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are highly specialized services of a registered professional nurse
and are provided non-routinely and so infrequently so that the
provision of such services directly would be impracticable and
prohibitively expensive.’’.
(b) CONFORMING PAYMENT PROVISION.—Section 1814(i) (42
U.S.C. 1395f(i)), as amended by section 512(b), is amended by
adding at the end the following new paragraph:
‘‘(5) In the case of hospice care provided by a hospice program
under arrangements under section 1861(dd)(5)(D) made by another
hospice program, the hospice program that made the arrangements
shall bill and be paid for the hospice care.’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to hospice care provided on or after the date of the
enactment of this Act.
SEC. 
947. 
APPLICATION 
OF 
OSHA 
BLOODBORNE 
PATHOGENS
STANDARD TO CERTAIN HOSPITALS.
(a) IN GENERAL.—Section 1866 (42 U.S.C. 1395cc), as amended
by section 506, is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (T), by striking ‘‘and’’ at the end;
(B) in subparagraph (U), by striking the period at
the end and inserting ‘‘, and’’; and
(C) by inserting after subparagraph (U) the following
new subparagraph:
‘‘(V) in the case of hospitals that are not otherwise subject
to the Occupational Safety and Health Act of 1970 (or a State
occupational safety and health plan that is approved under
18(b) of such Act), to comply with the Bloodborne Pathogens
standard under section 1910.1030 of title 29 of the Code of
Federal Regulations (or as subsequently redesignated).’’; and
(2) by adding at the end of subsection (b) the following
new paragraph:
‘‘(4)(A) A hospital that fails to comply with the requirement
of subsection (a)(1)(V) (relating to the Bloodborne Pathogens
standard) is subject to a civil money penalty in an amount described
in subparagraph (B), but is not subject to termination of an agree-
ment under this section.
‘‘(B) The amount referred to in subparagraph (A) is an amount
that is similar to the amount of civil penalties that may be imposed
under section 17 of the Occupational Safety and Health Act of
1970 for a violation of the Bloodborne Pathogens standard referred
to in subsection (a)(1)(U) by a hospital that is subject to the provi-
sions of such Act.
‘‘(C) A civil money penalty under this paragraph shall be
imposed and collected in the same manner as civil money penalties
under subsection (a) of section 1128A are imposed and collected
under that section.’’.
(b) EFFECTIVE DATE.—The amendments made by this sub-
section (a) shall apply to hospitals as of July 1, 2004.
SEC. 948. BIPA-RELATED TECHNICAL AMENDMENTS AND CORREC-
TIONS.
(a) TECHNICAL AMENDMENTS RELATING
TO ADVISORY COM-
MITTEE UNDER BIPA SECTION 522.—(1) Subsection (i) of section
1114 (42 U.S.C. 1314)—
(A) is transferred to section 1862 and added at the end
of such section; and
H. R. 1—361
(B) is redesignated as subsection (j).
(2) Section 1862 (42 U.S.C. 1395y) is amended—
(A) in the last sentence of subsection (a), by striking ‘‘estab-
lished under section 1114(f)’’; and
(B) in subsection (j), as so transferred and redesignated—
(i) by striking ‘‘under subsection (f)’’; and
(ii) by striking ‘‘section 1862(a)(1)’’ and inserting ‘‘sub-
section (a)(1)’’.
(b) TERMINOLOGY CORRECTIONS.—(1) Section 1869(c)(3)(I)(ii) (42
U.S.C. 1395ff(c)(3)(I)(ii)) is amended—
(A) in subclause (III), by striking ‘‘policy’’ and inserting
‘‘determination’’; and
(B) in subclause (IV), by striking ‘‘medical review policies’’
and inserting ‘‘coverage determinations’’.
(2) Section 1852(a)(2)(C) (42 U.S.C. 1395w–22(a)(2)(C)) is
amended by striking ‘‘policy’’ and ‘‘POLICY’’ and inserting ‘‘deter-
mination’’ each place it appears and ‘‘DETERMINATION’’, respectively.
