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SEC. 15622. RESTRICTIONS ON DIRECT BILLING FOR LAB-
ORATORY SERVICES.
(a) REQUIREMENT FOR DIRECT BILLING.—Section
1833(h) (42 U.S.C. 1395l(h)) is amended by adding at
the end the following new paragraph:
‘‘(7)(A) Effective for services furnished on or October
1, 1996, an individual or entity that performs clinical lab-
oratory diagnostic tests shall not present or cause to be
presented a claim, bill, or demand for payment to any per-
son, other than the individual receiving such services or
the health plan designated by such person, except that (i)
in the case of a test performed by one laboratory at the
request of another laboratory, which meets the require-
ments of clause (i), (ii), or (iii) of paragraph (5)(A), pay-
ment may be made to the requesting laboratory, and (ii)
the Secretary may by regulation establish appropriate ex-
ceptions to the requirement of this subparagraph.
‘‘(B)(i) Any person that collects any amounts that
were billed in violation of paragraph (7)(A) above shall
be liable for such amounts to the person from whom such
amounts were collected.
‘‘(ii) Any person that furnishes clinical laboratory
services for which payment is made under paragraph
(1)(D)(i) or paragraph (2)(D)(i) that knowingly violates
subparagraph (A) is subject to a civil money penalty of
not more than $10,000 for each such violation. The provi-
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sions of section 1128A (other than subsections (a) and
(b)) shall apply to a civil money penalty under this para-
graph in the same manner as such provisions apply with
respect to a penalty or proceeding under section 1128A(a).
‘‘(iii)(I) Any individual or entity that the Secretary
determines has repeatedly violated subparagraph (A) may
be excluded from participation in any Federal health care
program. The provisions of section 1128A (other than
subsections (a) and (b)) shall apply to an exclusion under
this paragraph in the same manner as such provisions
apply with respect to a penalty or proceeding under section
1128A(a).
‘‘(II) The provisions of section 1128(e) of the Social
Security Act shall apply to any exclusion under clause
(iii)(I) in the same manner as such provisions apply to
a proceeding under section 1128.
‘‘(iv) If the Secretary finds, after a reasonable notice
and opportunity for a hearing, that a laboratory which
holds a certificate pursuant to section 353 of the Public
Health Service Act has on a repeated basis violated sub-
paragraph (A), the Secretary may suspend, revoke, or
limit such certification in accordance with the procedures
established in section 353(k) of Public Health Service Act.
‘‘(C) For purposes of this paragraph, the following
definitions shall apply:
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‘‘(i) The term ‘Federal health care program’
means—
‘‘(I) any plan or program that provides
health benefits, whether directly, through insur-
ance, or otherwise, which is funded, in whole or
in part, by the United States Government; or
‘‘(II) any State health care program, as
defined in section 1128(h).
‘‘(ii) The term ‘health plan’ means any hospital
or medical service policy or certificate, hospital or
medical service plan contract, or health maintenance
organization contract offered by an insurer, except
that such term does not include any of the following:
‘‘(I) Coverage only for accident, dental, vi-
sion, disability income, or long-term care insur-
ance, or any combination thereof.
‘‘(II) Medicare supplemental health insur-
ance.
‘‘(III) Coverage issued as a supplement to
liability insurance.
‘‘(IV) Liability insurance, including general
liability insurance and automobile liability in-
surance.
‘‘(V) Worker’s compensation or similar in-
surance.
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‘‘(VI) Automobile medical-payment insur-
ance.
‘‘(VII) Coverage for a specified disease or
illness.
‘‘(VIII) A hospital or fixed indemnity pol-
icy.
(b) LOOK BACK PROVISIONS TO ASSURE SAVINGS.—
(1) IN GENERAL.—Section 1833(h)(4)(B) (42
U.S.C. 1395l(h)(4)(B)), as amended by section
15604(b), is amended—
(A) in clause (vii), by striking ‘‘and’’ at the
end;
(B) in clause (viii)—
(i) by inserting ‘‘and before January
1, 2000,’’ after ‘‘1996,’’, and
(ii) by striking the period at the end
and inserting ‘‘, and’’; and
(C) by adding at the end the following new
clause:
‘‘(ix) after December 31, 1999, is equal to such
percentage of such median as the Secretary estab-
lishes under paragraph (8)(B), or, if the Secretary
does not act under paragraph (8)(B), is equal to 65
percent of such median.’’.
