1861(v), but without regard to the amount of 
the customary or other charges with respect to 
such services or the limitations established 
under subsection (a).’’. 
(2) CONFORMING CHANGES.—
(A) IN
GENERAL.—Section 1814(b) (42 
U.S.C. 1395f(b)), as amended by subsection 
(b)(2)(A), is further amended in the matter 
preceding paragraph (1)—
(i) by inserting ‘‘other than a skilled 
nursing facility providing covered skilled 
nursing facility services (as defined in sec-
tion 1888(e)(2)) or posthospital extended 
care services to which section 1888(e)(13) 
applies,’’ after ‘‘inpatient critical access 
hospital services’’; and 
(ii) by striking ‘‘1813 1886,’’ and in-
serting ‘‘1813, 1886, 1888,’’. 
(B) CONSOLIDATED BILLING.—
(i) RECIPIENT OF PAYMENT.—Section 
1842(b)(6)(E) (42 U.S.C. 1395u(b)(6)(E)) 
is amended by inserting ‘‘services to which 
paragraph (7)(C) or (13) of section 
1888(e) applies and’’ after ‘‘other than’’.
(ii) EXCEPTION TO EXCLUSION FROM 
COVERAGE.—Section 
1862(a)(18) 
(42 
U.S.C. 1395y(a)(18)) is amended by in-
serting ‘‘(other than services to which 
paragraph (7)(C) or (13) of section 
1888(e) 
applies)’’ 
after 
‘‘section 
1888(e)(2)(A)(i)’’. 
(d) PAYMENTS TO DISTINCT PART PSYCHIATRIC OR 
REHABILITATION UNITS OF CAHS.—Section 1886(b) (42 
U.S.C. 1395ww(b)) is amended—
(1) in paragraph (1), by inserting ‘‘, other than 
a distinct part psychiatric or rehabilitation unit to 
which paragraph (8) applies,’’ after ‘‘subsection 
(d)(1)(B)’’; and 
(2) by adding at the end the following: 
‘‘(8) EXEMPTION OF CERTAIN DISTINCT PART PSY-
CHIATRIC OR REHABILITATION UNITS FROM COST LIM-
ITS.—In determining payments under this part for inpa-
tient hospital services furnished on or after October 1, 
2003, by a distinct part psychiatric or rehabilitation unit 
(described in the matter following clause (v) of subsection 
(d)(1)(B)) of a critical access hospital (as defined in sec-
tion 1861(mm)(1))—
‘‘(A) the limits imposed under the preceding 
paragraphs of this subsection shall not apply; and
‘‘(B) payment shall be made on the basis of the 
reasonable costs incurred in furnishing such services 
as determined under section 1861(v), but without re-
gard to the amount of the customary or other 
charges with respect to such services.’’. 
(e) ELIMINATION OF ISOLATION TEST FOR COST-
BASED CAH AMBULANCE SERVICES.—Paragraph (8) of 
section 1834(l) (42 U.S.C. 1395m(l)), as added by section 
205(a) of BIPA, is amended by striking the comma at 
the end of the last subparagraph and all that follows and 
inserting a period. 
(f) RETURN ON EQUITY.—Section 1861(v)(1)(P) (42 
U.S.C. 1395x(v)(1)(P)), as amended by section 2(b)(4), 
is further amended by adding at the end the following: 
‘‘(iii)(I) Notwithstanding clause (i), subparagraph 
(S)(i), and section 1886(g)(2), such regulations shall pro-
vide, in determining the reasonable costs of the services 
described in subclause (II) furnished by a critical access 
hospital on or after October 1, 2003, for payment of a 
return on equity capital at a rate of return equal to 150 
percent of the average specified in clause (i). 
‘‘(II) The services referred to in subclause (I) are in-
patient critical access hospital services (as defined in sec-
tion 1861(mm)(2)), outpatient critical access hospital 
services (as defined in section 1861(mm)(3)), extended
care services provided pursuant to an agreement under 
section 1883, posthospital extended care services to which 
section 1888(e)(13) applies, home health services to which 
section 1895(f) applies, ambulance services to which sec-
tion 1834(l) applies, and inpatient hospital services to 
which section 1886(b)(8) applies. 
‘‘(III) Payment under this clause shall be made with-
out regard to whether a provider is a proprietary pro-
vider.’’. 
(g) COVERAGE OF COSTS FOR EMERGENCY ROOM 
ON-CALL PHYSICIAN ASSISTANTS AND NURSE PRACTI-
TIONERS.—Section 1834(g) (42 U.S.C. 1395m(g)) is 
amended by adding at the end the following new para-
graph: 
‘‘(6) COVERAGE
OF
COSTS
FOR
EMERGENCY 
ROOM ON-CALL PHYSICIAN ASSISTANTS AND NURSE 
PRACTITIONERS.—In determining the reasonable 
costs of outpatient critical access hospital services 
under paragraphs (1) and (2)(A), the Secretary shall 
recognize as allowable costs, amounts (as defined by 
the Secretary) for reasonable compensation and re-
lated costs for emergency room physician assistants 
and nurse practitioners who are on-call (as defined 
by the Secretary for purposes of paragraph (5)) but 
who are not present on the premises of the critical
access hospital involved, and are not otherwise fur-
nishing services which would be physicians’ services 
if furnished by a physician and are not on-call at 
any other provider or facility.’’. 
(h) TECHNICAL CORRECTIONS.—
(1) SECTION
403(b)
OF
BBRA
1999.—Section 
1820(b)(2) (42 U.S.C. 1395i–4(b)(2)) is amended 
by striking ‘‘nonprofit or public hospitals’’ and in-
serting ‘‘hospitals’’. 
(2) SECTION
203(b)
OF
BIPA
2000.—Section 
1883(a)(3) (42 U.S.C. 1395tt(a)(3)) is amended—
(A) by inserting ‘‘section 1861(v)(1)(G) 
or’’ after ‘‘Notwithstanding’’; and 
(B) by striking ‘‘covered skilled nursing fa-
cility’’. 
(i) EFFECTIVE DATES.—
(1) ELIMINATION
OF
REQUIREMENTS.—The 
amendment made by subsections (a) and (b) shall 
apply to services furnished on or after October 1, 
2003. 
(2) TECHNICAL CORRECTIONS.—
(A) BBRA.—The amendment made by 
subsection (h)(1) shall be effective as if in-
cluded in the enactment of section 403(b) of the 
Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999 (Appendix F, 
113 Stat. 1501A–321), as enacted into law by 
section 1000(a)(6) of Public Law 106–113. 
(B) BIPA.—The amendment made by sub-
section (h)(2) shall be effective as if included in 
the enactment of section 203(b) of the Medi-
care, Medicaid, and SCHIP Benefits Improve-
ment and Protection Act of 2000 (Appendix F, 
114 Stat. 2763A–463), as enacted into law by 
section 1(a)(6) of Public Law 106–554.
Æ