104 STAT. 1388-88 PUBLIC LAW 101-508—NOV. 5, 1990 specialist' mean, for purposes of this Act, a physician assistant, nurse practitioner, or clinical nurse specialist who performs". 42 USC 1395k (©) EFFECTIVE DATE.—The amendments made by this section shall note. apply to services furnished on or after January 1, 1991. SEC. 4156. COVERAGE OF INJECTABLE DRUGS FOR TREATMENT OF OSTEOPOROSIS. (a) IN GENERAL.— Section 1861 (42 U.S.C. 1395x) is amended— (1) in subsection (s)(2)— (A) by striking "and" at the end of subparagraph (M), (B) by inserting "and" at the end of subparagraph (N), and (C) by inserting after subparagraph (N) the following new subparagraph: "(O) a covered osteoporosis drug and its administration (as defined in subsection (jj)) furnished on or after January 1, 1991, and on or before December 31, 1995; and"; and (2) by inserting after subsection (ii) the following new subsection: "Covered Osteoporosis Drug "(jj) The term 'covered osteoporosis drug' means an injectable drug approved for the treatment of a bone fracture related to postmenopausal osteoporosis provided to an individual if, in accordance with regulations promulgated by the Secretary— "(1) the individual's attending physician certifies that the patient is unable to learn the skills needed to self-administer such drug or is otherwise physically or mentally incapable of self-administering such drug; and "(2) the individual is confined to the individual's home (except when receiving items and services referred to in subsection (m)(7)). ". 42 USC 1395x (b) STUDY OF EFFECTS OF COVERAGE.— note. (1) IN GENERAL.—The Secretary of Health and Human Services shall conduct a study analyzing the effects of coverage of osteoporosis drugs under part B of title XVIII of the Social Security Act (as amended by subsection (a)) on the health of individuals enrolled under such part and the utilization of inpatient hospital and extended care services by such individuals. (2) REPORT. —By not later than October 1, 1994, the Secretary shall submit a report to Congress on the study conducted under paragraph (1), and shall include in such report such recommendations regarding expansion of coverage under the medicare program of items and services for individuals with post-menopausal osteoporosis as the Secretary considers appropriate. SEC. 4157. SEPARATE PAYMENT UNDER PART B FOR SERVICES OF CER- TAIN HEALTH PRACTITIONERS. (a) SERVICES OF CERTAIN HEALTH PRACTITIONERS NOT TO BE IN- CLUDED IN INPATIENT HOSPITAL SERVICES.— Section 1861(b) (42 U.S.C. 1395x(b)) is amended— (1) in paragraph (3), by striking "(including clinical psychologist (as defined by the Secretary))", and
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