104 STAT. 1388-118 PUBLIC LAW 101-508—NOV. 5, 1990 42 USC 1395dd note. 42 USC 1395WW note. 42 USC 1395WW note. 42 USC 1395pp note. (4) EFFECTIVE DATE. — The amendments made by this subsection 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. (b) EXTENSIONS OF EXPIRING PROVISIONS. — (1) PROHIBITION ON COST SAVINGS POLICIES BEFORE BEGINNING OF FISCAL YEAR.— Notwithstanding any other provision of law, the Secretary of Health and Human Services may not issue any proposed or final regulation, instruction, or other policy which is estimated by the Secretary to result in a net reduction in expenditures under title XVIII of the Social Security Act in a fiscal year (beginning with fiscal year 1991 and ending with fiscal year 1993, or, if later, the last fiscal year for which there is a maximum deficit amount specified under section 3(7) of the Congressional Budget and Impoundment Control Act of 1974) of more than $50,000,000, except as follows: (A) The Secretary may issue such a proposed regulation, instruction, or other policy with respect to the fiscal year before the May 15 preceding the beginning of the fiscal year. (B) The Secretary may issue such a final regulation, instruction, or other policy with respect to the fiscal year on or after October 15 of the fiscal year. (C) The Secretary may, at any time, issue such a proposed or final regulation, instruction, or other policy with respect to the fiscal year if required to implement specific provisions under statute. (2) PROHIBITION OF PAYMENT CYCLE CHANGES. —Notwithstanding any other provision of law, the Secretary of Health and Human Services is not authorized to issue, after the date of the enactment of this Act, any final regulation, instruction, or other policy change which is primarily intended to have the effect of slowing down or speeding up claims processing, or delaying payment of claims, under title XVIII of the Social Security Act. (3) WAIVER OF LIABILITY FOR HOME HEALTH AGENCIES. —Section 9305(g)(3) of the Omnibus Budget Reconciliation Act of 1986, as amended by section 426(d) of the Medicare Catastrophic Coverage Act of 1988, is amended by striking "November 1, 1990" and inserting "December 31, 1995". (4) EXTENSION AND EXPANSION OF WAIVERS FOR SOCIAL HEALTH MAINTENANCE ORGANIZATIONS. — (A) EXTENSION OF CURRENT WAIVERS.— Section 4018(b) of the Omnibus Budget Reconciliation Act of 1987 is amended— (i) in paragraph (1), by striking "September 30, 1992" and inserting "December 31, 1995"; and (ii) in paragraph (4)— (I) by striking "final" and inserting "second interim", and (II) by striking the period at the end and inserting the following: ", and shall submit a final report on the demonstration projects conducted under section 2355 of the Deficit Reduction Act of 1984 not later than March 31, 1996.". (B) EXPANSION OF DEMONSTRATIONS.— Section 2355 of the Deficit Reduction Act of 1984 is amended—
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