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(i) a hospital that is licensed to provide health care services by the State in which it is located,
(ii) an entity (including a health maintenance organization or group medical practice) that provides health care services and that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the Secretary), and
(iii) subject to subparagraph (B), a professional society (or committee thereof) of physicians or other licensed health care practitioners that follows a formal peer review process for the purpose of furthering quality health
care (as determined under regulations of the Secretary). (B) The term “health care entity" does not include a professional society (or committee thereof) if, within the previous 5 years, the society has been found by the Federal Trade Commission or any court to have engaged in any anticompetitive practice which had the effect of restricting the practice of licensed health care practitioners.
(5) The term "hospital” means an entity described in paragraphs (1) and (7) of section 1861(e) of the Social Security Act.
(6) The terms "licensed health care practitioner” and “practitioner" mean, with respect to a State, an individual (other than a physician) who is licensed or otherwise authorized by the State to provide health care services.
(7) The term "medical malpractice action or claim" means a written claim or demand for payment based on a health care provider's furnishing (or failure to furnish) health care services, and includes the filing of a cause of action, based on the law of tort, brought in any court of any State or the United States seeking monetary damages.
(8) The term “physician” means a doctor of medicine or osteopathy or a doctor of dental surgery or medical dentistry legally authorized to practice medicine and surgery or dentistry by a State (or any individual who, without authority holds himself or herself out to be so authorized).
(9) The term “professional review action" means an action or recommendation of a professional review body which is taken or made in the conduct of professional review activity, which is based on the competence or professional conduct of an individual physician (which conduct affects or could affect adversely the health or welfare of a patient or patients), and which affects (or may affect) adversely the clinical privileges, or membership in a professional society, of the physician. Such term includes a formal decision of a professional review body not to take an action or make a recommendation described in the previous sentence and also includes professional review activities relating to a professional review action. In this title, an act is not considered to be based on the competence or professional conduct of a physician if the action is primarily based
(A) the physician's association, or lack of association, with a professional society or association,
(B) the physician's fees or the physician's advertising or engaging in other competitive acts intended to solicit or retain business,
(C) the physician's participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis,
(D) a physician's association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional, or
(E) any other matter than does not relate to the competence or professional conduct of a physician. (10) The term “professional review activity” means an activity of a health care entity with respect to an individual physician
(A) to determine whether the physician may have clinical privileges with respect to, or membership in, the entity,
(B) to determine the scope or conditions of such privileges or membership,
(C) to change or modify such privileges or membership. (11) The term “professional review body" means a health care entity and the governing body or any committee of a health care entity which conducts profes
sional review activity, and includes any committee of the medical staff of such an entity when assisting the governing body in a professional review activity.
(12) The term “Secretary” means the Secretary of Health and Human Services.
(13) The term "State” means the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, erican Samoa, and the Northern Mariana Islands.
(14) The term "State licensing board” means, with respect to a physician or health care provider in a State, the agency of the State which is primarily responsible for the licensing of the physician or provider to furnish health care
services. SEC. 432. [42 U.S.C. 11152] REPORTS AND MEMORANDA OF UNDERSTANDING.
(a) ANNUAL REPORTS TO CONGRESS.—The Secretary shall report to Congress, annually during the three years after the date of the enactment of this Act, on the implementation of this title.
(b) MEMORANDA OF UNDERSTANDING.—The Secretary of Health and Human Serv. ices shall seek to enter into memoranda of understanding with the Secretary of Defense and the Administrator of Veterans' Affairs to apply the provisions of part B of this title to hospitals and other facilities and health care providers under the jurisdiction of the Secretary or Administrator, respectively. The Secretary shall report to Congress, not later than two years after the date of the enactment of this Act, on any such memoranda and on the cooperation among such officials in establishing such memoranda.
(c) MEMORANDUM OF UNDERSTANDING WITH DRUG ENFORCEMENT ADMINISTRATION :-The Secretary of Health and Human Services shall seek to enter into a memorandum of understanding with the Administrator of Drug Enforcement relating to providing for the reporting by the Administrator to the Secretary of information respecting physicians and other practitioners whose registration to dispense controlled substances has been suspended or revoked under section 304 of the Controlled Substances Act. The Secretary shall report to Congress, not later than two years after the date of the enactment of this Act, on any such memorandum and on the cooperation between the Secretary and the Administrator in establishing such a memorandum.
