transition period

(2) Definitions For purposes of this subsection: (A) Covered skilled nursing facility services (i) In general The term “covered skilled nursing facility services”— (I) means post-hospital extended care services as defined in section 1395x(i) of this title for which benefits are provided under part A; and (II) includes all items and services (other than items and services described in clauses (ii), (iii), and (iv)) for which payment may be made under part B and which are furnished to an individual who is a resident of a skilled nursing facility during the period in which the individual is provided covered post-hospital extended care services. (ii) Services excluded Services described in this clause are physicians’ services, services described by clauses (i) and (ii) of section 1395x(s)(2)(K) of this title , certified nurse-midwife services, qualified psychologist services, services of a certified registered nurse anesthetist, items and services described in subparagraphs (F) and (O) of section 1395x(s)(2) of this title , telehealth services furnished under section 1395m(m)(4)(C)(ii)(VII) of this title , and, only with respect to services furnished during 1998, the transportation costs of electrocardiogram equipment for electrocardiogram test services (HCPCS Code R0076). Services described in this clause do not include any physical, occupational, or speech-language therapy services regardless of whether or not the services are furnished by, or under the supervision of, a physician or other health care professional. (iii) Exclusion of certain additional items and services Items and services described in this clause are the following: (I) Ambulance services furnished to an individual in conjunction with renal dialysis services described in section 1395x(s)(2)(F) of this title . (II) Chemotherapy items (identified as of July 1, 1999 , by HCPCS codes J9000–J9020; J9040–J9151; J9170–J9185; J9200–J9201; J9206–J9208; J9211; J9230–J9245; and J9265–J9600 (and as subsequently modified by the Secretary)) and any additional chemotherapy items identified by the Secretary. (III) Chemotherapy administration services (identified as of July 1, 1999 , by HCPCS codes 36260–36262; 36489; 36530–36535; 36640; 36823; and 96405–96542 (and as subsequently modified by the Secretary)) and any additional chemotherapy administration services identified by the Secretary. (IV) Radioisotope services (identified as of July 1, 1999 , by HCPCS codes 79030–79440 (and as subsequently modified by the Secretary)) and any additional radioisotope services identified by the Secretary. (V) Customized prosthetic devices (commonly known as artificial limbs or components of artificial limbs) under the following HCPCS codes (as of July 1, 1999 (and as subsequently modified by the Secretary)), and any additional customized prosthetic devices identified by the Secretary, if delivered to an inpatient for use during the stay in the skilled nursing facility and intended to be used by the individual after discharge from the facility: L5050–L5340; L5500–L5611; L5613–L5986; L5988; L6050–L6370; L6400–L6880; L6920–L7274; and L7362–7366. (iv) Exclusion of certain rural health clinic and federally qualified health center services Services described in this clause are— (I) rural health clinic services (as defined in paragraph (1) of section 1395x(aa) of this title ); and (II) federally qualified health center services (as defined in paragraph (3) of such section); that would be described in clause (ii) if such services were furnished by an individual not affiliated with a rural health clinic or a federally qualified health center. (B) All costs The term “all costs” means routine service costs, ancillary costs, and capital-related costs of covered skilled nursing facility services, but does not include costs associated with approved educational activities. (C) Non-Federal percentage; Federal percentage For— (i) the first cost reporting period (as defined in subparagraph (D)) of a facility, the “non-Federal percentage” is 75 percent and the “Federal percentage” is 25 percent; (ii) the next cost reporting period of such facility, the “non-Federal percentage” is 50 percent and the “Federal percentage” is 50 percent; and (iii) the subsequent cost reporting period of such facility, the “non-Federal percentage” is 25 percent and the “Federal percentage” is 75 percent. (D) First cost reporting period The term “first cost reporting period” means, with respect to a skilled nursing facility, the first cost reporting period of the facility beginning on or after July 1, 1998 . (E) Transition period (i) In general The term “transition period” means, with respect to a skilled nursing facility, the 3 cost reporting periods of the facility beginning with the first cost reporting period. (ii) Treatment of new skilled nursing facilities In the case of a skilled nursing facility that first received payment for services under this subchapter on or after October 1, 1995 , payment for such services shall be made under this subsection as if all services were furnished after the transition period.

Source

42 USC § 1395yy(e)(2)


Scoping language

None identified. Default scope is assumed to be the entire title.
Is this correct? or