180
(C) by adding at the end the following new
subparagraph:
‘‘(D) INAPPLICABILITY TO PEDIATRIC FA-
CILITIES.—Subparagraphs (A) and (B) shall
not apply, as of October 1, 2002, to pediatric
facilities that do not have an exception rate de-
scribed in subparagraph (C) in effect on such
date. For purposes of this subparagraph, the
term ‘pediatric facility’ means a renal facility at
least 50 percent of whose patients are individ-
uals under 18 years of age.’’.
(2) CONFORMING
AMENDMENT.—The fourth
sentence 
of 
section 
1881(b)(7) 
(42 
U.S.C.
1395rr(b)(7)) is amended by striking ‘‘The Sec-
retary’’ and inserting ‘‘Subject to section 422(a)(2)
of the Medicare, Medicaid, and SCHIP Benefits Im-
provement and Protection Act of 2000, the Sec-
retary’’.
(c) INCREASE IN RENAL DIALYSIS COMPOSITE RATE
FOR SERVICES FURNISHED IN 2004.—Notwithstanding
any other provision of law, with respect to payment under
part B of title XVIII of the Social Security Act for renal
dialysis services furnished in 2004, the composite payment
rate otherwise established under section 1881(b)(7) of
181
such Act (42 U.S.C. 1395rr(b)(7)) shall be increased by
1.2 percent.
SEC. 517. IMPROVED PAYMENT FOR CERTAIN MAMMOG-
RAPHY SERVICES.
(a) EXCLUSION FROM OPD FEE SCHEDULE.—Sec-
tion 1833(t)(1)(B)(iv) (42 U.S.C. 1395l(t)(1)(B)(iv)) is
amended by inserting before the period at the end the fol-
lowing: ‘‘and does not include screening mammography (as
defined in section 1861(jj)) and unilateral and bilateral
diagnostic mammography’’.
(b) ADJUSTMENT TO TECHNICAL COMPONENT.—For
diagnostic mammography performed on or after January
1, 2004, for which payment is made under the physician
fee schedule under section 1848 of the Social Security Act
(42 U.S.C. 1395w–4), the Secretary, based on the most
recent cost data available, shall provide for an appropriate
adjustment in the payment amount for the technical com-
ponent of the diagnostic mammography.
(c) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to mammography performed on
or after January 1, 2004.
SEC. 518. WAIVER OF PART B LATE ENROLLMENT PENALTY
FOR CERTAIN MILITARY RETIREES; SPECIAL
ENROLLMENT PERIOD.
(a) WAIVER OF PENALTY.—
182
(1) IN GENERAL.—Section 1839(b) (42 U.S.C.
1395r(b)) is amended by adding at the end the fol-
lowing new sentence: ‘‘No increase in the premium
shall be effected for a month in the case of an indi-
vidual who is 65 years of age or older, who enrolls
under this part during 2001, 2002, or 2003, and
who demonstrates to the Secretary before December
31, 2003, that the individual is a covered beneficiary
(as defined in section 1072(5) of title 10, United
States Code). The Secretary of Health and Human
Services shall consult with the Secretary of Defense
in identifying individuals described in the previous
sentence.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to premiums for
months beginning with January 2003. The Secretary
of Health and Human Services shall establish a
method for providing rebates of premium penalties
paid for months on or after January 2003 for which
a penalty does not apply under such amendment but
for which a penalty was previously collected.
(b) MEDICARE PART B SPECIAL ENROLLMENT PE-
RIOD.—
(1) IN GENERAL.—In the case of any individual
who, as of the date of the enactment of this Act, is
183
65 years of age or older, is eligible to enroll but is
not enrolled under part B of title XVIII of the So-
cial Security Act, and is a covered beneficiary (as
defined in section 1072(5) of title 10, United States
Code), the Secretary of Health and Human Services
shall provide for a special enrollment period during
which the individual may enroll under such part.
Such period shall begin as soon as possible after the
date of the enactment of this Act and shall end on
December 31, 2003.
(2) COVERAGE PERIOD.—In the case of an indi-
vidual who enrolls during the special enrollment pe-
riod provided under paragraph (1), the coverage pe-
riod under part B of title XVIII of the Social Secu-
rity Act shall begin on the first day of the month
following the month in which the individual enrolls.
