PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-65 area to two or more individuals by two or more physicians within the same 12-month period for purposes of appeals provided for under • section 1869(b)(2). Such study shall be conducted in at least four carrier areas. The Secretary shall report on the results of such study and any recommendations to the Committee on Finance of the Senate and the Committees on Energy and Commerce and Ways and Means of the House of Representatives by December 31, 1992. SEC. 4114. UTILIZATION SCREENS FOR PHYSICIAN VISITS IN REHABILITA- 42 USC 1395u TION HOSPITALS. note. Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue guidelines to assure a uniform level of review of physician visits to patients of a rehabilitation hospital or unit patients after the medical review screen parameter established under section 4085(h) of the Omnibus Budget Reconciliation Act of 1987 has been exceeded. SEC. 4115. STUDY OF REGIONAL VARIATIONS IN IMPACT OF MEDICARE 42 USC 1395w-4 PHYSICIAN PAYMENT REFORM. note. (a) STUDY.— The Secretary of Health and Human Services shall conduct a study of— (1) factors that may explain geographic variations in Medicare reasonable charges for physicians' services that are not attributable to variations in physician practice costs (including the supply of physicians in an area and area variations in the mix of services furnished); (2) the extent to which the geographic practice cost indices applied under the fee schedule established under section 1848 of the Social Security Act accurately reflect variations in practice costs and malpractice costs (and alternative'*sources of information upon which to base such indices); (3) the impact of the transition to a national, resource-based fee schedule for physicians' services under Medicare on access to physicians' services in areas that experience a disproportionately large reduction in payments for physicians' services under the fee schedule by reason of such variations; and (4) appropriate adjustments or modifications in the transition to, or manner of determining payments under, the fee schedule established under section 1848 of the Social Security Act, to compensate for such variations and ensure continued access to physicians' services for Medicare beneficiaries in such areas. (b) REPORT. —By not later than July 1, 1992, the Secretary shall submit to Congress a report on the study conducted under subsection (a). SEC. 4116. LIMITATION ON BENEFICIARY LIABILITY. Section 1848(g)(2)(A) (42 U.S.C. 1395w-4(g)(2)(A)) is amended by adding at the end thereof the following: "In the case of evaluation and management services (as specified in section 1842(b)(16)(B)(ii)), the preceding sentence shall be applied by substituting *40 percent' for '25 percent'.". SEC. 4117. STATEWIDE FEE SCHEDULE AREAS FOR PHYSICIANS' SERV- 42 USC 1395w-4 ICES. note. (a) IN GENERAL. —Notwithstanding section 1848(j)(2) of the Social Security Act (42 U.S.C. 1395w-4(j)(2)), in the case of the States of Nebraska and Oklahoma, if the respective State meets the require-
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