(c) REFERENCE CORRECTIONS.—Section 1869(f)(4) (42 U.S.C.
1395ff(f)(4)) is amended—
(1) in subparagraph (A)(iv), by striking ‘‘subclause (I), (II),
or (III)’’ and inserting ‘‘clause (i), (ii), or (iii)’’;
(2) in subparagraph (B), by striking ‘‘clause (i)(IV)’’ and
‘‘clause (i)(III)’’ and inserting ‘‘subparagraph (A)(iv)’’ and
‘‘subparagraph (A)(iii)’’, respectively; and
(3) in subparagraph (C), by striking ‘‘clause (i)’’, ‘‘subclause
(IV)’’ and ‘‘subparagraph (A)’’ and inserting ‘‘subparagraph (A)’’,
‘‘clause (iv)’’ and ‘‘paragraph (1)(A)’’, respectively each place
it appears.
(d) OTHER CORRECTIONS.—Effective as if included in the enact-
ment of section 521(c) of BIPA, section 1154(e) (42 U.S.C. 1320c–
3(e)) is amended by striking paragraph (5).
(e) EFFECTIVE DATE.—Except as otherwise provided, the amend-
ments made by this section shall be effective as if included in
the enactment of BIPA.
SEC. 949. CONFORMING AUTHORITY TO WAIVE A PROGRAM EXCLU-
SION.
The first sentence of section 1128(c)(3)(B) (42 U.S.C. 1320a–
7(c)(3)(B)) is amended to read as follows: ‘‘Subject to subparagraph
(G), in the case of an exclusion under subsection (a), the minimum
period of exclusion shall be not less than five years, except that,
upon the request of the administrator of a Federal health care
program (as defined in section 1128B(f)) who determines that the
exclusion would impose a hardship on individuals entitled to bene-
fits under part A of title XVIII or enrolled under part B of such
title, or both, the Secretary may, after consulting with the Inspector
General of the Department of Health and Human Services, waive
the exclusion under subsection (a)(1), (a)(3), or (a)(4) with respect
to that program in the case of an individual or entity that is
the sole community physician or sole source of essential specialized
services in a community.’’.
SEC. 950. TREATMENT OF CERTAIN DENTAL CLAIMS.
(a) IN GENERAL.—Section 1862 (42 U.S.C. 1395y) is amended
by adding at the end, after the subsection transferred and redesig-
nated by section 948(a), the following new subsection:
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‘‘(k)(1) Subject to paragraph (2), a group health plan (as defined
in subsection (a)(1)(A)(v)) providing supplemental or secondary cov-
erage to individuals also entitled to services under this title shall
not require a medicare claims determination under this title for
dental benefits specifically excluded under subsection (a)(12) as
a condition of making a claims determination for such benefits
under the group health plan.
‘‘(2) A group health plan may require a claims determination
under this title in cases involving or appearing to involve inpatient
dental hospital services or dental services expressly covered under
this title pursuant to actions taken by the Secretary.’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall take effect on the date that is 60 days after the date of
the enactment of this Act.
SEC. 951. FURNISHING HOSPITALS WITH INFORMATION TO COMPUTE
DSH FORMULA.
Beginning not later than 1 year after the date of the enactment
of this Act, the Secretary shall arrange to furnish to subsection
(d) hospitals (as defined in section 1886(d)(1)(B) of the Social Secu-
rity Act, 42 U.S.C. 1395ww(d)(1)(B)) the data necessary for such
hospitals to compute the number of patient days used in computing
the disproportionate patient percentage under such section for that
hospital for the current cost reporting year. Such data shall also
be furnished to other hospitals which would qualify for additional
payments under part A of title XVIII of the Social Security Act
on the basis of such data.
SEC. 952. REVISIONS TO REASSIGNMENT PROVISIONS.
(a) 
IN
GENERAL.—Section 
1842(b)(6)(A) 
(42 
U.S.C.