SEC. 519. COVERAGE OF CHOLESTEROL AND BLOOD LIPID
SCREENING.
(a) COVERAGE.—Section 1861(s)(2) (42 U.S.C.
1395x(s)(2)), as amended by section 515(a), is amended—
(1) in subparagraph (V), by striking ‘‘and’’ at
the end;
(2) in subparagraph (W), by inserting ‘‘and’’ at
the end; and
184
(3) by adding at the end the following new sub-
paragraph:
‘‘(X) cholesterol and other blood lipid
screening tests (as defined in subsection (xx));’’.
(b) SERVICES DESCRIBED.—Section 1861 (42 U.S.C.
1395x), as amended by section 515(b), is amended by add-
ing at the end the following new subsection:
‘‘Cholesterol and Other Blood Lipid Screening Test
‘‘(xx)(1) The term ‘cholesterol and other blood lipid
screening test’ means diagnostic testing of cholesterol and
other lipid levels of the blood for the purpose of early de-
tection of abnormal cholesterol and other lipid levels.
‘‘(2) The Secretary shall establish standards, in con-
sultation with appropriate organizations, regarding the
frequency and type of cholesterol and other blood lipid
screening tests, except that such frequency may not be
more often than once every 2 years.’’.
(c) FREQUENCY.—Section 1862(a)(1) (42 U.S.C.
1395y(a)(1)), as amended by section 515(e), is amended
(1) by striking ‘‘and’’ at the end of subpara-
graph (I);
(2) by striking the semicolon at the end of sub-
paragraph (J) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
185
‘‘(K) in the case of a cholesterol and other
blood lipid screening test (as defined in section
1861(xx)(1)), which is performed more frequently
than is covered under section 1861(xx)(2).’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to tests furnished on or after Janu-
ary 1, 2004.
TITLE VI—PROVISIONS
RELATING TO PARTS A AND B
Subtitle A—Home Health Services
SEC. 601. ELIMINATION OF 15 PERCENT REDUCTION IN
PAYMENT RATES UNDER THE PROSPECTIVE
PAYMENT SYSTEM.
(a) IN GENERAL.—Section 1895(b)(3)(A) (42 U.S.C.
1395fff(b)(3)(A)) is amended to read as follows:
‘‘(A) INITIAL BASIS.—Under such system
the Secretary shall provide for computation of
a standard prospective payment amount (or
amounts) as follows:
‘‘(i) Such amount (or amounts) shall
initially be based on the most current au-
dited cost report data available to the Sec-
retary and shall be computed in a manner
so that the total amounts payable under
the system for fiscal year 2001 shall be
186
equal to the total amount that would have
been made if the system had not been in
effect and if section 1861(v)(1)(L)(ix) had
not been enacted.
‘‘(ii) For fiscal year 2002 and for the
first quarter of fiscal year 2003, such
amount (or amounts) shall be equal to the
amount (or amounts) determined under
this paragraph for the previous fiscal year,
updated under subparagraph (B).
‘‘(iii) For 2003, such amount (or
amounts) shall be equal to the amount (or
amounts) determined under this paragraph
for fiscal year 2002, updated under sub-
paragraph (B) for 2003.
‘‘(iv) For 2004 and each subsequent
year, such amount (or amounts) shall be
equal to the amount (or amounts) deter-
mined under this paragraph for the pre-
vious year, updated under subparagraph
(B).
Each such amount shall be standardized in a
manner that eliminates the effect of variations
in relative case mix and area wage adjustments
among different home health agencies in a
187
budget neutral manner consistent with the case
mix and wage level adjustments provided under
paragraph (4)(A). Under the system, the Sec-
retary may recognize regional differences or dif-
ferences based upon whether or not the services
or agency are in an urbanized area.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect as if included in the
amendments made by section 501 of the Medicare, Med-
icaid, and SCHIP Benefits Improvement and Protection
Act of 2000 (as enacted into law by section 1(a)(6) of
Public Law 106–554).
SEC. 602. UPDATE IN HOME HEALTH SERVICES.
(a) CHANGE TO CALENDAR YEAR UPDATE.—
(1) IN GENERAL.—Section 1895(b) (42 U.S.C.
