‘‘(iv) A clinical social worker (as defined in sec-
tion 1861(hh)(1)).
‘‘(v) A clinical psychologist (as defined by the
Secretary for purposes of section 1861(ii)).
‘‘(D) For purposes of this paragraph, a service fur-
nished by a practitioner described in subparagraph (C) in-
cludes any services and supplies furnished as incident to
the service as would otherwise be covered under this part
if furnished by a physician or as incident to a physician’s
service.’’.
(2) CONFORMING AMENDMENTS.—
(A) Section 1833 (42 U.S.C. 1395l) is
amended—
(i) in subsection (l)(5), by striking
subparagraph (B) and redesignating sub-
paragraph (C) as subparagraph (B);
(ii) by striking subsection (p); and
(iii) in subsection (r), by striking
paragraph (3) and redesignating para-
graph (4) as paragraph (3).
(B) 
Section 
1842(b)(12) 
(42 
U.S.C.
1395u(b)(12)) is amended by striking subpara-
graph (C).
(c) INFORMATION ON EXTRA-BILLING LIMITS.—
(1) PART OF EXPLANATION OF MEDICARE BEN-
EFITS.—Section 
1842(h)(7) 
(42 
U.S.C.
1395u(h)(7)) is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (B),
(B) in subparagraph (C), by striking ‘‘shall
include’’,
(C) in subparagraph (C), by striking the
period at the end and inserting ‘‘, and’’, and
(D) by adding at the end the following new
subparagraph:
‘‘(D) in the case of services for which the billed
amount exceeds the limiting charge imposed under
section 1848(g), information regarding such applica-
ble limiting charge (including information concern-
ing 
the 
right 
to 
a 
refund 
under 
section
1848(g)(1)(A)(iv)).’’.
(2) DETERMINATIONS BY CARRIERS.—Subpara-
graph (G) of section 1842(b)(3) (42 U.S.C.
1395u(b)(3)) is amended to read as follows:
‘‘(G) will, for a service that is furnished with
respect to an individual enrolled under this part,
that is not paid on an assignment-related basis, and
that is subject to a limiting charge under section
1848(g)—
‘‘(i) determine, prior to making payment,
whether the amount billed for such service ex-
ceeds the limiting charge applicable under sec-
tion 1848(g)(2);
‘‘(ii) notify the physician, supplier, or other
person periodically (but not less often than once
every 30 days) of determinations that amounts
billed exceeded such applicable limiting charges;
and
‘‘(iii) provide for prompt response to in-
quiries of physicians, suppliers, and other per-
sons concerning the accuracy of such limiting
charges for their services;’’.
(d) REPORT ON CHARGES IN EXCESS OF LIMITING
CHARGE.—Section 1848(g)(6)(B) (42 U.S.C. 1395w–
4(g)(6)(B)) is amended by inserting ‘‘information on the
extent to which actual charges exceed limiting charges, the
number and types of services involved, and the average
amount of excess charges and information’’ after ‘‘report
to the Congress’’.
(e) MISCELLANEOUS
AND
TECHNICAL
AMEND-
MENTS.—Section 
1833(h)(5)(D) 
(42 
U.S.C.
1395l(h)(5)(D)) is amended—
(1) by striking ‘‘paragraphs (2) and (3)’’ and
by inserting ‘‘paragraph (2)’’; and
(2) by adding at the end the following: ‘‘Para-
graph (4) of such section shall apply in this sub-
paragraph in the same manner as such paragraph
applies to such section.’’.
(f) EFFECTIVE DATES.—
(1) 
ENFORCEMENT; 
MISCELLANEOUS
AND
TECHNICAL AMENDMENTS.—The amendments made
by subsections (a) and (e) shall apply to services fur-
nished on or after the date of the enactment of this
Act; except that the amendments made by sub-
section (a) shall not apply to services of a
nonparticipating supplier or other person furnished
before January 1, 1995.
(2) PRACTITIONERS.—The amendments made
by subsection (b) shall apply to services furnished on
or after January 1, 1995.
(3) EOMBS.—The amendments made by sub-
section (c)(1) shall apply to explanations of benefits
provided on or after July 1, 1995.
(4) CARRIER
DETERMINATIONS.—The amend-
ments made by subsection (c)(2) shall apply to con-
tracts as of January 1, 1995.
(5) REPORT.—The amendment made by sub-
section (d) shall apply to reports for years beginning
with 1995.
SEC. 124. RELATIVE VALUES FOR PEDIATRIC SERVICES.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall fully develop, by not later than July
1, 1995, relative values for the full range of pediatric phy-
sicians’ services which are consistent with the relative val-
ues developed for other physicians’ services under section
1848(c) of the Social Security Act. In developing such val-
ues, the Secretary shall conduct such refinements as may
be necessary to produce appropriate estimates for such rel-
ative values.
(b) STUDY.—
(1) IN GENERAL.—The Secretary shall conduct
a study of the relative values for pediatric and other
services to determine whether there are significant
variations in the resources used in providing similar
services to different populations. In conducting such
study, the Secretary shall consult with appropriate
organizations representing pediatricians and other
physicians and physical and occupational therapists.
(2) REPORT.—Not later than July 1, 1995, the
Secretary shall submit to Congress a report on the
study conducted under paragraph (1). Such report
shall include any appropriate recommendations re-
garding needed changes in coding or other payment
policies to ensure that payments for pediatric serv-
ices appropriately reflect the resources required to
provide these services.
SEC. 125. ADMINISTRATION OF CLAIMS RELATING TO PHY-
SICIANS’ SERVICES.
(a) LIMITATION ON CARRIER USER FEES.—Section
1842(c) (42 U.S.C. 1395u(c)) is amended by adding at
the end the following new paragraph:
‘‘(4) Neither a carrier nor the Secretary may impose
a fee under this title—
‘‘(A) for the filing of claims related to physi-
cians’ services,
‘‘(B) for an error in filing a claim relating to
physicians’ services or for such a claim which is de-
nied,
‘‘(C) for any appeal under this title with respect
to physicians’ services,
‘‘(D) for applying for (or obtaining) a unique
identifier under subsection (r), or
‘‘(E) for responding to inquiries respecting phy-
sicians’ services or for providing information with re-
spect to medical review of such services.’’.
