PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2235 note. 42 USC 1395rr note. 42 USC 1395rr note. -; order which are considered employment only by virtue of an election made by the religious order under section 3121(r) of the Internal Revenue Code of 1986.". (2) EFFECTIVE DATE.— The amendment made by paragraph (1) 42 USC I395y shall apply to items and services furnished on or after Octo- ber 1, 1989. SEC. 6203. PAYMENT FOR END STAGE RENAL DISEASE SERVICES. (a) MAINTENANCE OF CURRENT COMPOSITE RATE.— (1) IN GENERAL. —Section 9335(a)(l) of the Omnibus Budget Reconciliation Act of 1986 is amended— (A) by striking "and before October 1, 1988" and inserting "and before October 1, 1990", and (B) by adding at the end the following: "No change may r be made in the base rate in effect as of September 30, 1990, unless the Secretary makes such change in accordance with notice and comment requirements set forth in section 1871(b)(l)ofsuchAct.". (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986. (b) REQUIREMENTS FOR PATIENTS DEAUNG DIRECTLY WITH MEDI- CARE. — (1) LIMITATION ON AMOUNT OF PAYMENT GENERALLY. —Section 188ia>)(7) of the Social Security Act (42 U.S.C. 1395rr(b)(7)) is amended by inserting after the second sentence the following new sentence: "The amount of a payment made under any method other than a method based on a single composite weighted formula may not exceed the amount (or, in the case of continuous cycling peritoneal dialysis, 130 percent of the amount) of the median payment that would have been made under the formula for hospital-based facilities.". (2) AGREEMENTS WITH PROVIDERS OF SERVICES. — Section 1881(b)(4) of such Act (42 U.S.C. 1395rrOt)X4)) is amended— (A) by striking "(4)" and inserting "(4)(A)", and (B) by adding at the end the following new subparagraph: "(B) The Secretary shall make payments to a supplier of home dialysis supplies and equipment furnished to a patient whose self- care home dialysis is not under the direct supervision of an ap- proved provider of services or renal dialysis facility only in accordance with a written agreement under which— "(i) the patient certifies that the supplier is the sole provider of such supplies and equipment to the patient, "(ii) the supplier agrees to receive payment for the cost of such supplies and equipment only on an assignment-related basis, and "(iii) the supplier certifies that it has entered into a written agreement with an approved provider of services or renal dialy- sis facility under which such provider or facility agrees to furnish to such patient £dl self-care home dialysis support serv- ices and all other necessary dialysis services and supplies, including institutional dialysis services and supplies and emer- gency services.". (3) EFFECTIVE DATE.—The amendments made by this subsec- tion shall apply with respect to dialysis services, supplies, and equipment furnished on or after February 1, 1990. 42 USC 1395rr note.
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