1395fff(b)(3)) is amended—
(A) in paragraph (3)(B)(i)—
(i) by striking ‘‘each fiscal year (be-
ginning with fiscal year 2002)’’ and insert-
ing ‘‘fiscal year 2002 and for each subse-
quent year (beginning with 2003)’’; and
(ii) by inserting ‘‘or year’’ after ‘‘the
fiscal year’’;
(B) in paragraph (3)(B)(ii)—
188
(i) in subclause (II), by striking ‘‘fis-
cal year’’ and inserting ‘‘year’’ and by re-
designating such subclause as subclause
(III); and
(ii) in subclause (I), by striking ‘‘each
of fiscal years 2002 and 2003’’ and insert-
ing the following: ‘‘fiscal year 2002, the
home health market basket percentage in-
crease (as defined in clause (iii)) minus 1.1
percentage points;
‘‘(II) 2003’’;
(C) in paragraph (3)(B)(iii), by inserting
‘‘or year’’ after ‘‘fiscal year’’ each place it ap-
pears;
(D) in paragraph (3)(B)(iv)—
(i) by inserting ‘‘or year’’ after ‘‘fiscal
year’’ each place it appears; and
(ii) by inserting ‘‘or years’’ after ‘‘fis-
cal years’’; and
(E) in paragraph (5), by inserting ‘‘or
year’’ after ‘‘fiscal year’’.
(2) TRANSITION RULE.—The standard prospec-
tive payment amount (or amounts) under section
1895(b)(3) of the Social Security Act for the cal-
endar quarter beginning on October 1, 2002, shall
189
be such amount (or amounts) for the previous cal-
endar quarter.
(b) CHANGES IN UPDATES FOR 2003, 2004, AND
2005.—Section 
1895(b)(3)(B)(ii) 
(42 
U.S.C.
1395fff(b)(3)(B)(ii)), as amended by subsection (a)(1)(B),
is amended—
(1) in subclause (II), by striking ‘‘the home
health market basket percentage increase (as defined
in clause (iii)) minus 1.1 percentage points’’ and in-
serting ‘‘2.0 percentage points’’;
(2) by striking ‘‘or’’ at the end of subclause
(II);
(3) by redesignating subclause (III) as sub-
clause (V); and
(4) by inserting after subclause (II) the fol-
lowing new subclause:
‘‘(III) 
2004, 
1.1 
percentage
points;
‘‘(IV) 
2005, 
2.7 
percentage
points; or’’.
(c) PAYMENT ADJUSTMENT.—
(1) IN
GENERAL.—Section 1895(b)(5) (42
U.S.C. 1395fff(b)(5)) is amended by striking ‘‘5 per-
cent’’ and inserting ‘‘3 percent’’.
190
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to years beginning with
2003.
SEC. 603. OASIS TASK FORCE; SUSPENSION OF CERTAIN
OASIS DATA COLLECTION REQUIREMENTS
PENDING TASK FORCE SUBMITTAL OF RE-
PORT.
(a) ESTABLISHMENT.—The Secretary of Health and
Human Services shall establish and appoint a task force
(to be known as the ‘‘OASIS Task Force’’) to examine
the data collection and reporting requirements under
OASIS. For purposes of this section, the term ‘‘OASIS’’
means the Outcome and Assessment Information Set re-
quired by reason of section 4602(e) of Balanced Budget
Act of 1997 (42 U.S.C. 1395fff note).
(b) COMPOSITION.—The OASIS Task Force shall be
composed of the following:
(1) Staff of the Centers for Medicare & Med-
icaid Services with expertise in post-acute care.
(2) Representatives of home health agencies.
(3) Health care professionals and research and
health care quality experts outside the Federal Gov-
ernment with expertise in post-acute care.
(4) Advocates for individuals requiring home
health services.
192
not later than 18 months after the date of the enact-
ment of this Act.
(d) SUNSET.—The OASIS Task Force shall termi-
nate 60 days after the date on which the report is sub-
mitted under subsection (c)(2).
(e) NONAPPLICATION OF FACA.—The provisions of
the Federal Advisory Committee Act shall not apply to
the OASIS Task Force.