(b) CLARIFICATION OF PERMISSIBLE SUBSTITUTE
BILLING ARRANGEMENTS.—
(1) IN
GENERAL.—Clause (D) of section
1842(b)(6) (42 U.S.C. 1395u(b)(6)) is amended to
read as follows: ‘‘(D) payment may be made to a
physician for physicians’ services (and services fur-
nished incident to such services) furnished by a sec-
ond physician to patients of the first physician if (i)
the first physician is unavailable to provide the serv-
ices; (ii) the services are furnished pursuant to an
arrangement between the two physicians that (I) is
informal and reciprocal, or (II) involves per diem or
other fee-for-time compensation for such services;
(iii) the services are not provided by the second phy-
sician over a continuous period of more than 60
days; and (iv) the claim form submitted to the car-
rier for such services includes the second physician’s
unique identifier (provided under the system estab-
lished under subsection (r)) and indicates that the
claim meets the requirements of this subparagraph
for payment to the first physician’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to services furnished on
or after the first day of the first month beginning
more than 60 days after the date of the enactment
of this Act.
SEC. 126. MISCELLANEOUS AND TECHNICAL CORRECTIONS.
(a) 
OVERVALUED
PROCEDURES.—(1) 
Section
1842(b)(16)(B)(iii) (42 U.S.C. 1395u(b)(16)(B)(iii)) is
amended—
(A) by striking ‘‘, simple and subcutaneous’’,
(B) by striking ‘‘; small’’ and inserting ‘‘and
small’’,
(C) by striking ‘‘treatments;’’ the first place it
appears and inserting ‘‘and’’,
(D) by striking ‘‘lobectomy;’’,
(E) by striking ‘‘enterectomy; colectomy; chole-
cystectomy;’’,
(F) by striking ‘‘; transurerethral resection’’
and inserting ‘‘and resection’’, and
(G) by striking ‘‘sacral laminectomy;’’.
(2) Section 4101(b)(2) of OBRA–1990 is amended—
(A) in the matter before subparagraph (A), by
striking 
‘‘1842(b)(16)’’ 
and 
inserting
‘‘1842(b)(16)(B)’’, and
(B) in subparagraph (B)—
(i) by striking ‘‘, simple and subcutane-
ous’’,
(ii) by striking ‘‘(HCPCS codes 19160 and
19162)’’ and inserting ‘‘(HCPCS code 19160)’’,
and
(iii) by striking all that follows ‘‘(HCPCS
codes 92250’’ and inserting ‘‘and 92260).’’.
(b) RADIOLOGY SERVICES.—(1) Section 1834(b)(4)
(42 U.S.C. 1395m(b)(4)) is amended by redesignating the
subparagraphs (E) and (F) redesignated by section
4102(a)(1) of OBRA–1990 as subparagraphs (F) and
(G), respectively.
(2) 
Section 
1834(b)(4)(D) 
(42 
U.S.C.
1395m(b)(4)(D)) is amended—
(A) in the matter before clause (i), by striking
‘‘shall be determined as follows:’’ and inserting
‘‘shall, subject to clause (vii), be reduced to the ad-
justed conversion factor for the locality determined
as follows:’’,
(B) in clause (iv), by striking ‘‘LOCAL ADJUST-
MENT.—Subject to clause (vii), the conversion factor
to be applied to’’ and inserting ‘‘ADJUSTED CONVER-
SION FACTOR.—The adjusted conversion factor for’’,
(C) in clause (vii), by striking ‘‘under this sub-
paragraph’’, and
(D) in clause (vii), by inserting ‘‘reduced under
this subparagraph by’’ after ‘‘shall not be’’.
(3) Section 4102(c)(2) of OBRA–1990 is amended
by striking ‘‘radiology services’’ and all that follows and
inserting ‘‘nuclear medicine services.’’.
(4) Section 4102(d) of OBRA–1990 is amended by
striking ‘‘new paragraph’’ and inserting ‘‘new subpara-
graph’’.
(5) 
Section 
1834(b)(4)(E) 
(42 
U.S.C.
1395m(b)(4)(E)) is amended by inserting ‘‘RULE FOR
CERTAIN SCANNING SERVICES.—’’ after ‘‘(E)’’.
(6) Section 1848(a)(2)(D)(iii) (42 U.S.C. 1395w–
4(a)(2)(D)(iii)) is amended by striking ‘‘that are subject
to section 6105(b) of the Omnibus Budget Reconciliation
Act of 1989’’ and by striking ‘‘provided under such sec-
tion’’ and inserting ‘‘provided under section 6105(b) of the
Omnibus Budget Reconciliation Act of 1989’’.
(c) ANESTHESIA SERVICES.—(1) Section 4103(a) of
OBRA–1990 is amended by striking ‘‘REDUCTION IN FEE
SCHEDULE’’ and inserting ‘‘REDUCTION IN PREVAILING
CHARGES’’.
(2) 
Section 
1842(q)(1)(B) 
(42 
U.S.C.
1395u(q)(1)(B)) is amended—
(A) in the matter before clause (i), by striking
‘‘shall be determined as follows:’’ and inserting
‘‘shall, subject to clause (iv), be reduced to the ad-
justed prevailing charge conversion factor for the lo-
cality determined as follows:’’, and
(B) in clause (iii), by striking ‘‘Subject to
clause (iv), the prevailing charge conversion factor to
be applied in’’ and inserting ‘‘The adjusted prevail-
ing charge conversion factor for’’.
(d) ASSISTANTS AT SURGERY.—(1) Section 4107(c)
of OBRA–1990 is amended by inserting ‘‘(a)(1)’’ after
‘‘subsection’’.
(2) Section 4107(a)(2) of OBRA–1990 is amended
by adding at the end the following: ‘‘In applying section
1848(g)(2)(D) of the Social Security Act for services of
an assistant-at-surgery furnished during 1991, the recog-
nized payment amount shall not exceed the maximum
amount specified under section 1848(i)(2)(A) of such Act
(as applied under this paragraph in such year).’’.
(e) TECHNICAL COMPONENTS OF DIAGNOSTIC SERV-
ICES.—Section 1842(b) (42 U.S.C. 1395u(b)) is amended
by redesignating paragraph (18), as added by section
4108(a) of OBRA–1990, as paragraph (17) and, in such
paragraph, by inserting ‘‘, tests specified in paragraph
(14)(C)(i),’’ after ‘‘diagnostic laboratory tests’’.
(f) STATEWIDE FEE SCHEDULES.—Section 4117 of
OBRA–1990 is amended—
(1) in subsection (a)—
(A) by striking ‘‘(a) IN GENERAL.—’’, and
(B) by striking ‘‘, if the’’ and all that fol-
lows through ‘‘1991,’’; and
(2) by striking subsections (b), (c), and (d).