1395u(b)(6)(A)) is amended by striking ‘‘or (ii) (where the service
was provided in a hospital, critical access hospital, clinic, or other
facility) to the facility in which the service was provided if there
is a contractual arrangement between such physician or other per-
son and such facility under which such facility submits the bill
for such service,’’ and inserting ‘‘or (ii) where the service was pro-
vided under a contractual arrangement between such physician
or other person and an entity, to the entity if, under the contractual
arrangement, the entity submits the bill for the service and the
contractual arrangement meets such program integrity and other
safeguards as the Secretary may determine to be appropriate,’’.
(b) CONFORMING AMENDMENT.—The second sentence of section
1842(b)(6) (42 U.S.C. 1395u(b)(6)) is amended by striking ‘‘except
to an employer or facility as described in clause (A)’’ and inserting
‘‘except to an employer or entity as described in subparagraph
(A)’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to payments made on or after the date of the enactment
of this Act.
SEC. 953. OTHER PROVISIONS.
(a) GAO REPORTS ON THE PHYSICIAN COMPENSATION.—
(1) SUSTAINABLE GROWTH RATE AND UPDATES.—Not later
than 6 months after the date of the enactment of this Act,
the Comptroller General of the United States shall submit
to Congress a report on the appropriateness of the updates
in the conversion factor under subsection (d)(3) of section 1848
of the Social Security Act (42 U.S.C. 1395w–4), including the
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appropriateness of the sustainable growth rate formula under
subsection (f) of such section for 2002 and succeeding years.
Such report shall examine the stability and predictability of
such updates and rate and alternatives for the use of such
rate in the updates.
(2) PHYSICIAN COMPENSATION GENERALLY.—Not later than
12 months after the date of the enactment of this Act, the
Comptroller General shall submit to Congress a report on all
aspects of physician compensation for services furnished under
title XVIII of the Social Security Act, and how those aspects
interact and the effect on appropriate compensation for physi-
cian services. Such report shall review alternatives for the
physician fee schedule under section 1848 of such title (42
U.S.C. 1395w–4).
(b) ANNUAL PUBLICATION
OF LIST
OF NATIONAL COVERAGE
DETERMINATIONS.—The Secretary shall provide, in an appropriate
annual publication available to the public, a list of national coverage
determinations made under title XVIII of the Social Security Act
in the previous year and information on how to get more information
with respect to such determinations.
(c) GAO REPORT ON FLEXIBILITY IN APPLYING HOME HEALTH
CONDITIONS OF PARTICIPATION TO PATIENTS WHO ARE NOT MEDI-
CARE BENEFICIARIES.—Not later than 6 months after the date of
the enactment of this Act, the Comptroller General of the United
States shall submit to Congress a report on the implications if
there were flexibility in the application of the medicare conditions
of participation for home health agencies with respect to groups
or types of patients who are not medicare beneficiaries. The report
shall include an analysis of the potential impact of such flexible
application on clinical operations and the recipients of such services
and an analysis of methods for monitoring the quality of care
provided to such recipients.
(d) OIG REPORT ON NOTICES RELATING TO USE OF HOSPITAL
LIFETIME RESERVE DAYS.—Not later than 1 year after the date
of the enactment of this Act, the Inspector General of the Depart-
ment of Health and Human Services shall submit a report to
Congress on—
(1) the extent to which hospitals provide notice to medicare
beneficiaries in accordance with applicable requirements before
they use the 60 lifetime reserve days described in section
1812(a)(1) of the Social Security Act (42 U.S.C. 1395d(a)(1));
and
(2) the appropriateness and feasibility of hospitals pro-
viding a notice to such beneficiaries before they completely
exhaust such lifetime reserve days.
TITLE X—MEDICAID AND
MISCELLANEOUS PROVISIONS
Subtitle A—Medicaid Provisions
SEC. 1001. MEDICAID DISPROPORTIONATE SHARE HOSPITAL (DSH)
PAYMENTS.
(a) TEMPORARY INCREASE.—Section 1923(f)(3) (42 U.S.C. 1396r–
4(f)(3)) is amended—