[Internal References.S.S. Act 91921(b) cites the Health Care Quality Improvement Act of 1986 and S.S. Act title XVIII catchline has a footnote referring to P.L. 99-660.]
P.L. 100-139, Approved October 26, 1987 (101 Stat. 822) Cow Creek Band of Umpqua Tribe of Indians Distribution of Judgment Funds Act
SEC. 4 (None assigned) DISTRIBUTION AND USE OF FUNDS.
(h) GENERAL CONDITIONS.—The following conditions will apply to the management and use of the judgment funds by the tribe's governing body:
(6) Benefits received pursuant to this Act shall be considered supplementary to existing Federal programs and their existence shall not be used by any Fed
eral agency as a basis to deny eligibility in whole or in part for existing Federal programs.
(Internal References.S.S. Act title IV, part B, $$1612(b) and 1613(a) catchlines and 1402(a) have footnotes referring to P.L. 100-139.]
P.L. 100-177, Approved December 1, 1987 (101 Stat. 986)
SEC. 204. (42 U.S.C. 2540 note) SPECIAL REPAYMENT PROVISIONS.
(AXi) breached a written contract entered into under section 338A of the Public Health Service Act (42 U.S.C. 2541) by failing either to begin such individual's service obligation in accordance with section 338C of such Act (as redesignated by section 201(2) of this Act) or to complete such service obligation; or
(ii) otherwise breached such a contract; and
(B) as of November 1, 1987, is liable to the United States under section
338E(b) of such Act (as redesignated by section 20 of this Act), shall be relieved of liability to the United States under such section if the individual provides notice to the Secretary in accordance with paragraph (2) and provides service in accordance with a written contract with the Secretary that obligates the individual to provide service in accordance with subsection (b) or (c). The Secretary may exclude an individual from relief from liability under this section for reasons related to the individual's professional competence or conduct.
(Internal Reference.-SS. Act $1892(a) cites the Public Health Service Amendments of 1987.)
P.L. 100-203, Approved December 22, 1987 (101 Stat. 1330)
Omnibus Budget Reconciliation Act of 1987
Sec. 4001 [2 U.S.C. 902 note) EXTENSION OF REDUCTIONS UNDER SEQUESTER ORDER.
Notwithstanding any other provision of law (including any other provision of this Act), the reductions in the amount of payments required under title XVIII of the Social Security Act made by the final sequester order issued by the President on November 20, 1987, pursuant to section 252(b) of the Balanced Budget Emergency Deficit Control Act of 1985 shall continue to be effective (as provided by sections 252(a)(4)(B) and 256(d)2) of such Act) through
(1) March 31, 1988, with respect to payments for inpatient hospital services under such title (including payments under section 1886 of such title attributable or allocated to part A of such title); and
(2) December 31, 1987, with respect to payments for other items and services under part A of such title.
SEC. 4002 BASIC HOSPITAL PROSPECTIVE PAYMENT RATES.
(g) (42 U.S.C. 1395ww note) EFFECTIVE DATES.