(g) 
OTHER
MISCELLANEOUS
AND
TECHNICAL
AMENDMENTS.—(1) The heading of section 1834(f) (42
U.S.C. 1395m(f)) is amended by striking ‘‘FISCAL YEAR’’.
(2)(A) Section 4105(b) of OBRA–1990 is amended—
(i) in paragraph (2), by striking ‘‘amendments’’
and inserting ‘‘amendment’’, and
(ii) in paragraph (3), by striking ‘‘amendments
made by paragraphs (1) and (2)’’ and inserting
‘‘amendment made by paragraph (1)’’.
(B) Section 1848(f)(2)(C) (42 U.S.C. 1395w–
4(f)(2)(C)) is amended by inserting ‘‘PERFORMANCE
STANDARD
RATES
OF
INCREASE
FOR
FISCAL
YEAR
1991.—’’ after ‘‘(C)’’.
(C) Section 4105(d) of OBRA–1990 is amended by
inserting ‘‘PUBLICATION OF PERFORMANCE STANDARD
RATES.—’’ after ‘‘(d)’’.
(3) Section 4106(c) of OBRA–1990 is amended by
inserting 
‘‘of 
the 
Social 
Security 
Act’’ 
after
‘‘1848(d)(1)(B)’’.
(4) Section 4114 of OBRA–1990 is amended by
striking ‘‘patients’’ the second place it appears.
(5) Section 1848(e)(1)(C) (42 U.S.C. 1395w–
4(e)(1)(C)) is amended by inserting ‘‘date of the’’ after
‘‘since the’’.
(6) Section 4118(f)(1)(D) of OBRA–1990 is amend-
ed by striking ‘‘is amended’’.
(7) Section 4118(f)(1)(N)(ii) of OBRA–1990 is
amended by striking ‘‘subsection (f)(5)(A)’’ and inserting
‘‘subsection (f)(5)(A))’’.
(8) Section 1845(e) (42 U.S.C. 1395w–1(e)) is
amended—
(A) by striking paragraph (2); and
(B) by redesignating paragraphs (3), (4), and
(5) as paragraphs (2), (3), and (4).
(9) Section 4118(j)(2) of OBRA–1990 is amended by
striking ‘‘In section’’ and inserting ‘‘Section’’.
(10)(A) Section 1848(i)(3) (42 U.S.C. 1395w–
4(i)(3)) is amended by striking the space before the period
at the end.
(B) 
Section 
1834(a)(10)(B) 
(42 
U.S.C.
1395m(a)(10)(B)) is amended—
(i) by striking ‘‘apply to’’ and inserting ‘‘would
otherwise apply to’’, and
(ii) by inserting before the period at the end
‘‘but for the application of section 1848(i)(3)’’.
(h) OTHER CORRECTIONS.—(1) Effective on the date
of the enactment of this Act, section 6102(d)(4) of
OBRA–1989 is amended by striking all that follows the
first sentence.
(2) Effective for payments for fiscal years beginning
with fiscal year 1994, section 1842(c)(1) (42 U.S.C.
1395u(c)(1)) is amended—
(A) in subparagraph (A), by striking ‘‘(A) Any
contract’’ and inserting ‘‘Any contract’’; and
(B) by striking subparagraph (B).
(i) EFFECTIVE DATE.—Except as provided in sub-
section (i), the amendments made by this section and the
provisions of this section shall take effect as if included
in the enactment of OBRA–1990.
PART II—DURABLE MEDICAL EQUIPMENT
SEC. 131. CERTIFICATION OF SUPPLIERS.
(a) REQUIREMENTS.—
(1) IN
GENERAL.—Section 1834 (42 U.S.C.
1395m), as amended by section 13544(b)(1) of
OBRA–1993, is amended by adding at the end the
following new subsection:
‘‘(j) REQUIREMENTS FOR SUPPLIERS OF MEDICAL
EQUIPMENT AND SUPPLIES.—
‘‘(1) ISSUANCE
AND
RENEWAL
OF
SUPPLIER
NUMBER.—
‘‘(A) PAYMENT.—Except as provided in
subparagraph (C), no payment may be made
under this part after the date of the enactment
of the Social Security Act Amentments of 1994
for items furnished by a supplier of medical
equipment and supplies unless such supplier ob-
tains (and renews at such intervals as the Sec-
retary may require) a supplier number.
‘‘(B) STANDARDS FOR POSSESSING A SUP-
PLIER NUMBER.—A supplier may not obtain a
supplier number unless—
‘‘(i) for medical equipment and sup-
plies furnished on or after the date of en-
actment of the Social Security Act Amend-
ments of 1994, and before January 1,
1996, the supplier meets standards pre-
scribed by the Secretary in regulations is-
sued on June 18, 1992; and
‘‘(ii) for medical equipment and sup-
plies furnished on or after January 1,
1996, the supplier meets revised standards
prescribed by the Secretary (in consulta-
tion with representatives of suppliers of
medical equipment and supplies, carriers,
and consumers) that shall include require-
ments that the supplier—
‘‘(I) comply with all applicable
State and Federal licensure and regu-
latory requirements;
‘‘(II) maintain a physical facility
on an appropriate site;
‘‘(III) have proof of appropriate
liability insurance; and
‘‘(IV) meet such other require-
ments as the Secretary may specify.
‘‘(C) EXCEPTION FOR ITEMS FURNISHED
AS
INCIDENT
TO
A
PHYSICIAN’S
SERVICE.—
Subparagraph (A) shall not apply with respect
to medical equipment and supplies furnished in-
cident to a physician’s service.
‘‘(D) PROHIBITION
AGAINST
MULTIPLE
SUPPLIER NUMBERS.—The Secretary may not
issue more than one supplier number to any
supplier of medical equipment and supplies un-
less the issuance of more than one number is
appropriate to identify subsidiary or regional
entities under the supplier’s ownership or con-
trol.
‘‘(E) PROHIBITION AGAINST DELEGATION
OF
SUPPLIER
DETERMINATIONS.—The Sec-
retary may not delegate (other than by contract
under section 1842) the responsibility to deter-
mine whether suppliers meet the standards nec-
essary to obtain a supplier number.
‘‘(2) CERTIFICATES OF MEDICAL NECESSITY.—
‘‘(A) LIMITATION ON INFORMATION PRO-
VIDED
BY
SUPPLIERS
ON
CERTIFICATES
OF
MEDICAL NECESSITY.—
‘‘(i) IN GENERAL.—Effective 60 days
after the date of enactment of the Social
Security Act Amendments of 1994, a sup-
plier of medical equipment and supplies
may distribute to physicians, or to individ-
uals entitled to benefits under this part, a
certificate of medical necessity for commer-
cial purposes which contains no more than
the following information completed by the
supplier:
‘‘(I) An identification of the sup-
plier and the beneficiary to whom
such medical equipment and supplies
are furnished.