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(2) 
PROCESS
FOR
REDUCTIONS.—Section
1833(h) (42 U.S.C. 1395l(h)), as amended by sub-
section (a), is amended by adding at the end the fol-
lowing new paragraph:
‘‘(8)(A) On July 31, 1999, the Secretary shall esti-
mate—
‘‘(i) the amount of expenditures under this sec-
tion for clinical diagnostic laboratory tests which will
be made in the period from January 1, 1997,
through September 30, 2002, and
‘‘(ii) the amount of expenditures which would
have been made under this section for clinical diag-
nostic laboratory tests in the period from January 1,
1997, through September 30, 2002, if paragraph (7)
had not been enacted.
‘‘(B) If the amount estimated under subparagraph
(A)(i) is greater than 97 percent of the amount estimated
under subparagraph (A)(ii), the Secretary shall establish
a limitation amount under paragraph (4)(B)(ix) such that,
when such limitation amount is considered, the amount
estimated under subparagraph (A)(i) is 97 percent of the
amount estimated under subparagraph (A)(ii).
‘‘(C) The Director of the Congressional Budget Office
(hereafter in this subparagraph referred to as the ‘Direc-
tor’) shall—
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‘‘(i) independently estimate the amounts speci-
fied in subparagraph (A) and compute any limitation
amount required under subparagraph (B), and
‘‘(ii) submit a report on such estimates and
computation to Congress not later than August 31,
1999.
The Secretary shall provide the Director with such data
as the Director reasonably requires to prepare such esti-
mates and computation.’’.
PART 4—QUALITY STANDARDS FOR DURABLE
MEDICAL EQUIPMENT
SEC. 15631. RECOMMENDATIONS FOR QUALITY STANDARDS
FOR DURABLE MEDICARE EQUIPMENT.
(a) APPOINTMENT
OF
TASK
FORCE
BY
SEC-
RETARY.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall establish a broadly based task
force to develop recommendations for quality stand-
ards for durable medical equipment under part B of
the medicare program.
(2) COMPOSITION.—The task force shall include
individuals selected by the Secretary from represent-
atives of suppliers of items of durable medical equip-
ment under part B, consumers, and other users of
such equipment. In appointing members, the Sec-
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retary shall assure representation from various geo-
graphic regions of the United States.
(3) NO COMPENSATION FOR SERVICE.—Mem-
bers of the task force shall not receive any com-
pensation for service on the task force.
(4) TERMINATION.—The task force shall termi-
nate 30 days after it submits the report described in
subsection (b).
(b) REPORT.—Not later than 1 year after the date
of the enactment of this Act, the task force established
under subsection (a) shall submit to the Secretary its rec-
ommendations for quality standards for durable medicare
equipment under part B of the medicare program.
Subtitle H—Provisions Relating to
Medicare Parts A and B
PART 1—PAYMENTS FOR HOME HEALTH
SERVICES
SEC. 15701. PAYMENT FOR HOME HEALTH SERVICES.
(a) IN GENERAL.—Title XVIII (42 U.S.C. 1395 et
seq.), as amended by section 15106, is amended by adding
at the end the following new section:
‘‘PAYMENT FOR HOME HEALTH SERVICES
‘‘SEC. 1894. (a) IN GENERAL.—
‘‘(1) PER
VISIT
PAYMENTS.—Subject to sub-
section (c), the Secretary shall make per visit pay-
ments beginning with fiscal year 1997 to a home
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June 30, 1994, increased (in a compounded
manner) by the home health market basket per-
centage increase for fiscal years 1995, 1996,
and 1997; and
‘‘(B) for each subsequent fiscal year, is an
amount equal to the national per visit payment
rate in effect for the preceding fiscal year, in-
creased by the home health market basket per-
centage increase for such subsequent fiscal year
minus 2 percentage points.
‘‘(3) REBASING
OF
RATES.—The Secretary
shall provide for an update to the national per visit
payment rates under this subsection for cost report-
ing periods beginning not later than the first day of
the fifth fiscal year which begins after fiscal year
1997, and not later than every 5 years thereafter, to
reflect the most recent available data.
