P.L. 101-239 (e) [42 U.S.C. 13951 note] EFFECTIVE DATE.-The amendments made by this section, and the provisions of subsection (c), shall apply to services furnished on or after July 1, 1990, and the amendments made by subsection (d) shall apply to expenses incurred in a year beginning with 1990. SEC. 6205. COSTS OF NURSING AND ALLIED HEALTH EDUCATION. (a) RECOGNITION OF COSTS OF CERTAIN HOSPITAL-BASED NURSING SCHOOLS .(1) IN GENERAL.—(A) [42 U.S.C. 1395x note] The reasonable costs incurred by a hospital in training students of a hospital-based nursing school shall be allowable as reasonable costs under title XVIII of the Social Security Act and reimbursed under such title on the same basis as if they were allowable direct costs of a hospital-operated educational program (other than an approved graduate medical education program) if, before June 15, 1989, and thereafter, the hospital demonstrates that for each year, it incurs at least 50 percent of the costs of training nursing students at such school, the nursing school and the hospital share some common board members, and all instruction is provided at the hospital or, if in another building, a building on the immediate grounds of the hospital. The Secretary of Health and Human Services shall develop a national data system for linking, for any infant up to age one (1) the infant's birth record, (2) any death record for the infant, and (3) information on any claims submitted under title XIX of the Social Security Act for health care furnished to the infant or with respect to the birth of the infant. SEC. 6509. [42 U.S.C. 701 note] MATERNAL AND CHILD HEALTH HANDBOOK. (a) IN GENERAL.— (1) DEVELOPMENT.-The Secretary of Health and Human Services shall develop a maternal and child health handbook in consultation with the National Commission to Prevent Infant Mortality and public and private organizations interested in the health and welfare of mothers and children. (3) AVAILABILITY AND DISTRIBUTION.-The Secretary shall make the handbook available to pregnant women and families with young children, and shall provide copies of the handbook to maternal and child health programs (including maternal and child health clinics supported through either title V or title XIX of the Social Security Act, community and migrant health centers under sections 329 and 330 of the Public Health Service Act, the grant program for the homeless under section 340 of the Public Health Service Act, the "WIC" program under section 17 of the Child Nutrition Act of 1966, and the head start program under the Head Start Act) that serve high-risk women. The Secretary shall coordinate the distribution of the handbook with State maternal and child health departments, State and local public health clinics, private providers of obstetric and pediatric care, and community groups where applicable. The Sec P.L. 101-239 retary shall make efforts to involve private entities in the distribution of the handbook under this paragraph. SEC. 10404. [42 U.S.C. 1395b-1 note] DEMONSTRATION PROJECT. (a) NUMBER OF PROJECTS.-In order to determine whether, and if so, the extent to which, the use of volunteer senior aides to provide basic medical assistance and support to families with moderately or severely disabled or chronically ill children contributes to reducing the costs of care for such children, not more than 10 communities may conduct demonstration projects under this section. (b) DUTIES OF THE SECRETARY.— (1) CONSIDERATION OF APPLICATIONS.-The Secretary of Health and Human Services (in this section referred to as the "Secretary") shall consider all applications received from communities desiring to conduct demonstration projects under this section. (2) APPROVAL OF CERTAIN APPLICATIONS.-The Secretary shall approve not more than 10 applications to conduct projects which appear likely to contribute significantly to the achievement of the purpose of this section. (3) GRANTS.-The Secretary shall make grants to each community the application of which to conduct a demonstration project under this section is approved by the Secretary to assist the community in carrying out the project. (c) REQUIREMENTS.-Each community receiving a grant with respect to a demonstration project under this section shall conduct the project in accordance with such requirements as the Secretary may prescribe. (d) LIMITATION ON AUTHORIZATION OF APPROPRIATIONS.-For grants under this section, there are authorized to be appropriated to the Secretary of Health and Human Services not to exceed (1) $1,000,000 for each of the fiscal years 1990 and 1991; and (2) $2,000,000 for each of the fiscal years 1992, 1993, and 1994. (e) EFFECTIVE DATE.-This section shall take effect on October 1, 1989. SEC. 10405. [None assigned] AGENT ORANGE SETTLEMENT PAYMENTS EXCLUDED FROM COUNTABLE INCOME AND RESOURCES UNDER FEDERAL MEANS-TESTED PROGRAMS. (a) IN GENERAL.— (1) TREATMENT OF PAYMENTS.-The payments made from the Agent Orange Settlement Fund or any other fund established pursuant to the settlement in the In re Agent Orange product liability litigation, M.D.L. No. 381 (E.D.N.Y.), shall not be considered income or resources in determining eligibility for the amount of benefits under any Federal or federally assisted program described in paragraph (2). (2) PROGRAMS INVOLVED.-The program benefits described in this paragraph are (A) benefits under the supplemental security income program under title XVI of the Social Security Act; (B) aid to families with dependent children under a State plan approved under section 402(a) of the Social Security Act; (C) medical assistance under a State plan approved under section 1902(a) of the Social Security Act; (D) benefits under title XX of the Social Security Act; (E) benefits under the food stamp program (as defined in section 3(h) of the Food Stamp Act of 1977); (F) benefits under the special supplemental food program for women, infants, and children established under section 17 of the Child Nutrition Act of 1966; P.L. 101-508 (G) benefits under section 336 of the Older Americans Act; (H) benefits under the National School Lunch Act; (I) benefits under any housing assistance program for lower income families or elderly or handicapped persons which is administered by the Secretary of Housing and Urban Development or the Secretary of Agriculture; (J) benefits under the Low-Income Home Energy Assistance Act of 1981; (K) benefits under part A of the Energy Conservation in Existing Buildings Act of 1976; (L) benefits under any educational assistance grant or loan program which is administered by the Secretary of Education; and (M) benefits under a State plan approved under title I, X, XIV, or XVI of the Social Security Act. (b) EFFECTIVE DATE.-Subsection (a) shall take effect on January 1, 1989. [Internal References.-S.S. Act §§501(a), 1848(f), and 1905(s) cite the Omnibus Budget Reconciliation Act of 1989 and S.S. Act titles II, IV, V, XVI, XVIII, and Part B, XIX, and XX and §§408, 1612(b), 1613(a), 1804, 1814(i), and 1848 catchlines and §§2(a), 230(b), 1002(a), 1402(a), 1602(a)(State), 1819(b) and (g), 1842(b), 1864(a), 1870(c), and 1888(a) have footnotes referring to P.L. 101-239.] P.L. 101-277, Approved April 30, 1990 (104 Stat. 143) (b) None of the funds held in trust by the United States under this Act (including interest and investment income accrued on such funds while such funds are held in trust by the United States), and none of the funds distributed per capita or made available under this Act for programs, shall be subject to Federal, State, or local income taxes, nor shall such funds nor their availability be considered as income or resources or otherwise utilized as the basis for denying or reducing the financial assistance or other benefits to which such household or member would otherwise be entitled under the Social Security Act or, except for per capita payments in excess of $2,000, any other Federal or federally assisted program. [Internal References.-S.S. Act §§1612(b) catchline and §§2(a) and 1402(a) have footnotes referring to P.L. 101-277.] P.L. 101-508, Approved November 5, 1990 (104 Stat. 143) Omnibus Budget Reconciliation Act of 1990 SEC. 4002. PROSPECTIVE PAYMENT HOSPITALS. * * P.L. 101-508 (e) EXTENSION OF REGIONAL FLOOR ON STANDARDIZED AMOUNTS.— * (2) [42 U.S.C. 1395ww note] STUDY. (A) The Secretary of Health and Human Services shall collect sufficient data on the input prices associated with the non-wage-related portion of the adjusted average standardized amounts established under section 1886(d)(3) of the Social Security Act to identify the extent to which variations in such amounts among hospitals located in different geographic areas are attributable to differences in such prices. (B) Not later than June 1, 1993. the Secretary shall submit a report to Congress analyzing such data, and shall include in such report recommendations regarding a methodology for adjusting such average standardized amounts to reflect such variations. (C) The provisions of chapter 35 of title 44, United States Code, shall not apply to data collected by the Secretary under subparagraph (A). (b) [42 U.S.C. 1395ww note] EFFECTIVE DATE.-The amendment made by subsection (a) shall apply (1) in the case of any services provided during the day immediately preceding the date of a patient's admission (without regard to whether the services are related to the admission), to services furnished on or after the date of the enactment of this Act and before October 1, 1991; (2) in the case of diagnostic services (including clinical diagnostic laboratory tests), to services furnished on or after January 1, 1991; and (3) in the case of any other services, to services furnished on or after October 1, 1991. SEC. 4004. [42 U.S.C. 1395ww note] PAYMENTS FOR MEDICAL EDUCATION COSTS. (a) HOSPITAL GRADUATE MEDICAL EDUCATION RECOUPMENT.– (1) IN GENERAL.-The Secretary of Health and Human Services may not, before October 1, 1991, recoup payments from a hospital because of alleged overpayments to such hospital under part A of title XVIII of the Social Security Act due to a determination that the amount of payments made for graduate medical education programs exceeds the amount allowable under section 1886(h). (2) CAP ON ANNUAL AMOUNT OF RECOUPMENT.-With respect to overpayments to a hospital described in paragraph (1), the Secretary may not recoup more than 25 percent of the amount of such overpayments from the hospital during a fiscal year. (3) EFFECTIVE DATE.-Paragraphs (1) and (2) shall take effect October 1, 1990. (b) UNIVERSITY HOSPITAL NURSING EDUCATION.— (1) IN GENERAL.-The reasonable costs incurred by a hospital (or by an educational institution related to the hospital by common ownership or control) during a cost reporting period for clinical training (as defined by the Secretary) conducted on the premises of the hospital under approved nursing and allied health education programs that are not operated by the hospital shall be allowable as reasonable costs under part A of title XVIII of the Social Security Act and reimbursed under such part on a pass-through basis. P.L. 101-508 (2) CONDITIONS FOR REIMBURSEMENT.-The reasonable costs incurred by a hospital during a cost reporting period shall be reimbursable pursuant to paragraph (1) only if— (A) the hospital claimed and was reimbursed for such costs during the most recent cost reporting period that ended on or before October 1, 1989; (B) the proportion of the hospital's total allowable costs that is attributable to the clinical training costs of the approved program, and allowable under (b)(1) during the cost reporting period does not exceed the proportion of total allowable costs that were attributable to the clinical training costs during the cost reporting period described in subparagraph (A); (C) the hospital receives a benefit for the support it furnishes to such program through the provision of clinical services by nursing or allied health students participating in such programs; and (D) the costs incurred by the hospital for such program do not exceed the costs that would be incurred by the hospital if it operated the program itself. (3) PROHIBITION AGAINST RECOUPMENT OF COSTS BY SECRETARY.— (A) IN GENERAL.-The Secretary of Health and Human Services may not recoup payments from (or otherwise reduce or adjust payments under part A of title XVIII of the Social Security Act to) a hospital because of alleged overpayments to such hospital under such title due to a determination that costs which were reported by the hospital on its medicare cost reports for cost reporting periods beginning on or after October 1, 1983, and before October 1, 1990, relating to approved nursing and allied health education programs did not meet the requirements for allowable nursing and allied health education costs (as developed by the Secretary pursuant to section 1861(v) of such Act). (B) REFUND OF AMOUNTS RECOUPED.-If, prior to the date of the enactment of this Act, the Secretary has recouped payments from (or otherwise reduced or adjusted payments under part A of title XVIII of the Social Security Act to) a hospital because of overpayments described in subparagraph (A), the Secretary shall refund the amount recouped, reduced, or adjusted from the hospital. (4) SPECIAL AUDIT TO DETERMINE COSTS.-In determining the amount of costs incurred by, claimed by, and reimbursed to, a hospital for purposes of this subsection, the Secretary shall conduct a special audit (or use such other appropriate mechanism) to ensure the accuracy of such past claims and payments. (5) EFFECTIVE DATE.-Except as provided in paragraph (3), the provisions of this subsection shall apply to cost reporting periods beginning on or after October 1, 1990. SEC. 4005. PPS-EXEMPT HOSPITALS. (b) [42 U.S.C. 1395ww note] DEVELOPMENT OF NATIONAL PROSPECTIVE PAYMENT RATES FOR CURRENT NON-PPS HOSPITALS.— (1) DEVELOPMENT OF PROPOSAL.-The Secretary of Health and Human Services shall develop a proposal to modify the current system under which hospitals that are not subsection (d) hospitals (as defined in section 1886(d)(1)(B) of the Social Security Act) receive payment for the operating and capital-related costs of inpatient hospital services under part A of the medicare program or a proposal to replace such system with a system under which such payments would be made on the basis of nationally-determined average standardized amounts. In developing any proposal under this paragraph to replace the current system with a prospective payment system, the Secretary shall (A) take into consideration the need to provide for appropriate limits on increases in expenditures under the medical program; (B) provide for adjustments to prospectively determined rates to account for changes in a hospital's case mix, severity of illness of patients, volume |