104 STAT. 1388-44 PUBLIC LAW 101-508—NOV. 5, 1990 SEC. 4008. MISCELLANEOUS AND TECHNICAL PROVISIONS RELATING TO PART A. (a) WAIVER OF LIABILITY FOR SKILLED NURSING FACILITIES AND HOSPICES.— (1) SKILLED NURSING FACILITIES.—The second sentence of section 9126(c) of the Consolidated Omnibus Budget Reconciliation 42 USC 1395y Act of 1985 is amended by striking "October 31, 1990" and note. inserting "December 31, 1995". (2) HOSPICES.— Section 9305(f)(2) of the Omnibus Budget Rec- 42 USC 1395y onciliation Act of 1986 is amended by striking "November 1, note. 1990" and inserting "December 31, 1995". 42 USC 1395y (3) EFFECTIVE DATE.— The amendments made by paragraphs note. (1) and (2) shall take effect on the date of the enactment of this Act. (b) HOSPITAL OBLIGATIONS WITH RESPECT TO TREATMENT OF EMER- GENCY MEDICAL CONDITIONS.— (1) CIVIL MONETARY PENALTIES.— Section 1867(d)(2)(A) (42 U.S.C. 1395dd(d)(2)(A)) is amended by striking "knowingly" and inserting "negligently". (2) APPLICATION OF PENALTIES TO SMALL HOSPITALS. — Section 1867(d)(2)(A) (42 U.S.C. 1395dd(d)(2)(A)) is amended by inserting "(or not more than $25,000 in the case of a hospital with less than 100 beds)" after "$50,000". (3) TERMINATION OF HOSPITAL PROVIDER AGREEMENTS. — (A) Section 1867 (42 U.S.C. 1395dd) is further amended— (i) by striking paragraph (1) of subsection (d), (ii) by redesignating paragraphs (2) and (3) of subsection (d) as paragraph (1) and (2), respectively, and (iii) in subsection (c)(2)(C), by striking "(d)(2)(C)" and inserting "(d)(1)(C)". (B) Section 1866(a)(l)(I)(i) (42 U.S.C. 1395cc(a)(l)(I)(i)) is amended by inserting "and to meet the requirements of such section" before the comma at the end. 42 USC 1395CC (4) EFFECTIVE DATE,—The amendments made by this subsecnote. tion shall apply to actions occurring on or after the first day of the sixth month beginning after the date of the enactment of this Act. 42 USC 1395dd (c) INSPECTOR GENERAL STUDY OF PROHIBITION ON HOSPITAL note. EMPLOYMENT OF PHYSICIANS. — (1) STUDY.— The Secretary of Health and Human Services (acting through the Inspector General of the Department of Health and Human Services) shall conduct a study of the effect of State laws prohibiting the employment of physicians by hospitals on the availability and accessibility of trauma and emergency care services, and shall include in such study an analysis of the effect of such laws on the ability of hospitals to meet the requirements of section 1867 of the Social Security Act relating to the examination and treatment of individuals with an emergency medical condition and women in labor. (2) REPORT. — By not later than 1 year after the date of the enactment of this Act, the Secretary shall submit a report to Congress on the study conducted under paragraph (1). (d) DESIGNATION OF RURAL PRIMARY CARE HOSPITALS. — (1) PRIORITY DESIGNATIONS OF BORDER STATE HOSPITALS. — Section 1820(i)(2)(C) (42 U.S.C. 1395i-4(i)(2)(C)) is amended by adding at the end the following new sentence: "In designating facilities
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