(1) PPS HOSPITALS, DRG PORTION OF PAYMENT.-In the case of a subsection (d) hospital (as defined in paragraph (6)
(A) the amendments made by subsections (a) and (c) shall apply to payments made under section 1886(0X1XA)(iii) of the Social Security Act on the basis of discharges occurring on or after April 1, 1988, and
(B) for discharges occurring on or after October 1, 1988, the applicable percentage increase (described in section 1886(b)(3)(B) of such Act) for discharges occurring during fiscal year 1987 is deemed to have been such per
centage increase as amended by subsection (a). (2) PPS SOLE COMMUNITY HOSPITALS, HOSPITAL SPECIFIC PORTION OF PAYMENT.—In the case of a subsection (d) hospital which receives payments made under section 1886(d)(1)(A) of the Social Security Act because it is a sole community hospital
(A) the amendment made by subsections (a) and (c) shall apply to payments under section 1886(0)1XAXiiXI) of the Social Security Act made on the basis of discharges occurring during a cost reporting period of a hospital, for the hospital's cost reporting period beginning on or after October 1, 1987;
(B) notwithstanding subparagraph (A), for cost reporting period beginning
(i) first 51 days of the cost reporting period shall be o percent,
(iii) remainder of such period of the cost reporting period shall be the applicable percentage increase (as so defined, as amended by subsection
(a)); and (C) for cost reporting periods beginning on or after October 1, 1988, the applicable percentage increase (as so defined) with respect to the previous cost reporting period shall be deemed to have been the applicable percent
age increase (as so defined, as amended by subsection (a)). (3) PPS-EXEMPT HOSPITALS.—In the case of a hospital that is not a subsection (d) hospital
(A) the amendments made by subsection (e) shall apply to cost reporting periods beginning on or after October 1, 1987;
(B) notwithstanding subparagraph (A), for the hospital's cost reporting period beginning during fiscal year 1988, payment under title XVIII of the Social Security Act shall be made as though the applicable percentage increase described in section 1886(bX3XB) of such Act were equal to the product of 2.7 percent and the ratio of 315 to 366; and
(C) for cost reporting periods beginning on or after October 1, 1988, the applicable percentage increase (as so defined) with respect to the cost reporting period beginning during fiscal year 1988 shall be deemed to have been 2.7 percent.
(6) DEFINITION.-In this subsection, the term “subsection (d) hospital" has the meaning given such term in section 1886(d)(1XB) of the Social Security Act. SEC. 4003 INCREASE IN DISPROPORTIONATE SHARE ADJUSTMENT AND REDUCTION IN INDIRECT MEDICAL EDUCATION PAYMENTS.
(d) (None assigned) SPECIAL RULE .-In the case of a hospital which
(1) consists of 2 inpatient hospital facilities which are more than 4 miles apart and each of which is in a separate political jurisdiction within the same
State and one of which meets the criteria under section 1886(d)(5)(F) of the Social Security Act for serving a significantly disproportionate number of low-income patients as if that facility were a separate hospital; and
(2) receives payments (other than under section 1886(d)(5)(F) of such Act) for inpatient hospital services under title XVIII of the Social Security Act which are
less than the hospital's reasonable costs of such services, the Secretary of Health and Human Services, upon application by the hospital, may treat each of the facilities of the hospital as separate hospitals for purposes of applying section 1886(d)(5)F) of the Social Security Act, for discharges occurring on or after October 1, 1988.
(b) (42 U.S.C. 1395ww note) CLINIC HOSPITAL WAGE INDICES.-In calculating the wage index under section 1886(d) of the Social Security Act for purposes of making payment adjustments after September 30, 1988, as required under paragraphs (2XH) and (3)(E) of such section, in the case of any institution which received the waiver specified in section 602(k) of the Social Security Amendments of 1983, the Secretary of Health and Human Services shall include wage costs paid to related organization employees directly involved in the delivery and administration of care provided by the related organization to hospital inpatients. For purposes of the preceding sentence, the term "wage costs” does not include costs of overhead or home office administrative salaries or any costs that are not incurred in the hospitals Metropolitan Statistical Area.
Sec. 4005. RURAL HOSPITALS.
(a) REVISION OF STANDARDS FOR INCLUDING A RURAL COUNTY IN AN URBAN AREA.—
(2) [None assigned] LOCATION OF HOSPITAL.-For purposes of section 1886 of the Social Security Act, Watertown Memorial Hospital in Watertown, Wisconsin is deemed to be located in Jefferson County, Wisconsin.
SEC. 4008. OTHER PROVISIONS RELATING TO PAYMENT FOR INPATIENT HOSPITAL SERVICES.
(d) (42 U.S.C. 1395ww note)
(3) REPORT ON OUTLIER PAYMENTS.—The Secretary of Health and Human Services shall include in the annual report submitted to the Congress pursuant to section 1875(b) of the Social Security Act a comparison with respect to hospitals located in an urban area and hospitals located in a rural area in the amount of reductions under section 1886(d)(3)(B) of the Social Security Act and additional payments under section 1886(d)(5)A) of such Act.
SEC. 4009. MISCELLANEOUS PROVISIONS.