‘‘(II) A description of such medi-
cal equipment and supplies.
‘‘(III) Any product code identify-
ing such medical equipment and sup-
plies.
‘‘(IV) Any other administrative
information (other than information
relating to the beneficiary’s medical
condition) identified by the Secretary.
‘‘(ii) 
INFORMATION
ON
PAYMENT
AMOUNT AND CHARGES.—If a supplier dis-
tributes a certificate of medical necessity
containing any of the information per-
mitted to be supplied under clause (i), the
supplier shall also list on the certificate of
medical necessity the fee schedule amount
and the supplier’s charge for the medical
equipment or supplies being furnished
prior to distribution of such certificate to
the physician.
‘‘(iii) PENALTY.—Any supplier of
medical equipment and supplies who know-
ingly and willfully distributes a certificate
of medical necessity in violation of clause
(i) or fails to provide the information re-
quired under clause (ii) is subject to a civil
money penalty in an amount not to exceed
$1,000 for each such certificate of medical
necessity so distributed. The provisions of
section 1128A (other than subsections (a)
and (b)) shall apply to civil money pen-
alties under this subparagraph in the same
manner as they apply to a penalty or pro-
ceeding under section 1128A(a).
‘‘(B) DEFINITION.—For purposes of this
paragraph, the term ‘certificate of medical ne-
cessity’ means a form or other document con-
taining information required by the carrier to
be submitted to show that an item is reasonable
and necessary for the diagnosis or treatment of
illness or injury or to improve the functioning
of a malformed body member.
‘‘(3) COVERAGE AND REVIEW CRITERIA.—The
Secretary shall annually review the coverage and uti-
lization of items of medical equipment and supplies
to determine whether such items should be made
subject to coverage and utilization review criteria,
and if appropriate, shall develop and apply such cri-
teria to such items.
‘‘(4) DEFINITION.—The term ‘medical equip-
ment and supplies’ means—
‘‘(A) durable medical equipment (as de-
fined in section 1861(n));
‘‘(B) prosthetic devices (as described in
section 1861(s)(8));
‘‘(C) orthotics and prosthetics (as de-
scribed in section 1861(s)(9));
‘‘(D) surgical dressings (as described in
section 1861(s)(5));
‘‘(E) such other items as the Secretary
may determine; and
‘‘(F) for purposes of paragraphs (1) and
(3)—
‘‘(i) home dialysis supplies and equip-
ment 
(as 
described 
in 
section
1861(s)(2)(F)),
‘‘(ii) immunosuppressive drugs (as de-
scribed in section 1861(s)(2)(J)),
‘‘(iii) therapeutic shoes for diabetics
(as described in section 1861(s)(12)),
‘‘(iv) oral drugs prescribed for use as
an anticancer therapeutic agent (as de-
scribed in section 1861(s)(2)(Q)), and
‘‘(v) self-administered erythropoetin
(as described in section 1861(s)(2)(P)).’’.
(2) CONFORMING
AMENDMENT.—Effective 60
days after the date of enactment of the Social Secu-
rity Act Amendments of 1994, paragraph (16) of
section 1834(a) (42 U.S.C. 1395m(a)) is repealed.
(b) USE OF COVERED ITEMS BY DISABLED BENE-
FICIARIES.—
(1) IN GENERAL.—The Secretary of Health and
Human Services, in consultation with representa-
tives of suppliers of durable medical equipment
under part B of the medicare program and individ-
uals entitled to benefits under such program on the
basis of disability, shall conduct a study of the ef-
fects of the methodology for determining payments
for items of such equipment under such part on the
ability of such individuals to obtain items of such
equipment, including customized items.
(2) REPORT.—Not later than one year after the
date of the enactment of this Act, the Secretary
shall submit a report to Congress on the study con-
ducted under paragraph (1), and shall include in the
report such recommendations as the Secretary con-
siders appropriate to assure that disabled medicare
beneficiaries have access to items of durable medical
equipment.
(c) CRITERIA FOR TREATMENT OF ITEMS AS PROS-
THETIC DEVICES OR ORTHOTICS AND PROSTHETICS.—
Not later than one year after the date of the enactment
of this Act, the Secretary of Health and Human Services
shall submit a report to the Committees on Ways and
Means and Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the Senate
describing prosthetic devices or orthotics and prosthetics
covered under part B of the medicare program that do
not require individualized or custom fitting and adjust-
ment to be used by a patient. Such report shall include
recommendations for an appropriate methodology for de-
termining the amount of payment for such items under
such program.
SEC. 132. RESTRICTIONS ON CERTAIN MARKETING AND
SALES ACTIVITIES.
(a) PROHIBITING UNSOLICITED TELEPHONE CON-
TACTS FROM SUPPLIERS OF DURABLE MEDICAL EQUIP-
MENT TO MEDICARE BENEFICIARIES.—
(1) IN GENERAL.—Section 1834(a) (42 U.S.C.
1395m(a)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(17) PROHIBITION
AGAINST
UNSOLICITED
TELEPHONE CONTACTS BY SUPPLIERS.—
‘‘(A) IN GENERAL.—A supplier of a cov-
ered item under this subsection may not contact
an individual enrolled under this part by tele-
phone regarding the furnishing of a covered
item to the individual unless 1 of the following
applies:
‘‘(i) The individual has given written
permission to the supplier to make contact
by telephone regarding the furnishing of a
covered item.
‘‘(ii) The supplier has furnished a cov-
ered item to the individual and the supplier
is contacting the individual only regarding
the furnishing of such covered item.
‘‘(iii) If the contact is regarding the
furnishing of a covered item other than a
covered item already furnished to the indi-
vidual, the supplier has furnished at least
1 covered item to the individual during the
15-month period preceding the date on
which the supplier makes such contact.
‘‘(B) PROHIBITING PAYMENT FOR ITEMS
FURNISHED
SUBSEQUENT
TO
UNSOLICITED
CONTACTS.—If a supplier knowingly contacts
an individual in violation of subparagraph (A),
no payment may be made under this part for
any item subsequently furnished to the individ-
ual by the supplier.