‘‘(4) HOME
HEALTH
MARKET
BASKET
PER-
CENTAGE
INCREASE.—For purposes of this sub-
section, the term ‘home health market basket per-
centage increase’ means, with respect to a fiscal
year, a percentage (estimated by the Secretary be-
fore the beginning of the fiscal year) determined and
applied with respect to the types of home health
services described in subsection (a)(2) in the same
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manner as the market basket percentage increase
under section 1886(b)(3)(B)(iii) is determined and
applied to inpatient hospital services for the fiscal
year.
‘‘(c) PER EPISODE LIMIT.—
‘‘(1) AGGREGATE LIMIT.—
‘‘(A) IN GENERAL.—Except as provided in
paragraph (2), a home health agency may not
receive aggregate per visit payments under sub-
section (a) for a fiscal year in excess of an
amount equal to the sum of the following prod-
ucts determined for each case-mix category for
which the agency receives payments:
‘‘(i) The number of episodes of each
case-mix category during the fiscal year;
multiplied by
‘‘(ii) the per episode limit determined
for such case-mix category for such fiscal
year.
‘‘(B) ESTABLISHMENT
OF
PER
EPISODE
LIMITS.—
‘‘(i) IN
GENERAL.—The per episode
limit for a fiscal year for any case-mix cat-
egory for the area in which a home health
agency is located is equal to—
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‘‘(I) the mean number of visits
for each type of home health service
described in subsection (a)(2) fur-
nished during an episode of such case-
mix category in such area during fis-
cal year 1994, adjusted by the case-
mix adjustment factor determined in
clause (ii) for the fiscal year involved;
multiplied by
‘‘(II) the per visit payment rate
established under subsection (b) for
such type of home health service for
the fiscal year for which the deter-
mination is being made.
‘‘(ii) CASE
MIX
ADJUSTMENT
FAC-
TOR.—For purposes of clause (i), the case-
mix adjustment factor for a year is the
factor determined by the Secretary to as-
sure that aggregate payments for home
health services under this section during
the year will not exceed the payment for
such services during the previous year as a
result of changes in the number and type
of home health visits within case-mix cat-
egories over the previous year.
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‘‘(iii) REBASING
OF
PER
EPISODE
AMOUNTS.—Beginning with fiscal year
1999 and every 2 years thereafter, the Sec-
retary shall revise the mean number of
home health visits determined under clause
(i)(I) for each type of home health service
visit described in subsection (a)(2) fur-
nished during an episode in a case-mix cat-
egory to reflect the most recently available
data on the number of visits.
‘‘(iv) DETERMINATION
OF
APPLICA-
BLE AREA.—For purposes of determining
per episode limits under this subpara-
graph, the area in which a home health
agency is considered to be located shall be
such area as the Secretary finds appro-
priate for purposes of this subparagraph.
‘‘(C) CASE-MIX CATEGORY.—For purposes
of this paragraph, the term ‘case-mix category’
means each of the 18 case-mix categories estab-
lished under the Phase II Home Health Agency
Prospective Payment Demonstration Project
conducted by the Health Care Financing Ad-
ministration. The Secretary may develop an al-
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ternate methodology for determining case-mix
categories.
‘‘(D) EPISODE.—
‘‘(i) IN
GENERAL.—For purposes of
this paragraph, the term ‘episode’ means
the continuous 120-day period that—
‘‘(I) begins on the date of an in-
dividual’s first visit for a type of home
health service described in subsection
(a)(2) for a case-mix category, and
‘‘(II) is immediately preceded by
a 60-day period in which the individ-
ual did not receive visits for a type of
home health service described in sub-
section (a)(2).
‘‘(ii) TREATMENT OF EPISODES SPAN-
NING
COST
REPORTING
PERIODS.—The
Secretary shall provide for such rules as
the Secretary considers appropriate regard-
ing the treatment of episodes under this
paragraph which begin during a cost re-
porting period and end in a subsequent
cost reporting period.
‘‘(E) EXEMPTIONS
AND
EXCEPTIONS.—
The Secretary may provide for exemptions and
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exceptions to the limits established under this
paragraph for a fiscal year as the Secretary
deems appropriate, to the extent such exemp-
tions and exceptions do not result in greater
payments under this section than the exemp-
tions and exceptions provided under section
1861(v)(1)(L)(ii) in fiscal year 1994, increased
by the home health market basket percentage
increase for the fiscal year involved (as defined
in subsection (b)(4)).