(f) SUSPENSION OF OASIS REQUIREMENT FOR COL-
LECTION OF DATA ON NON-MEDICARE AND NON-MED-
ICAID PATIENTS PENDING TASK FORCE REPORT.—
(1) IN GENERAL.—During the period described
in paragraph (2), the Secretary of Health and
Human Services may not require, under section
4602(e) of the Balanced Budget Act of 1997 or oth-
erwise under OASIS, a home health agency to gath-
er or submit information that relates to an indi-
vidual who is not eligible for benefits under either
title XVIII or title XIX of the Social Security Act.
(2) PERIOD OF SUSPENSION.—The period de-
scribed in this paragraph—
(A) begins on January 1, 2003, and
(B) ends on the last day of the 2nd month
beginning after the date the report is submitted
under subsection (c)(2).
193
SEC. 604. MEDPAC STUDY ON MEDICARE MARGINS OF
HOME HEALTH AGENCIES.
(a) STUDY.—The Medicare Payment Advisory Com-
mission shall conduct a study of payment margins of home
health agencies under the home health prospective pay-
ment system under section 1895 of the Social Security Act
(42 U.S.C. 1395fff). Such study shall examine whether
systematic differences in payment margins are related to
differences in case mix (as measured by home health re-
source groups (HHRGs)) among such agencies. The study
shall use the partial or full-year cost reports filed by home
health agencies.
(b) REPORT.—Not later than 2 years after the date
of the enactment of this Act, the Commission shall submit
to Congress a report on the study under subsection (a).
Subtitle B—Direct Graduate
Medical Education
SEC. 611. REDISTRIBUTION OF UNUSED RESIDENT POSI-
TIONS.
(a) IN GENERAL.—Section 1886(h)(4) (42 U.S.C.
1395ww(h)(4)) is amended—
(1) in subparagraph (F)(i), by inserting ‘‘sub-
ject to subparagraph (I),’’ after ‘‘October 1, 1997,’’;
(2) in subparagraph (H)(i), by inserting ‘‘sub-
ject to subparagraph (I),’’ after ‘‘subparagraphs (F)
and (G),’’; and
194
(3) by adding at the end the following new sub-
paragraph:
‘‘(I) REDISTRIBUTION
OF
UNUSED
RESI-
DENT POSITIONS.—
‘‘(i) REDUCTION IN LIMIT BASED ON
UNUSED POSITIONS.—
‘‘(I) IN
GENERAL.—If a hos-
pital’s resident level (as defined in
clause (iii)(I)) is less than the other-
wise applicable resident limit (as de-
fined in clause (iii)(II)) for each of
the reference periods (as defined in
subclause (II)), effective for cost re-
porting periods beginning on or after
January 1, 2003, the otherwise appli-
cable resident limit shall be reduced
by 75 percent of the difference be-
tween such limit and the reference
resident level specified in subclause
(III) (or subclause (IV) if applicable).
‘‘(II) REFERENCE PERIODS DE-
FINED.—In this clause, the term ‘ref-
erence periods’ means, for a hospital,
the 3 most recent consecutive cost re-
porting periods of the hospital for
195
which cost reports have been settled
(or, if not, submitted) on or before
September 30, 2001.
‘‘(III) 
REFERENCE
RESIDENT
LEVEL.—Subject to subclause (IV),
the reference resident level specified in
this subclause for a hospital is the
highest resident level for the hospital
during any of the reference periods.
‘‘(IV) ADJUSTMENT PROCESS.—
Upon the timely request of a hospital,
the Secretary may adjust the ref-
erence resident level for a hospital to
be the resident level for the hospital
for the cost reporting period that in-
cludes July 1, 2002.
‘‘(ii) REDISTRIBUTION.—
‘‘(I) IN
GENERAL.—The Sec-
retary is authorized to increase the
otherwise applicable resident limits for
hospitals by an aggregate number es-
timated by the Secretary that does
not exceed the aggregate reduction in
such limits attributable to clause (i)
(without taking into account any ad-
196
justment under subclause (IV) of such
clause).
‘‘(II) EFFECTIVE DATE.—No in-
crease under subclause (I) shall be
permitted or taken into account for a
hospital for any portion of a cost re-
porting period that occurs before July
1, 2003, or before the date of the hos-
pital’s application for an increase
under this clause. No such increase
shall be permitted for a hospital un-
less the hospital has applied to the
Secretary for such increase by Decem-
ber 31, 2004.