‘‘(C) EXCLUSION
FROM
PROGRAM
FOR
SUPPLIERS ENGAGING IN PATTERN OF UNSO-
LICITED
CONTACTS.—If a supplier knowingly
contacts individuals in violation of subpara-
graph (A) to such an extent that the supplier’s
conduct establishes a pattern of contacts in vio-
lation of such subparagraph, the Secretary shall
exclude the supplier from participation in the
programs under this Act, in accordance with
the procedures set forth in subsections (c), (f),
and (g) of section 1128.’’.
(2) REQUIRING
REFUND
OF
AMOUNTS
COL-
LECTED FOR DISALLOWED ITEMS.—Section 1834(a)
(42 U.S.C. 1395m(a)), as amended by paragraph
(1), is amended by adding at the end the following
new paragraph:
‘‘(18) REFUND OF AMOUNTS COLLECTED FOR
CERTAIN DISALLOWED ITEMS.—
‘‘(A) IN GENERAL.—If a nonparticipating
supplier furnishes to an individual enrolled
under this part a covered item for which no
payment may be made under this part by rea-
son of paragraph (17)(B), the supplier shall re-
fund on a timely basis to the patient (and shall
be liable to the patient for) any amounts col-
lected from the patient for the item, unless—
‘‘(i) the supplier establishes that the
supplier did not know and could not rea-
sonably have been expected to know that
payment may not be made for the item by
reason of paragraph (17)(B), or
‘‘(ii) before the item was furnished,
the patient was informed that payment
under this part may not be made for that
item and the patient has agreed to pay for
that item.
‘‘(B) SANCTIONS.—If a supplier knowingly
and willfully fails to make refunds in violation
of subparagraph (A), the Secretary may apply
sanctions against the supplier in accordance
with section 1842(j)(2).
‘‘(C) NOTICE.—Each carrier with a con-
tract in effect under this part with respect to
suppliers of covered items shall send any notice
of denial of payment for covered items by rea-
son of paragraph (17)(B) and for which pay-
ment is not requested on an assignment-related
basis to the supplier and the patient involved.
‘‘(D) TIMELY BASIS DEFINED.—A refund
under subparagraph (A) is considered to be on
a timely basis only if—
‘‘(i) in the case of a supplier who does
not request reconsideration or seek appeal
on a timely basis, the refund is made with-
in 30 days after the date the supplier re-
ceives a denial notice under subparagraph
(C), or
‘‘(ii) in the case in which such a re-
consideration or appeal is taken, the re-
fund is made within 15 days after the date
the supplier receives notice of an adverse
determination on reconsideration or ap-
peal.’’.
(b) CONFORMING AMENDMENT.—Section 1834(h)(3)
(42 U.S.C. 1395m(h)(3)) is amended by striking ‘‘Para-
graph (12)’’ and inserting ‘‘Paragraphs (12) and (17)’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to items furnished after
the expiration of the 60-day period that begins on the date
of the enactment of this Act.
SEC. 133. BENEFICIARY LIABILITY FOR NONCOVERED
SERVICES.
(a) UNASSIGNED CLAIMS.—
(1) IN GENERAL.—Section 1834(j) (42 U.S.C.
1395m(i)), as added by section 131(a)(1), is amend-
ed—
(A) by redesignating paragraph (4) as
paragraph (5), and
(B) by inserting after paragraph (3) the
following new paragraph:
‘‘(4) LIMITATION ON PATIENT LIABILITY.—If a
supplier of medical equipment and supplies (as de-
fined in paragraph (5))—
‘‘(A) furnishes an item or service to a ben-
eficiary for which no payment may be made by
reason of paragraph (1);
‘‘(B) furnishes an item or service to a ben-
eficiary for which payment is denied in advance
under subsection (a)(15); or
‘‘(C) furnishes an item or service to a ben-
eficiary for which payment is denied under sec-
tion 1862(a)(1);
any expenses incurred for items and services fur-
nished to an individual by such a supplier not on an
assigned basis shall be the responsibility of such
supplier. The individual shall have no financial re-
sponsibility for such expenses and the supplier shall
refund on a timely basis to the individual (and shall
be liable to the individual for) any amounts collected
from the individual for such items or services. The
provisions of subsection (a)(18) shall apply to re-
funds required under the previous sentence in the
same manner as such provisions apply to refunds
under such subsection.’’.
(2) 
CONFORMING
AMENDMENT.—Section
1128B(b)(3)(B) (42 U.S.C. 1320a–7b(b)(3)(B)), as
amended by section 134(a), is amended by striking
‘‘1834(j)(4)’’ and inserting ‘‘1834(j)(5)’’.
(b) ASSIGNED CLAIMS.—Section 1879 (42 U.S.C.
1395pp) is amended by adding at the end the following
new subsection:
‘‘(h) If a supplier of medical equipment and supplies
(as defined in section 1834(j)(5))—
‘‘(1) furnishes an item or service to a bene-
ficiary for which no payment may be made by reason
of section 1834(j)(1);
‘‘(2) furnishes an item or service to a bene-
ficiary for which payment is denied in advance under
section 1834(a)(15); or
‘‘(3) furnishes an item or service to a bene-
ficiary for which no payment may be made by reason
of section 1834(a)(17)(B),
any expenses incurred for items and services furnished to
an individual by such a supplier on an assignment-related
basis shall be the responsibility of such supplier. The indi-
vidual shall have no financial responsibility for such ex-
penses and the supplier shall refund on a timely basis to
the individual (and shall be liable to the individual for)
any amounts collected from the individual for such items
or services. The provisions of section 1834(a)(18) shall
apply to refunds required under the previous sentence in
the same manner as such provisions apply to refunds
under such section.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to items or services furnished on
or after January 1, 1995.
SEC. 134. ADJUSTMENTS FOR INHERENT REASONABLE-
NESS.
(a) ADJUSTMENTS
MADE
TO
FINAL
PAYMENT
AMOUNTS.—
(1) IN GENERAL.—Section 1834(a)(10)(B) (42
U.S.C. 1395m(a)(10)(B)) is amended by adding at
the end the following: ‘‘In applying such provisions
to payments for an item under this subsection, the
Secretary shall make adjustments to the payment
basis for the item described in paragraph (1)(B) if
the Secretary determines (in accordance with such
provisions and on the basis of prices and costs appli-
cable at the time the item is furnished) that such
payment basis is not inherently reasonable.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall take effect on the date of the
enactment of this Act.
(b) ADJUSTMENT REQUIRED FOR CERTAIN ITEMS.—
(1) IN GENERAL.—In accordance with section
1834(a)(10)(B) of the Social Security Act (as
amended by subsection (a)), the Secretary of Health
and Human Services shall determine whether the
payment amounts for the items described in para-
graph (2) are not inherently reasonable, and shall
adjust such amounts in accordance with such section
if the amounts are not inherently reasonable.