‘‘(2) RECONCILIATION OF AMOUNTS.—
‘‘(A) OVERPAYMENTS
TO
HOME
HEALTH
AGENCIES.—Subject to subparagraph (B), if a
home health agency has received aggregate per
visit payments under subsection (a) for a fiscal
year in excess of the amount determined under
paragraph (1) with respect to such home health
agency for such fiscal year, the Secretary shall
reduce payments under this section to the home
health agency in the following fiscal year in
such manner as the Secretary considers appro-
priate (including on an installment basis) to re-
capture the amount of such excess.
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‘‘(B) EXCEPTION
FOR
HOME
HEALTH
SERVICES FURNISHED OVER A PERIOD GREAT-
ER THAN 165 DAYS.—
‘‘(i) IN
GENERAL.—For purposes of
subparagraph (A), the amount of aggre-
gate per visit payments determined under
subsection (a) shall not include payments
for home health visits furnished to an indi-
vidual on or after a continuous period of
more than 165 days after an individual be-
gins an episode described in subsection
(c)(1)(D) (if such period is not interrupted
by the beginning of a new episode).
‘‘(ii) 
REQUIREMENT
OF
CERTIFI-
CATION.—Clause (i) shall not apply if the
agency has not obtained a physician’s cer-
tification with respect to the individual re-
quiring such visits that includes a state-
ment that the individual requires such con-
tinued visits, the reason for the need for
such visits, and a description of such serv-
ices furnished during such visits.
‘‘(C) SHARE OF SAVINGS.—
‘‘(i) BONUS
PAYMENTS.—If a home
health agency has received aggregate per
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visit payments under subsection (a) for a
fiscal year in an amount less than the
amount determined under paragraph (1)
with respect to such home health agency
for such fiscal year, the Secretary shall pay
such home health agency a bonus payment
equal to 50 percent of the difference be-
tween such amounts in the following fiscal
year, except that the bonus payment may
not exceed 5 percent of the aggregate per
visit payments made to the agency for the
year.
‘‘(ii) 
INSTALLMENT
BONUS
PAY-
MENTS.—The Secretary may make install-
ment payments during a fiscal year to a
home health agency based on the estimated
bonus payment that the agency would be
eligible to receive with respect to such fis-
cal year.
‘‘(d) MEDICAL REVIEW PROCESS.—The Secretary
shall implement a medical review process (with a particu-
lar emphasis on fiscal years 1997 and 1998) for the sys-
tem of payments described in this section that shall pro-
vide an assessment of the pattern of care furnished to in-
dividuals receiving home health services for which pay-
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ments are made under this section to ensure that such
individuals receive appropriate home health services. Such
review process shall focus on low-cost cases described in
subsection (e)(3) and cases described in subsection
(c)(2)(B) 
and 
shall 
require 
recertification 
by
intermediaries at 30, 60, 90, 120, and 165 days into an
episode described in subsection (c)(1)(D).
‘‘(e) ADJUSTMENT OF PAYMENTS TO AVOID CIR-
CUMVENTION OF LIMITS.—
‘‘(1) IN GENERAL.—The Secretary shall provide
for appropriate adjustments to payments to home
health agencies under this section to ensure that
agencies do not circumvent the purpose of this sec-
tion by—
‘‘(A) discharging patients to another home
health agency or similar provider;
‘‘(B) altering corporate structure or name
to avoid being subject to this section or for the
purpose of increasing payments under this title;
or
‘‘(C) undertaking other actions considered
unnecessary for effective patient care and in-
tended to achieve maximum payments under
this title.
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‘‘(2) TRACKING
OF
PATIENTS
THAT
SWITCH
HOME HEALTH AGENCIES DURING EPISODE.—
‘‘(A) DEVELOPMENT
OF
SYSTEM.—The
Secretary shall develop a system that tracks
home health patients that receive home health
services described in subsection (a)(2) from
more than 1 home health agency during an epi-
sode described in subsection (c)(1)(D).
‘‘(B) ADJUSTMENT
OF
PAYMENTS.—The
Secretary shall adjust payments under this sec-
tion to each home health agency that furnishes
an individual with a type of home health service
described in subsection (a)(2) to ensure that
aggregate payments on behalf of such individual
during such episode do not exceed the amount
that would be paid under this section if the in-
dividual received such services from a single
home health agency.
