 4354. Preventing Duplication.
          Sec. 4355. Loss Ratios and Refund of Premiums.
          Sec. 4356. Clarification of Treatment of Plans Offered by Health Maintenance Organizations.
          Sec. 4357. Pre-Existing Condition Limitations and Limitation on Medical Underwriting.
          Sec. 4358. Medicare Select Policies.
          Sec. 4359. Health Insurance Advisory Services for Medicare Beneficiaries.
          Sec. 4360. Health Insurance Information, Counseling, and Assistace Grants.
          Sec. 4361. Medicare and Medigap Information by Telephone.
    Subtitle B — Medicaid
       Part 1 — Reduction in Spending
          Sec. 4401. Reimbursement for Prescribed Drugs.
          Sec. 4402. Requiring Medicaid Payment of Premiums and Cost-Sharing for Enrollment Under Group Health Plans Where Cost-Effective.
       Part 2 — Protection of Low-Income Medicare Beneficiaries
          Sec. 4501. Phased-In Extension of Medicaid Payments for Medicare Premiums for Certain Individuals with Income Below 120 Percent of the Official Poverty Line.
       Part 3 — Improvements in Child Health
          Sec. 4601. Medicaid Child Health Provisions.
          Sec. 4602. Mandatory Use of Outreach Locations Other Than Welfare Offices.
          Sec. 4603. Mandatory Continuation of Benefits Throughout Pregnancy or First Year of Life.
          Sec. 4604. Adjustment in Payment for Hospital Services Furnished to Low-Income Children Under the Age of 6 Years.
          Sec. 4605. Presumptive Eligibility.
          Sec. 4606. Role in Paternity Determinations.
          Sec. 4607. Report and Transition on Errors in Eligibility Determinations.
       Part 4 — Miscellaneous
          Subpart A — Payments
             Sec. 4701. State Medicaid Matching Payments Through Voluntary Contributions and State Taxes.
             Sec. 4702. Disproportionate Share Hospitals: Counting of Inpatient Days.
             Sec. 4703. Disproportionate Share Hospitals: Alternative State Payment Adjustments and Systems.
             Sec. 4704. Federally-Qualified Health Centers.
             Sec. 4705. Hospice Payments.
             Sec. 4706. Limitation on Disallowances or Deferral of Federal Financial Participation for Certain Inpatient Psychiatric Hospital Services for Individuals Under Age 21.
             Sec. 4707. Treatment of Interest on Indiana Disallowance.
             Sec. 4708. Billing for Services of Substitute Physician.
          Subpart B — Eligibility and Coverage
             Sec. 4711. Home and Community-Based Care as Optional Service.
             Sec. 4712. Community Supported Living Arrangements Services.
             Sec. 4713. Providing Federal Medical Assistance for Payments for Premiums for `COBRA´ Continuation Coverage Where Cost Effective.
             Sec. 4714. Provisions Relating to Spousal Impoverishment.
             Sec. 4715. Disregarding German Reparation Payments from Post-Eligibility Treatment of Income Under the Medicaid Program.
             Sec. 4716. Amendments Relating to Medicaid Transition Provision.
             Sec. 4717. Clarifying Effect of Hospice Election.
             Sec. 4718. Medically Needy Income Levels for Certain 1-Member Families.
             Sec. 4719. Codification of Coverage of Rehabilitation Services.
             Sec. 4720. Personal Care Services for Minnesota.
             Sec. 4721. Medicaid Coverage of Personal Care Services Outside the Home.
             Sec. 4722. Medicaid Coverage of Alcoholism and Drug Dependency Treatment Services.
             Sec. 4723. Medicaid Spenddown Option.
             Sec. 4424. Optional State Medicaid Disability Determinations Independent of the Social Security Administration.
          Subpart C — Health Maintenance Organizations
             Sec. 4731. Regulation of Incentive Payments to Physicians.
             Sec. 4732. Special Rules.
             Sec. 4733. Extension and Expansion of Minnesota Prepaid Medicaid Demonstration Project.
             Sec. 4734. Treatment of Certain County-Operated Health Insuring Organizations.
          Subpart D — Demonstration Projects and Home and Community-Based Waivers
             Sec. 4741. Home and Community-Based Waivers.
             Sec. 4742. Timely Payment Under Waivers of Freedom of Choice of Hospital Services.
             Sec. 4744. Provisions Relating to Frail Elderly Demonstration Project Waivers.
             Sec. 4745. Demonstration Projects to Study the Effect of Allowing States to Extend Medicaid Coverage to Certain Low-Income Families Not Otherwise Qualified to Receive Medicaid Benefits.
             Sec. 4746. Medicaid Respite Demonstration Project Extended.
             Sec. 4747. Demonstration Project to Provide Medicaid Coverage for HIV-Positive Individuals.
          Subpart E — Miscellaneous
             Sec. 4751. Requirements for Advanced Directives Under State Plans for Medical Assistance.
             Sec. 4752. Improvement in Quality of Physician Services.
             Sec. 4753. Clarification of Authority of Inspector General.
             Sec. 4754. Notice to State Medical Boards When Adverse Actions Taken.
             Sec. 4755. Miscellaneous Provisions.
       Part 5 — Provisions Relating to Nursing Home Reform
          Sec. 4801. Technical Corrections Relating to Nursing Home Reform.