(2) ITEMS DESCRIBED.—The items referred to
in paragraph (1) are decubitus care equipment,
transcutaneous electrical nerve stimulators, and any
other items considered appropriate by the Secretary.
SEC. 135. MISCELLANEOUS AND TECHNICAL CORRECTIONS.
(a) UPDATES TO PAYMENT AMOUNTS.—(1) Subpara-
graph 
(A) 
of 
section 
1834(a)(14) 
(42 
U.S.C.
1395m(a)(14)) is amended to read as follows:
‘‘(A) for 1991 and 1992, the percentage
increase in the consumer price index for all
urban consumers (U.S. city average) for the 12-
month period ending with June of the previous
year reduced by 1 percentage point; and’’.
(2) The amendment made by paragraph (1) shall be
effective on the date of the enactment of this Act.
(b) ADVANCE DETERMINATIONS OF COVERAGE.—(1)
Effective on the date of the enactment of this Act, section
1834(a)(15) (42 U.S.C. 1395m(a)(15)) is amended to
read as follows:
‘‘(15) ADVANCE
DETERMINATIONS
OF
COV-
ERAGE FOR CERTAIN ITEMS.—
‘‘(A) DEVELOPMENT OF LISTS OF ITEMS
BY SECRETARY.—The Secretary may develop
and periodically update a list of items for which
payment may be made under this subsection
that the Secretary determines, on the basis of
prior payment experience, are frequently subject
to unnecessary utilization throughout a carrier’s
entire service area or a portion of such area.
‘‘(B) DEVELOPMENT OF LISTS OF SUPPLI-
ERS BY SECRETARY.—The Secretary may de-
velop and periodically update a list of suppliers
of items for which payment may be made under
this subsection with respect to whom—
‘‘(i) the Secretary has found that a
substantial number of claims for payment
under this part for items furnished by the
supplier have been denied on the basis of
the application of section 1862(a)(1); or
‘‘(ii) the Secretary has identified a
pattern of overutilization resulting from
the business practice of the supplier.
‘‘(C) DETERMINATIONS OF COVERAGE IN
ADVANCE.—A carrier shall determine in ad-
vance of delivery of an item whether payment
for the item may not be made because the item
is not covered or because of the application of
section 1862(a)(1) if—
‘‘(i) the item is included on the list
developed by the Secretary under subpara-
graph (A);
‘‘(ii) the item is furnished by a sup-
plier included on the list developed by the
Secretary under subparagraph (B); or
‘‘(iii) the item is a customized item
(other than inexpensive items specified by
the Secretary) and the patient to whom the
item is to be furnished or the supplier re-
quests that such advance determination be
made.’’.
(2) Effective for standards applied for contract years
beginning after the date of the enactment of this Act, sec-
tion 1842(c) (42 U.S.C. 1395u(c)), as amended by section
125(a), is amended by adding at the end the following new
paragraph:
‘‘(5) Each contract under this section which provides
for the disbursement of funds, as described in subsection
(a)(1)(B), shall require the carrier to meet criteria devel-
oped by the Secretary to measure the timeliness of carrier
responses to requests for payment of items described in
section 1834(a)(15)(C).’’.
(3) Effective on the date of the enactment of this Act,
section 1834(h)(3) (42 U.S.C. 1395m(h)(3)), as amended
by section 133(b), is amended by striking ‘‘(12) and (17)’’
and inserting ‘‘(12), (15), and (17)’’.
(c) STUDY OF VARIATIONS IN DURABLE MEDICAL
EQUIPMENT SUPPLIER COSTS.—
(1) COLLECTION AND ANALYSIS OF SUPPLIER
COST DATA.—The Administrator of the Health Care
Financing Administration shall, in consultation with
appropriate organizations, collect data on supplier
costs of durable medical equipment for which pay-
ment may be made under part B of the medicare
program, and shall analyze such data to determine
the proportions of such costs attributable to the
service and product components of furnishing such
equipment and the extent to which such proportions
vary by type of equipment and by the geographic re-
gion in which the supplier is located.
(2) DEVELOPMENT
OF
GEOGRAPHIC
ADJUST-
MENT
INDEX; REPORTS.—Not later than July 1,
1995—
(A) the Administrator shall submit a re-
port to the Committees on Energy and Com-
merce and Ways and Means of the House of
Representatives and the Committee on Finance
of the Senate on the data collected and the
analysis conducted under paragraph (1), and
shall include in such report the Administrator’s
recommendations for a geographic cost adjust-
ment index for suppliers of durable medical
equipment under the medicare program and an
analysis of the impact of such proposed index
on payments under the medicare program; and
(B) the Comptroller General shall submit a
report to the Committees on Energy and Com-
merce and Ways and Means of the House of
Representatives and the Committee on Finance
of the Senate analyzing on a geographic basis
the supplier costs of durable medical equipment
under the medicare program.
(d) 
OXYGEN
RETESTING.—(1) 
Section
1834(a)(5)(E) (42 U.S.C. 1395m(a)(5)(E)) is amended by
striking ‘‘55’’ and inserting ‘‘56’’.
(2) The amendment made by paragraph (1) shall be
effective on the date of the enactment of this Act.
(e) 
OTHER
MISCELLANEOUS
AND
TECHNICAL
AMENDMENTS.—(1) Section 4152(a)(3) of OBRA–1990
is amended by striking ‘‘amendment made by subsection
(a)’’ and inserting ‘‘amendments made by this sub-
section’’.
(2) Section 4152(c)(2) of OBRA–1990 is amended
by 
striking 
‘‘1395m(a)(7)(A)’’ 
and 
inserting
‘‘1395m(a)(7)’’.
(3) 
Section 
1834(a)(7)(A)(iii)(II) 
(42 
U.S.C.
1395m(a)(7)(A)(iii)(II)) is amended by striking ‘‘clause
(v)’’ and inserting ‘‘clause (vi)’’.
(4) 
Section 
1834(a)(7)(C)(i) 
(42 
U.S.C.
1395m(a)(7)(C)(i)) is amended by striking ‘‘or paragraph
(3)’’.
(5) Section 1834(a)(3) (42 U.S.C. 1395m(a)(3)) is
amended by striking subparagraph (D).
(6) Section 4153(c)(1) of OBRA–1990 is amended
by striking ‘‘1834(a)’’ and inserting ‘‘1834(h)’’.
