PUBLIC LAW 101-508 —NOV. 5, 1990 104 STAT. 1388-105 (1) IN GENERAL. —Not later than 9 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish and carry out a 3-year demonstration project to determine whether the services of a home dialysis staff assistant providing services to a patient during hemodialysis treatment at the patient's home may be covered under the medicare program in a cost-effective manner that ensures patient safety. (2) NUMBER OF PARTICIPANTS.— The total number of eligible patients receiving services under the demonstration project established under paragraph (1) may not exceed 800. (b) PAYMENTS TO PARTICIPATING PROVIDERS AND FACILITIES. — (1) SERVICES FOR WHICH PAYMENT MAY BE MADE. — (A) IN GENERAL.— Under the demonstration project established under subsection (a), the Secretary shall make pay- ments for 3 years under title XVIII of the Social Security Act to providers of services (other than a skilled nursing facility) or renal dialysis facilities for services of a home hemodialysis staff assistant provided to an individual described in subsection (c) during hemodialysis treatment at the individual's home in an amount determined under paragraph (2). (B) SERVICES DESCRIBED. —For purposes of subparagraph (A), the term "services of a home hemodialysis staff assistant" means— (i) technical sissistance with the operation of a hemodialysis machine in the patient's home and with such patient's care during in-home hemodialysis; and (ii) administration of medications within the patient's home to maintain the patency of the extra corporeal circuit. (2) AMOUNT OF PAYMENT. — (A) IN GENERAL. —Payment to a provider of services or renal dialysis facility participating in the demonstration project established under subsection (a) for the services described in paragraph (1) shall be prospectively determined by the Secretary, made on a per treatment basis, and shall be in an amount determined under subparagraph (B). (B) DETERMINATION OF PAYMENT AMOUNT. —(i) The amount of payment made under subparagraph (A) shall be the product of— (I) the rate determined under clause (ii) with respect to a provider of services or a renal dialysis facility; and (II) the factor by which the labor portion of the composite rate determined under section 1881(b)(7) of the Social Security Act is adjusted for differences in area wage levels. (ii) The rate determined under this clause, with respect to a provider of services or renal dialysis facility, shall be equal to the difference between— (I) two-thirds of the labor portion of the composite rate applicable under section 1881(b)(7) of such Act to the provider or facility (as adjusted to reflect dif- ferences in area wage levels), and (II) the product of the national median hourly wage for a home hemodialysis staff assistant and the national median time expended in the provision of home -194O-91-17:QL3Part2
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