PUBLIC LAW 103-432—OCT. 31, 1994 108 STAT. 4405 under section 1820(i)(2) of the Social Security Act, or" after "means". (2) EFFECTIVE DATE.— The amendment made by paragraph (1) shall apply to grants made on or after October 1, 1994. (b) EXTENSION OF AUTHORIZATION OF APPROPRIATIONS.— Section 4005(e)(9) of OBRA-1987 is amended— (1) by striking "1989 and" and inserting "1989,"; and (2) by striking "1992" and inserting "1992 and $30,000,000 for each of fiscal years 1993 through 1997". (c) FREQUENCY OF REQUIRED REPORTS.— Section 4008(e)(8)(B) of OBRA-1987 is amended by striking "every 6 months" and inserting "every 12 months", SEC. 104. PSYCHOLOGY SJ:RVICES IN HOSPITALS. Section 1861(e)(4) (42 U.S.C. 1395x(e)(4)) is amended by striking "physician;" and inserting "physician, except that a patient receiving qualified psychologist services (as defined in subsection (ii)) may be under the care of a clinical psychologist with respect to such services to the extent permitted under State law;". SEC. 105. MEDICARE-DEPENDENT, SMALL RURAL HOSPITALS AND SOLE COMMUNITY HOSPITALS. (a) MEDICARE DEPENDENT, SMALL RURAL HOSPITALS.— (1) CLARIFICATION OF ADDITIONAL PAYMENT.— Section 1886(d)(5)(G)(ii)(I) (42 U.S.C. 1395ww(d)(5)(G)(ii)(I)), as amended by section 13501(e)(1) of OBRA-1993, is amended by striking "the first 3 12-month cost reporting periods that begin" and inserting "the 36-month period beginning with the first day of the cost reporting period that begins". (2) CONFORMING TARGET AMOUNTS TO EXTENSION OF ADDI- TIONAL PAYMENTS. — Section 1886(b)(3)(D) (42 U.S.C. 1395ww(b)(3)(D)) is amended in the matter preceding clause (i) by striking "March 31, 1993" and inserting "September 30, 1994". (b) CLARIFICATION OF UPDATES.— Section 1886(b)(3)(B)(iv)(II) (42 U.S.C. 1395ww(b)(3)(B)(iv)(II)), as added by section 13501(a)(2) of OBRA-1993, is amended by striking "(taking into account" and all that follows through "1994)" and inserting "(adjusted to exclude any portion of a cost reporting period beginning during fiscal year 1993 for which the applicable percentage increase is determined under subparagraph (I))". SEC. 106. SKILLED NURSING FACILITIES. ' (a) CONSTRUCTION OF WAGE INDEX.— Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall begin to collect data on employee compensation and paid hours of employment in skilled nursing facilities for the purpose of constructing a skilled nursing facility wage index adjustment to the routine service cost limits required under section 1888(a)(4) of the Social Security Act. (b) CLARIFICATION OF REPEAL OF UTILIZATION REVIEW REQUIREMENTS (1) IN GENERAL. — (A) Section 1814(a)(5) (42 U.S.C. 1395f(a)(5)) is amended— (i) by striking "and with respect" and all that follows through "regulations"; (ii) by striking "or skilled nursing facility, as the case may be"; and 42 USC 1395WW note. 42 USC 1395WW note. 42 USC 1395WW note. 42 USC 1395yy note.
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