(7) Section 4153(d)(2) of OBRA–1990 is amended
by striking ‘‘Reconiliation’’ and inserting ‘‘Reconcili-
ation’’.
(8) The amendments made by this subsection shall
take effect as if included in the enactment of OBRA–1990.
PART III—OTHER ITEMS AND SERVICES
SEC. 141. AMBULATORY SURGICAL CENTER SERVICES.
(a) PAYMENT AMOUNTS FOR SERVICES FURNISHED
IN AMBULATORY SURGICAL CENTERS.—
(1) USE OF SURVEY TO DETERMINE INCURRED
COSTS.—Section 
1833(i)(2)(A)(i) 
(42 
U.S.C.
1395l(i)(2)(A)(i)) is amended by striking the comma
at the end and inserting the following: ‘‘, as deter-
mined in accordance with a survey (based upon a
representative sample of procedures and facilities)
taken not later than January 1, 1995, and every 5
years thereafter, of the actual audited costs incurred
by such centers in providing such services,’’.
(2) AUTOMATIC
APPLICATION
OF
INFLATION
ADJUSTMENT.—Section 
1833(i)(2) 
(42 
U.S.C.
1395l(i)(2)) is amended—
(A) in the second sentence of subpara-
graph (A) and the second sentence of subpara-
graph (B), by striking ‘‘and may be adjusted by
the Secretary, when appropriate,’’; and
(B) by adding at the end the following new
subparagraph:
‘‘(C) Notwithstanding the second sentence of sub-
paragraph (A) or the second sentence of subparagraph
(B), if the Secretary has not updated amounts established
under such subparagraphs with respect to facility services
furnished during a fiscal year (beginning with fiscal year
1996), such amounts shall be increased by the percentage
increase in the consumer price index for all urban consum-
ers (U.S. city average) as estimated by the Secretary for
the 12-month period ending with the midpoint of the year
involved.’’.
(3) CONSULTATION
REQUIREMENT.—The sec-
ond sentence of section 1833(i)(1) (42 U.S.C.
1395l(i)(1)) is amended by striking the period and
inserting the following: ‘‘, in consultation with ap-
propriate trade and professional organizations.’’.
(b) ADJUSTMENTS TO PAYMENT AMOUNTS FOR NEW
TECHNOLOGY INTRAOCULAR LENSES.—
(1) ESTABLISHMENT OF PROCESS FOR REVIEW
OF AMOUNTS.—Not later than 1 year after the date
of the enactment of this Act, the Secretary of
Health and Human Services (in this subsection re-
ferred to as the ‘‘Secretary’’) shall develop and im-
plement a process under which interested parties
may request review by the Secretary of the appro-
priateness of the reimbursement amount provided
under section 1833(i)(2)(A)(iii) of the Social Secu-
rity Act with respect to a class of new technology
intraocular lenses. For purposes of the preceding
sentence, an intraocular lens may not be treated as
a new technology lens unless it has been approved
by the Food and Drug Administration.
(2) FACTORS
CONSIDERED.—In determining
whether to provide an adjustment of payment with
respect to a particular lens under paragraph (1), the
Secretary shall take into account whether use of the
lens is likely to result in reduced risk of
intraoperative or postoperative complication or trau-
ma, accelerated postoperative recovery, reduced in-
duced astigmatism, improved postoperative visual
acuity, more stable postoperative vision, or other
comparable clinical advantages.
(3) NOTICE
AND
COMMENT.—The Secretary
shall publish notice in the Federal Register from
time to time (but no less often than once each year)
of a list of the requests that the Secretary has re-
ceived for review under this subsection, and shall
provide for a 30-day comment period on the lenses
that are the subjects of the requests contained in
such notice. The Secretary shall publish a notice of
the Secretary’s determinations with respect to intra-
ocular lenses listed in the notice within 90 days after
the close of the comment period.
(4) EFFECTIVE DATE OF ADJUSTMENT.—Any
adjustment of a payment amount (or payment limit)
made under this subsection shall become effective
not later than 30 days after the date on which the
notice with respect to the adjustment is published
under paragraph (3).
(c) TECHNICAL CORRECTION RELATING TO BLEND
AMOUNTS FOR AMBULATORY SURGICAL CENTER PAY-
MENTS.—
(1) IN GENERAL.—Subclauses (I) and (II) of
section 
1833(i)(3)(B)(ii) 
(42 
U.S.C.
1395l(i)(3)(B)(ii)) are each amended—
(A) by striking ‘‘for reporting’’ and insert-
ing ‘‘for portions of cost reporting’’; and
(B) by striking ‘‘and on or before’’ and in-
serting ‘‘and ending on or before’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) shall take effect as if included in
the enactment of OBRA–1990.
(d) TECHNICAL CORRECTION RELATED TO CATA-
RACT SURGERY.—Effective as if included in the enact-
ment of OBRA–1990, section 4151(c)(3) of such Act is
amended by striking ‘‘for the insertion of an intraocular
lens’’ and inserting ‘‘for an intraocular lens inserted’’.
SEC. 142. STUDY OF MEDICARE COVERAGE OF PATIENT
CARE COSTS ASSOCIATED WITH CLINICAL
TRIALS OF NEW CANCER THERAPIES.
(a) STUDY.—The Secretary of Health and Human
Services shall conduct a study of the effects of expressly
covering under the medicare program the patient care
costs for beneficiaries enrolled in clinical trials of new can-
cer therapies, where the protocol for the trial has been
approved by the National Cancer Institute or meets simi-
lar scientific and ethical standards, including approval by
an institutional review board. The study shall include—
(1) an estimate of the cost of such coverage,
taking into account the extent to which medicare
currently pays for such patient care costs in prac-
tice;
(2) an assessment of the extent to which such
clinical trials represent the best available treatment
for the patients involved and of the effects of partici-
pation in the trials on the health of such patients;
(3) an assessment of whether progress in devel-
oping new anticancer therapies would be assisted by
medicare coverage of such patient care costs; and
(4) an evaluation of whether there should be
special criteria for the admission of medicare bene-
ficiaries (on account of their age or physical condi-
tion) to clinical trials for which medicare would pay
the patient care costs.
(b) REPORT.—Not later than 2 years after the date
of the enactment of this Act, the Secretary of Health and
Human Services shall submit a report on the study con-
ducted under subsection (a) to the Committee on Ways
and Means and the Committee on Energy and Commerce
of the House of Representatives and the Committee on
Finance of the Senate. Such report shall include rec-
ommendations as to the coverage under the medicare pro-
gram of patient care costs of beneficiaries enrolled in clini-
cal trials of new cancer therapies.
