PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 431 year shall be reduced, or increased, respectively, by the amount of such excess or deficit. "(ii) LIMITATION ON CARRYFORWARD. —In no case may the increase effected under clause (i) for a fiscal year exceed $50,000,000. "(d) SUNSET. —I f the Secretary determines that the level of expenditures described in subsection (c)(1) for 3 consecutive fiscal years (with the first such year being not earlier than fiscal year 2002) exceeds the trigger level for such expenditures for such years (as determined under subsection (c)(2)), benefits shall be paid under this part for services described in subsection (a) and furnished on or after the first January 1 that occurs after such 3 consecutive years only with respect to an individual who has an election in effect under subsection (b) as of such January 1 and only during the duration of such election. "(e) ANNUAL REPORT. —At the beginning of each fiscal year (beginning with fiscal year 1999), the Secretary shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate an annual report on coverage and expenditures for services described in subsection (a) under this part and under State plans under title XIX. Such report shall include— "(1) level of expenditures described in subsection (c)(1) for the previous fiscal year and estimated for the fiscal year involved; "(2) trends in such level; and "(3) facts and circumstances of any significant change in such level from the level in previous fiscal years.". (b) MEDICAID. — (1) The third sentence of section 1902(a) (42 U.S.C. 1396a(a)) is amended by striking all that follows "shall not apply" and inserting "to a religious nonmedical health care institution (as defined in section 1861(ss)(l)).". (2) Section 1908(e)(1) (42 U.S.C. 1396g-l(e)(l)) is amended 42 USC I396g. by striking all that follows "does not include" and inserting "a religious nonmedical health care institution (as defined in section 1861(ss)(l)).". (c) CONFORMING AMENDMENTS.— (1) Section 1122(h) (42 U.S.C. 1320a-l(h)) is amended by striking all that follows "shall not apply to" and inserting "a religious nonmedical health care institution (as defined in section 1861(ss)(l)).". (2) Section 1162 (42 U.S.C. 1320c-ll) is amended— (A) by amending the heading to read as follows: " E X E MPT IONS FOR RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS"; and (B) by striking all that follows "shall not apply with respect to a" and inserting "religious nonmedical health care institution (as defined in section 1861(ss)(l)).". (d) EFFECTIVE DATE.—The amendments made by this section 42 USC i395i-5 shall take effect on the date of the enactment of this Act and "^o^. shall apply to items and services furnished on or after such date. By not later than July 1, 1998, the Secretary of Health and Human Regulations. Services shall first issue regulations to carry out such amendments. Such regulations may be issued so they are effective on an interim
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