‘‘(3) LOW-COST
CASES.—The Secretary shall
develop a system designed to adjust payments to a
home health agency for a fiscal year to eliminate any
increase in growth of the percentage of low-cost epi-
sodes for which home health services are furnished
by the agency over such percentage determined for
the agency for the 12-month cost reporting period
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ending on June 30, 1994. The Secretary shall define
a low-cost episode in a manner that provides that a
home health agency has an incentive to be cost effi-
cient in delivering home health services and that the
volume of such services does not increase as a result
of factors other than patient needs.
‘‘(f) REPORT BY MEDICARE PAYMENT REVIEW COM-
MISSION.—During the first 3 years in which payments are
made under this section, the Medicare Payment Review
Commission shall annually submit a report to Congress
on the effectiveness of the payment methodology estab-
lished under this section that shall include recommenda-
tions regarding the following:
‘‘(1) Case-mix and volume increases.
‘‘(2) Quality monitoring of home health agency
practices.
‘‘(3) Whether a capitated payment for home
care patients receiving care during a continuous pe-
riod exceeding 165 days is warranted.
‘‘(4) Whether public providers of service are
adequately reimbursed.
‘‘(5) The adequacy of the exemptions and ex-
ceptions to the limits provided under subsection
(c)(1)(E).
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‘‘(6) The appropriateness of the methods pro-
vided under this section to adjust the per episode
limits and annual payment updates to reflect
changes in the mix of services, number of visits, and
assignment to case categories to reflect changing
patterns of home health care.
‘‘(7) The geographic areas used to determine
the per episode limits.
‘‘(g) NO EFFECT ON NON-MEDICARE SERVICES.—
Nothing in this section may be construed to affect the pro-
vision of or payment for home health services for which
payment is not made under this title.’’.
(b) PAYMENT FOR PROSTHETICS AND ORTHOTICS
UNDER PART A.—Section 1814(k) (42 U.S.C. 1395f(k))
is amended—
(1) by inserting ‘‘and prosthetics and orthotics’’
after ‘‘durable medical equipment’’; and
(2) by inserting ‘‘and 1834(h), respectively’’
after ‘‘1834(a)(1)’’.
(c) CONFORMING AMENDMENTS.—
(1) 
PAYMENTS
UNDER
PART
A.—Section
1814(b) (42 U.S.C. 1395f(b)), as amended by sec-
tion 15522(b), is amended in the matter preceding
paragraph (1) by striking ‘‘1888 and 1888A’’ and
inserting ‘‘1888, 1888A, and 1894’’.
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(2) TREATMENT OF ITEMS AND SERVICES PAID
UNDER PART B.—
(A) PAYMENTS UNDER PART B.—Section
1833(a)(2) (42 U.S.C. 1395l(a)(2)) is amend-
ed—
(i) by amending subparagraph (A) to
read as follows:
‘‘(A) with respect to home health serv-
ices—
‘‘(i) that are a type of home health
service described in section 1894(a)(2),
and which are furnished to an individual
who (at the time the item or service is fur-
nished) is under a plan of care of a home
health agency, the amount determined
under section 1894; or
‘‘(ii) that are not described in clause
(i) (other than a covered osteoporosis
drug) (as defined in section 1861(kk)), the
lesser of—
‘‘(I) the reasonable cost of such
services, as determined under section
1861(v), or
‘‘(II) the customary charges with
respect to such services;’’.
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(ii) by striking ‘‘and’’ at the end of
subparagraph (E);
(iii) by adding ‘‘and’’ at the end of
subparagraph (F); and
(iv) by adding at the end the following
new subparagraph:
‘‘(G) with respect to items and services de-
scribed in section 1861(s)(10)(A), the lesser
of—
‘‘(i) the reasonable cost of such serv-
ices, as determined under section 1861(v),
or
‘‘(ii) the customary charges with re-
spect to such services,
or, if such services are furnished by a public
provider of services, or by another provider
which demonstrates to the satisfaction of the
Secretary that a significant portion of its pa-
tients are low-income (and requests that pay-
ment be made under this provision), free of
charge or at nominal charges to the public, the
amount determined in accordance with section
1814(b)(2);’’.
(B) REQUIRING PAYMENT FOR ALL ITEMS
AND SERVICES TO BE MADE TO AGENCY.—
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(i) IN GENERAL.—The first sentence
of 
section 
1842(b)(6) 
(42 
U.S.C.