SEC. 143. STUDY OF ANNUAL CAP ON AMOUNT OF MEDI-
CARE PAYMENT FOR OUTPATIENT PHYSICAL
THERAPY 
AND 
OCCUPATIONAL 
THERAPY
SERVICES.
(a) STUDY.—The Secretary of Health and Human
Services shall conduct a study of the appropriateness of
continuing an annual limitation on the amount of payment
for outpatient services of independently practicing physical
and occupational therapists under the medicare program.
(b) REPORT.—By not later than January 1, 1996,
the Secretary shall submit to the Committees on Energy
and Commerce and Ways and Means of the House of Rep-
resentatives and the Committee on Finance of the Senate
a report on the study conducted under subsection (a).
Such report shall include such recommendations for
changes in such annual limitation as the Secretary finds
appropriate.
SEC. 144. PAYMENT OF PART B PREMIUM LATE ENROLL-
MENT PENALTIES BY STATES.
Section 1839 (42 U.S.C. 1395r) is amended by add-
ing at the end the following new subsection:
‘‘(g)(1) Upon the request of a State, the Secretary
may enter into an agreement with the State under which
the State agrees to pay on a quarterly or other periodic
basis to the Secretary (to be deposited in the Treasury
to the credit of the Federal Supplementary Medical Insur-
ance Trust Fund) an amount equal to the amount of the
part B late enrollment premium increases with respect to
the premiums for eligible individuals (as defined in para-
graph (3)(A)).
‘‘(2) No part B late enrollment premium increase
shall apply to an eligible individual for premiums for
months for which the amount of such an increase is pay-
able under an agreement under paragraph (1).
‘‘(3) In this subsection:
‘‘(A) The term ‘eligible individual’ means an in-
dividual who is enrolled under this part B and who
is within a class of individuals specified in the agree-
ment under paragraph (1).
‘‘(B) The term ‘part B late enrollment premium
increase’ means any increase in a premium as a re-
sult of the application of subsection (b).’’.
SEC. 
145. 
APPLICATION 
OF 
MAMMOGRAPHY 
CERTIFI-
CATION REQUIREMENTS.
(a) SCREENING MAMMOGRAPHY.—Section 1834(c)
(42 U.S.C. 1395m(c)) is amended—
(1) in paragraph (1)(B), by striking ‘‘meets the
quality standards established under paragraph (3)’’
and inserting ‘‘is conducted by a facility that has a
certificate (or provisional certificate) issued under
section 354 of the Public Health Service Act’’;
(2) in paragraph (1)(C)(iii), by striking ‘‘para-
graph (4)’’ and inserting ‘‘paragraph (3)’’;
(3) by striking paragraph (3); and
(4) by redesignating paragraphs (4) and (5) as
paragraphs (3) and (4).
(b) 
DIAGNOSTIC
MAMMOGRAPHY.—Section
1861(s)(3) (42 U.S.C. 1395x(s)(3)) is amended by insert-
ing ‘‘and including diagnostic mammography if conducted
by a facility that has a certificate (or provisional certifi-
cate) issued under section 354 of the Public Health Serv-
ice Act’’ after ‘‘necessary’’.
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section
1862(a)(1)(F) (42 U.S.C. 1395y(a)(1)(F)) is amended by
striking ‘‘or which does not meet the standards established
under section 1834(c)(3)’’ and inserting ‘‘or which is not
conducted 
by 
a 
facility 
described 
in 
section
1834(c)(1)(B)’’.
(2) Section 1863 (42 U.S.C. 1395z) is amended by
striking ‘‘or whether screening mammography meets the
standards established under section 1834(c)(3),’’.
(3) The first sentence of section 1864(a) (42 U.S.C.
1395aa(a)) is amended by striking ‘‘, or whether screening
mammography meets the standards established under sec-
tion 1834(c)(3)’’.
(4) The third sentence of section 1865(a) (42 U.S.C.
1395bb(a)) is amended by striking ‘‘1834(c)(3),’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to mammography furnished by a
facility on and after the first date that the certificate re-
quirements of section 354(b) of the Public Health Service
Act apply to such mammography conducted by such facil-
ity.
SEC. 146. COVERAGE OF SERVICES OF SPEECH-LANGUAGE
PATHOLOGISTS AND AUDIOLOGISTS.
(a) SERVICES DEFINED.—Section 1861 (42 U.S.C.
1395x), as amended by section 148(f)(6)(E), is amended
by inserting after subsection (kk) the following new sub-
section:
‘‘Speech-Language Pathology Services; Audiology
Services
‘‘(ll)(1) The term ‘speech-language pathology serv-
ices’ means such speech, language, and related function
assessment and rehabilitation services furnished by a
qualified speech-language pathologist as the speech-lan-
guage pathologist is legally authorized to perform under
State law (or the State regulatory mechanism provided by
State law) as would otherwise be covered if furnished by
a physician.
‘‘(2) The term ‘audiology services’ means such hear-
ing and balance assessment services furnished by a quali-
fied audiologist as the audiologist is legally authorized to
perform under State law (or the State regulatory mecha-
nism provided by State law), as would otherwise be cov-
ered if furnished by a physician.
‘‘(3) In this subsection:
‘‘(A) The term ‘qualified speech-language pa-
thologist’ means an individual with a master’s or
doctoral degree in speech-language pathology who—
107
be eligible for medical assistance for medicare cost-sharing
under State medicaid plans as qualified medicare bene-
ficiaries, and for transmitting such information to the
State in which such a beneficiary resides.
SEC. 155. HOSPITAL AGREEMENTS WITH ORGAN PROCURE-
MENT ORGANIZATIONS.
(a) HOSPITAL AGREEMENTS.—
(1) IN GENERAL.—
(A) 
IDENTIFICATION
OF
ORGAN
DO-
NORS.—Section 1138(a)(1)(A)(iii) (42 U.S.C.
1320b–8(a)(1)(A)(iii)) is amended to read as
follows:
‘‘(iii) require that such hospital’s des-
ignated organ procurement agency (as defined
in paragraph (3)(B)) is notified of potential
organ donors;’’.
(B) 
AGREEMENTS
WITH
DESIGNATED
ORGAN
PROCUREMENT
AGENCIES.—Section
1138(a)(1) 
(42 
U.S.C. 
1320b–8(a)(1)) 
is
amended—
(i) by striking the period at the end of
subparagraph (B) and inserting ‘‘; and’’;
and
(ii) by adding at the end the following
new subparagraph: