107 STAT. 636 PUBLIC LAW 103-66—AUG. 10, 1993 42 USC 1396b note. 42 USC 1396a note. each year of such session shall be deemed to be a separate regular session of the State legislature. SEC. 1S«24. APPLICATION OF MEDICABE RULES LIMITING CERTAIN PHYSICIAN RBFERRALa (a) IN GENERAL. — Section 1903 (42 U.S.C. 1396b) is amended by inserting after subsection (r) the following new subsection: ' ' (s) Notwithstanding the preceding provisions of this section, no payment shall be made to a State under this section for expenditures for medical assistance under the State plan consisting of a designated health service (as defined in subsection (h)(6) of section 1877) furnished to an individual on the basis of a referral that would result in the denial of payment for the service under title XVIII if such title provided for coverage of such service to the same extent and under the same terms and conditions as under the State plan, and subsections (f) and (g)(5) of such section shall apply to a provider of such a designated health service for which payment may be made under this title in the same manner as such subsections apply to a provider of such a service for which payment may be made under such title.". (b) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to referrals made on or after December 31, 1994. SEC. 13«26. STATE MEDICAID FRAUD CONTROL. (a) IN GENERAL. —Section 1902(a) (42 U.S.C. 1396a(a)), as amended by section 13623(a), is amended— (1) by striking "and" at the end of paragraph (59); (2) by striking the period at the end of paragraph (60) and inserting "; and"; and (3) by inserting after paragraph (60) the following new paragraph: ^61) provide that the State must demonstrate that it operates a medicaid fraud and abuse control unit described in section 1903(q) that effectively carries out the functions and requirements described in such section, as determined in accordance with standards established by the Secretary, unless the State demonstrates to the satisfaction of the Secretary that the effective operation of such a unit in the State would not be cost-effective because minimal fraud exists in connection with the provision of covered services to eligible individuals under the State plan, and that beneficiaries under the plan will be protected from abuse and neglect in connection with the provision of medical assistance under the plan without the existence of such a unit.". (b) EFFECTIVE DATE. — Section 1902(a)(61) of the Social Security Act (as added by subsection (a)) shall take effect January 1, 1995, and the standards referred to in such section shall be established not later than March 31, 1994. PART IV—IMMUNIZATIONS SEC. 13631. BIEDICAID PEDIATRIC IMMUNIZATION PROVISIONS. (a) STATE PLAN REQUIREMENT FOR PEDIATRIC IMMUNIZATION DISTRIBUTION PROGRAM. — Section 1902(a) (42 U.S.C. 1396a(a)), as amended by sections 13623(a) and 13625(a), is amended— (1) by striking "and" at the end of paragraph (60); (2) by^ striking the period at the end of paragraph (61) and inserting "; and"; and
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