PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-173 (1) by striking "a State which elects" and all that follows through "with respect to" the first place it appears, (2) by striking "skilled nursing or intermediate care facility" in subparagraphs (A) and (C) and inserting "nursing facility or intermediate care facility for the mentally retarded"; (3) by striking "the amounts allocated under the plan for room and board in the facility, in accordance with the rates established under section 1902(a)(13)," and inserting "the additional amount described in section 1902(a)(13)(D)", and (4) by striking the last sentence. (b) EFFECTIVE DATE.—The amendments made by subsection (a) 42 USC I396d shall be effective as if included in the amendments made by section note. 6408(c)(1) of the Omnibus Budget Reconciliation Act of 1989. SEC. 4706. LIMITATION ON DISALLOWANCES OR DEFERRAL OF FEDERAL 42 USC 1396d FINANCIAL PARTICIPATION FOR CERTAIN INPATIENT PSY- note. CHIATRIC HOSPITAL SERVICES FOR INDIVIDUALS UNDER AGE 21. (a) IN GENERAL.— (1) If the Secretary of Health and Human Services makes a determination that a psychiatric facility has failed to comply with certification of need requirements for inpatient psy- chiatric hospital services for individuals under age 21 pursuant to section 1905(h) of the Social Security Act, and such determination has not been subject to a final judicial decision, any disallowance or deferral of Federal financial participation under such Act based on such determination shall only apply to the period of time beginning with the first day of noncompliance and ending with the date by which the psychiatric facility develops documentation (using plan of care or utilization review procedures) of the need for inpatient care with respect to such individuals. (2) Any disallowance of Federal financial participation under title XIX of the Social Security Act relating to the failure of a psychiatric facility to comply with certification of need requirements— (A) shall not exceed 25 percent of the amount of Federal financial participation for the period described in paragraph (1); and (B) shall not apply to any fiscal year before the fiscal year that is 3 years before the fiscal year in which the determination of noncompliance described in paragraph (1) is made. (b) EFFECTIVE DATE.— Subsection (a) shall apply to disallowance actions and deferrals of Federal financial participation with respect to services provided before the date of enactment of this Act. SEC. 4707. TREATMENT OF INTEREST ON INDIANA DISALLOWANCE. With respect to any disallowance of Federal financial participation under section 1903(a) of the Social Security Act for intermediate care facility services, intermediate care facility services for the mentally retarded, or skilled nursing facility services on the ground that the facilities in the State of Indiana were not certified in accordance with law during the period beginning June 1, 1982, and ending September 30, 1984, payment of such disallowance may be deferred without interest that would otherwise accrue without regard to this subsection, until every opportunity to appeal has been exhausted. SEC. 4708. BILLING FOR SERVICES OF SUBSTITUTE PHYSICIAN. (a) UNDER MEDICAID.— Section 1902(a)(32) (42 U.S.C. 1396a(a)(32))—
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