PUBLIC LAW 106-554—APPENDIX F 114 STAT. 2763A-501 (c) No EFFECT ON BBRA TEMPORARY INCREASE. —The provisions of this section shall have no effect on the application of section 131 of BBRA. (d) APPLICATION OF WAGE INDEX. — Notwithstanding section 1814(i) of the Social Security Act (42 U.S.C. 1395fli)), the Secretary of Health and Human Services shall use 1.0043 as the hospice wage index value for the Wichita, Kansas Metropolitan Statistical Area in calculating pa3nnents under such section for a hospice program providing hospice care in such area during fiscal year 2000. The Secretary may provide for an appropriate timely lump sum payment to reflect the application of the previous sentence. (e) TECHNICAL AMENDMENT. —Section 1814(a)(7)(A)(ii) (42 U.S.C. 1395f(a)(7)(A)(ii)) is amended by striking the period at the end and inserting a semicolon. SEC. 322. CLARIFICATION OF PHYSICIAN CERTIFICATION. (a) CERTIFICATION BASED ON NORMAL COURSE OF ILLNESS.— (1) IN GENERAL. — Section 1814(a) (42 U.S.C. 1395fla)) is amended by adding at the end the following new sentence: "The certification regarding terminal illness of an individual under paragraph (7) shall be based on the physician's or medical director's clinical judgment regarding the normal course of the individual's illness.". (2) EFFECTIVE DATE. —The amendment made by paragraph (1) shall apply to certifications made on or after the date of the enactment of this Act. (b) STUDY AND REPORT ON PHYSICIAN CERTIFICATION REQUIRE- MENT FOR HOSPICE BENEFITS.— (1) STUDY.— The Secretary of Health and Human Services shall conduct a study to examine the appropriateness of the certification regarding terminal illness of an individual under section 1814(a)(7) of the Social Security Act (42 U.S.C. 1395f(a)(7)) that is required in order for such individual to receive hospice benefits under the medicare program under title XVIII of such Act. In conducting such study, the Secretary shall take into account the effect of the amendment made by subsection (a). (2) REPORT. — Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under paragraph (1), together with any recommendations for legislation that the Secretary deems appropriate. SEC. 323. MEDPAC REPORT ON ACCESS TO, AND USE OF, HOSPICE BENEFIT. (a) IN GENERAL. — The Medicare Payment Advisory Commission shall conduct a study to examine the factors affecting the use of hospice benefits under the medicare program under title XVIII of the Social Security Act, including a delay in the time (relative to death) of entry into a hospice program, and differences in such use between urban and rural hospice programs and based upon the presenting condition of the patient. (b) REPORT.—Not later than 18 months after the date of the enactment of this Act, the Commission shall submit to Congress a report on the study conducted under subsection (a), together with any recommendations for legislation that the Commission deems appropriate.
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