1395u(b)(6)), as amended by section
15525(a)(1), is amended—
(I) by striking ‘‘and (E)’’ and in-
serting ‘‘(E)’’; and
(II) by striking the period at the
end and inserting the following: ‘‘,
and (F) in the case of types of home
health services described in section
1894(a)(2) furnished to an individual
who (at the time the item or service is
furnished) is under a plan of care of
a home health agency, payment shall
be made to the agency (without re-
gard to whether or not the item or
service was furnished by the agency,
by others under arrangement with
them made by the agency, or other-
wise).’’.
(ii) CONFORMING AMENDMENT.—Sec-
tion 1832(a)(1) (42 U.S.C. 1395k(a)(1)),
as amended by section 15525(a)(3), is
amended 
by 
striking 
‘‘section
1842(b)(6)(E);’’ and inserting ‘‘subpara-
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graphs 
(E) 
and 
(F) 
of 
section
1842(b)(6);’’.
(C) EXCLUSIONS FROM COVERAGE.—Sec-
tion 1862(a) (42 U.S.C. 1395y(a)), as amended
by section 15525(a)(2) and section 15609B(a),
is amended—
(i) by striking ‘‘or’’ at the end of
paragraph (16);
(ii) by striking the period at the end
of paragraph (17) and inserting ‘‘; or’’;
and
(iii) by adding at the end the follow-
ing new paragraph:
‘‘(18) where such expenses are for home health
services furnished to an individual who is under a
plan of care of the home health agency if the claim
for payment for such services is not submitted by
the agency.’’.
(3) SUNSET
OF
REASONABLE
COST
LIMITA-
TIONS.—Section 
1861(v)(1)(L) 
(42 
U.S.C.
1395x(v)(1)(L)) is amended by adding at the end
the following new clause:
‘‘(iv) This subparagraph shall apply only to services
furnished by home health agencies during cost reporting
periods ending on or before September 30, 1996.’’.
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(d) LIMITATION ON PART A COVERAGE.—
(1) IN
GENERAL.—Section 1812(a)(3) (42
U.S.C. 1395d(a)(3)) is amended by striking the
semicolon and inserting ‘‘for up to 165 days during
any spell of illness;’’.
(2) 
CONFORMING
AMENDMENT.—Section
1812(b) (42 U.S.C. 1395d(b)) is amended—
(A) by striking ‘‘or’’ at the end of para-
graph (2),
(B) by striking the period at the end of
paragraph (3) and inserting ‘‘; or’’, and
(C) by adding at the end the following new
paragraph:
‘‘(4) home health services furnished to the indi-
vidual during such spell after such services have
been furnished to the individual for 165 days during
such spell.’’.
(3) EXCLUSION OF ADDITIONAL PART B COSTS
FROM DETERMINATION OF PART B MONTHLY PRE-
MIUM.—Section 1839(a) (42 U.S.C. 1395r(a)) is
amended—
(A) in the second sentence of paragraph
(1), by striking ‘‘enrollees.’’ and inserting ‘‘en-
rollees (except as provided in paragraph (5)).’’;
and
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(B) by adding at the end the following new
paragraph:
‘‘(5) In estimating the benefits and administrative
costs which will be payable from the Federal Supple-
mentary Medical Insurance Trust Fund for a year (begin-
ning with 1996), the Secretary shall exclude an estimate
of any benefits and costs attributable to home health serv-
ices for which payment would have been made under part
A during the year but for paragraph (4) of section
1812(b).’’.
(4) EFFECTIVE DATE.—The amendments made
by this subsection shall apply to spells of illness be-
ginning on or after October 1, 1995.
(e) EFFECTIVE DATE.—Except as provided in sub-
section (d)(4), the amendments made by this section shall
apply to cost reporting periods beginning on or after Octo-
ber 1, 1996.
SEC. 15702. MAINTAINING SAVINGS RESULTING FROM TEM-
PORARY FREEZE ON PAYMENT INCREASES
FOR HOME HEALTH SERVICES.
(a) BASING UPDATES TO PER VISIT COST LIMITS ON
LIMITS
FOR
FISCAL
YEAR
1993.—Section
1861(v)(1)(L)(iii) (42 U.S.C. 1395x(v)(1)(L)(iii)) is
amended by adding at the end the following sentence: ‘‘In
establishing limits under this subparagraph, the Secretary