157
‘‘(C) OFFSET.—Any amount of fees col-
lected in a fiscal year under this subsection that
exceeds the amount of such fees available for
expenditure in such fiscal year, as specified in
appropriation Acts, shall be credited to the
Health Care Financing Administration Pro-
gram Management Account, and shall be avail-
able for obligation in subsequent fiscal years to
the extent provided in subsequent appropriation
Acts.
‘‘(4) AVAILABILITY OF FEES.—Fees authorized
under this subsection shall be available for obligation
only to the extent and in the amount provided in ad-
vance in appropriation Acts. Such fees are author-
ized to be appropriated to remain available until ex-
pended for the costs of the activities for which they
were assessed.’’.
SEC. 734. FEES FOR SURVEY AND CERTIFICATION.
(a) IN
GENERAL.—Section 1864(e) (42 U.S.C.
1395aa(e)) is amended to read as follows:
‘‘(e) FEES FOR CONDUCTING CERTIFICATION SUR-
VEYS.—
‘‘(1) AUTHORITY TO IMPOSE FEES.—Except as
provided in paragraph (6), the Secretary shall im-
158
pose, or require States as a condition of agreements
under this section to impose—
‘‘(A) fees for surveys for the purpose of
making initial determinations as to whether en-
tities meet requirements under this title; and
‘‘(B) annual fees to cover the costs of peri-
odic surveys to determine whether entities par-
ticipating in the program under this title con-
tinue to meet such requirements.
‘‘(2) ASSESSMENT OF FEES.—
‘‘(A) TYPES OF FEES.—
‘‘(i) FEES
FOR
INITIAL
SURVEYS.—
Fee amounts assessed pursuant to para-
graph (1)(A) against an entity in a class in
a State shall not exceed the estimated av-
erage cost of an initial survey and deter-
mination for an entity in such class and
State.
‘‘(ii) FEES
FOR
RECERTIFICATION
SURVEYS.—
‘‘(I) IN GENERAL.—Fee amounts
assessed 
pursuant 
to 
paragraph
(1)(B) against entities in a class in a
State shall not exceed the amount
which the Secretary reasonably esti-
159
mates will generate total revenues suf-
ficient to cover the applicable percent-
age specified in subclause (II) of total
annual costs for such surveys and de-
terminations with respect to such
class and State.
‘‘(II) 
APPLICABLE
PERCENT-
AGES.—For purposes of subclause (I),
the applicable percentage is—
‘‘(aa) 33 percent for fiscal
year 2000;
‘‘(bb) 66 percent for fiscal
year 2001; and
‘‘(cc) 100 percent for fiscal
year 2002 and each succeeding
fiscal year.
‘‘(B) REDUCTION OR WAIVER OF FEES.—
The Secretary may reduce or waive the fees
under this subsection in exceptional cir-
cumstances which the Secretary determines to
be in the public interest.
‘‘(3) COLLECTION AND CREDITING OF FEES.—
‘‘(A) FEES FOR INITIAL SURVEYS.—
‘‘(i) COLLECTION OF FEES.—Fees as-
sessed against an entity in a State pursu-
160
ant to paragraph (1)(A) shall be payable
at the time of the initial survey to the Sec-
retary (or, in the case of surveys per-
formed by a State agency, to such agency).
‘‘(ii) REMITTANCE
OF
FEE
AMOUNT
TO SECRETARY WHERE STATE COLLECTS
FEES.—In the event a State agency col-
lects a fee pursuant to clause (i), such
agency shall remit to the Secretary an
amount equal to the Secretary’s share of
the cost of the activities described in para-
graph (1)(A).
‘‘(iii) CREDITING
OF
FEES.—Fees
paid to the Secretary pursuant to clause (i)
or remitted to the Secretary pursuant to
clause (ii) shall be credited to the Health
Care Financing Administration Program
Management Account.
‘‘(B) FEES
FOR
RECERTIFICATION
SUR-
VEYS.—
‘‘(i) COLLECTION OF FEES.—Fees as-
sessed against an entity pursuant to para-
graph (1)(B) shall be payable annually and
may be deducted from amounts otherwise
161
payable from a Trust Fund under this title
to such entity.
‘‘(ii) 
REIMBURSEMENT
OF
STATE
AGENCY
COSTS.—Of amounts collected
pursuant to clause (i), an amount equal to
the State’s share of the cost of activities
described in paragraph (1)(B) shall be
transferred to the appropriate State agen-
cy.
‘‘(iii) 
REIMBURSEMENT
OF
SEC-
RETARY’S
COSTS.—The balance of the
amount collected pursuant to clause (i)
that is not paid to a State agency pursuant
to clause (ii) shall be credited to the
Health Care Financing Administration
Program Management Account.
‘‘(C) OFFSET.—Any amount of fees col-
lected in a fiscal year under this subsection that
exceeds the amount of such fees available for
expenditure in such fiscal year, as specified in
appropriation Acts, shall be credited to the
Health Care Financing Administration Pro-
gram Management Account, and shall be avail-
able for obligation in subsequent fiscal years to