‘‘(III) CONSIDERATIONS
IN
RE-
DISTRIBUTION.—In determining for
which hospitals the increase in the
otherwise applicable resident limit is
provided under subclause (I), the Sec-
retary shall take into account the
need for such an increase by specialty
and location involved, consistent with
subclause (IV).
‘‘(IV) PRIORITY FOR RURAL AND
SMALL
URBAN
AREAS.—In 
deter-
197
mining for which hospitals and resi-
dency training programs an increase
in the otherwise applicable resident
limit is provided under subclause (I),
the Secretary shall first distribute the
increase to programs of hospitals lo-
cated in rural areas or in urban areas
that are not large urban areas (as de-
fined for purposes of subsection (d))
on a first-come-first-served basis (as
determined by the Secretary) based on
a demonstration that the hospital will
fill the positions made available under
this clause and not to exceed an in-
crease of 25 full-time equivalent posi-
tions with respect to any hospital.
‘‘(V) APPLICATION OF LOCALITY
ADJUSTED
NATIONAL
AVERAGE
PER
RESIDENT AMOUNT.—With respect to
additional residency positions in a
hospital attributable to the increase
provided under this clause, notwith-
standing any other provision of this
subsection, the approved FTE resi-
dent amount is deemed to be equal to
198
the locality adjusted national average
per resident amount computed under
subparagraph (E) for that hospital.
‘‘(VI) CONSTRUCTION.—Nothing
in this clause shall be construed as
permitting the redistribution of reduc-
tions in residency positions attrib-
utable to voluntary reduction pro-
grams under paragraph (6) or as af-
fecting the ability of a hospital to es-
tablish new medical residency training
programs under subparagraph (H).
‘‘(iii) RESIDENT
LEVEL
AND
LIMIT
DEFINED.—In this subparagraph:
‘‘(I) 
RESIDENT
LEVEL.—The
term ‘resident level’ means, with re-
spect to a hospital, the total number
of full-time equivalent residents, be-
fore the application of weighting fac-
tors (as determined under this para-
graph), in the fields of allopathic and
osteopathic medicine for the hospital.
‘‘(II) OTHERWISE
APPLICABLE
RESIDENT
LIMIT.—The term ‘other-
wise applicable resident limit’ means,
199
with respect to a hospital, the limit
otherwise applicable under subpara-
graphs (F)(i) and (H) on the resident
level for the hospital determined with-
out regard to this subparagraph.’’.
(b) NO APPLICATION OF INCREASE TO IME.—Sec-
tion 1886(d)(5)(B)(v) (42 U.S.C. 1395ww(d)(5)(B)(v)) is
amended by adding at the end the following: ‘‘The provi-
sions of clause (i) of subparagraph (I) of subsection (h)(4)
shall apply with respect to the first sentence of this clause
in the same manner as it applies with respect to subpara-
graph (F) of such subsection, but the provisions of clause
(ii) of such subparagraph shall not apply.’’.
(c) REPORT
ON
EXTENSION
OF
APPLICATIONS
UNDER REDISTRIBUTION PROGRAM.—Not later than July
1, 2004, the Secretary shall submit to Congress a report
containing recommendations regarding whether to extend
the deadline for applications for an increase in resident
limits under section 1886(h)(4)(I)(ii)(II) of the Social Se-
curity Act (as added by subsection (a)).
200
SEC. 612. INCREASING FOR 5 YEARS TO 100 PERCENT OF
THE LOCALITY ADJUSTED NATIONAL AVER-
AGE PER RESIDENT AMOUNT THE PAYMENT
FLOOR FOR DIRECT GRADUATE MEDICAL
EDUCATION PAYMENTS UNDER THE MEDI-
CARE PROGRAM.
Section 
1886(h)(2)(D)(iii) 
(42 
U.S.C.
1395ww(h)(2)(D)(iii)), as amended by section 511 of
BIPA, is amended—
(1) by striking ‘‘and’’ after ‘‘70 percent,’’; and
(2) by inserting after ‘‘85 percent,’’ the fol-
lowing: ‘‘and for cost reporting periods beginning
during the period beginning on October 1, 2002, and
ending on September 31, 2007, shall not be less
than 100 percent,’’.
Subtitle C—Other Provisions
SEC. 621. MODIFICATIONS TO MEDICARE PAYMENT ADVI-
SORY COMMISSION (MEDPAC).
(a) EXAMINATION OF BUDGET CONSEQUENCES.—
Section 1805(b) (42 U.S.C. 1395b–6(b)) is amended by
adding at the end the following new paragraph:
‘‘(8) 
EXAMINATION
OF
BUDGET
CON-
SEQUENCES.—Before making any recommendations,
the Commission shall examine the budget con-
sequences of such recommendations, directly or
201
through consultation with appropriate expert enti-
ties.’’.
(b) CONSIDERATION OF EFFICIENT PROVISION OF
SERVICES.—Section 1805(b)(2)(B)(i) (42 U.S.C. 1395b–
6(b)(2)(B)(i)) is amended by inserting ‘‘the efficient provi-
sion of’’ after ‘‘expenditures for’’.
(c) ADDITIONAL REPORTS.—
(1) DATA NEEDS AND SOURCES.—The Medicare
Payment Advisory Commission shall conduct a
study, and submit a report to Congress by not later
than June 1, 2003, on the need for current data,
and sources of current data available, to determine
the solvency and financial circumstances of hospitals
and other medicare providers of services. The Com-
mission shall examine data on uncompensated care,
as well as the sahre of uncompensated care ac-
counted for by the expenses for treating illegal
aliens.
(2) USE
OF
TAX-RELATED
RETURNS.—Using
return information provided under Form 990 of the
Internal Revenue Service, the Commission shall sub-
mit to Congress, by not later than June 1, 2003, a
report on the following:
202
(A) Investments and capital financing of
hospitals participating under the medicare pro-
gram and related foundations.
(B) Access to capital financing for private
and for not-for-profit hospitals.
SEC. 622. DEMONSTRATION PROJECT FOR DISEASE MAN-
AGEMENT FOR CERTAIN MEDICARE BENE-
FICIARIES WITH DIABETES.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall conduct a demonstration project
under this section (in this section referred to as the
‘‘project’’) to demonstrate the impact on costs and health
outcomes of applying disease management to certain medi-
care beneficiaries with diagnosed diabetes. In no case may
the number of participants in the project exceed 30,000
at any time.
(b) VOLUNTARY PARTICIPATION.—
(1) ELIGIBILITY.—Medicare beneficiaries are
eligible to participate in the project only if—
(a) they are Hispanic, as determined by
the Secretary;
(A) they meet specific medical criteria
demonstrating the appropriate diagnosis and
the advanced nature of their disease;
203
(B) their physicians approve of participa-
tion in the project; and
(C) 
they 
are 
not 
enrolled 
in 
a
Medicare+Choice plan.
(2) BENEFITS.—A medicare beneficiary who is
enrolled in the project shall be eligible—
(A) for disease management services re-
lated to their diabetes; and
(B) for payment for all costs for prescrip-
tion drugs without regard to whether or not
they relate to the diabetes, except that the
project may provide for modest cost-sharing
with respect to prescription drug coverage.
(c) CONTRACTS WITH DISEASE MANAGEMENT ORGA-
NIZATIONS.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall carry out the project through
contracts with up to three disease management orga-
nizations. The Secretary shall not enter into such a
contract with an organization unless the organiza-
tion demonstrates that it can produce improved
health outcomes and reduce aggregate medicare ex-
penditures consistent with paragraph (2).
(2) 
CONTRACT
PROVISIONS.—Under 
such
contracts—
204
(A) such an organization shall be required
to provide for prescription drug coverage de-
scribed in subsection (b)(2)(B);
(B) such an organization shall be paid a
fee negotiated and established by the Secretary
in a manner so that (taking into account sav-
ings in expenditures under parts A and B of
the medicare program under title XVIII of the
Social Security Act) there will be no net in-
crease, and to the extent practicable, there will
be a net reduction in expenditures under the
medicare program as a result of the project;
and
(C) such an organization shall guarantee,
through an appropriate arrangement with a re-
insurance company or otherwise, the prohibition
on net increases in expenditures described in
subparagraph (B).
(3) PAYMENTS.—Payments to such organiza-
tions shall be made in appropriate proportion from
the Trust Funds established under title XVIII of the
Social Security Act.
(4) WORKING GROUP.—The Secretary shall es-
tablish within the Department of Health and
Human Services a working group consisting of em-