Page 273

107 STAT. 584 PUBLIC LAW 103-66—AUG. 10, 1993 sia cases, the fee schedule amount to be applied shall be equal to one-half of the amount described in subpara- graph (B). "(B) AMOUNT.—^The amount described in tiiis subpara- graph, for a physician's medical direction of the perform- ance of anesthesia services, is the following percentage of tiie fee schedule amoimt otherwise appUcable vmder this section if the anesthesia services were personally per- formed by the physician alone: (i) For services furnished during 1994, 120 per- cent. **(ii) For services furnished during 1995, 115 per- cent. "(iii) For services furnished during 1996, 110 per- cent. "(iv) For services furnished during 1997, 105 per- cent. **(v) For services furnished after 1997, 100 per- cent.". (2) ELIMINATION OF REDUCTION FOR MEDICAL DIRECTION OF MULTIPLE NURSE ANESTHETISTS AND ESTABUSHMENT OF CONSISTENT BASE AND TIME UNITS.—Paragraph (13) of section 1842(b) (42 U.S.C. 1395u(b)) is amended— (A) by striking subparagraphs (A) and (B) and inserting the following: "(ISXA) In determining payments under section 1833(1) and section 1848 for anesthesia services furnished on or after January 1, 1994, the methodology for determining the base and time imits used shall be the same for services furnished by physicians, for medical direction by physicians of two, three, or four certified reg- istered nurse anesthetists, or for services furnished by a certified registered nurse anesthetist (whether or not medically directed) and shall be based on the methodology in effect, for anesthesia services furnished by physicians, as of the date of the enactment of the Omnibus Budget Reconciliation Act of 1993."; (B) by redesignating subparagraph (C) as subpara- graph (B); and (C) by striking "subparagraph (A) or (B)" in subpara- graph (B) (as so redesignated) and inserting "subparagraph (A)-*. (b) PAYMENT TO A CERTIFIED REGISTERED NURSE ANESTHETIST FOR MEDICALLY DIRECTED SERVICES.—Section 1833(1X4XB) (42 U.S.C. 13951(1X4XB)) is amended— (1) in clause (i), by inserting "and before January 1, 1994," after "1991,"; (2) in clause (ii)— (A) by adding "and" at the end of subclause (II), (B) by striking the comma at the end of subclause (III) and inserting a period, and (C) by striking subclauses (IV) through (VII); and (3) by adding at the end the following new clause: "(iii) In the case of services of a certified registered nurse anesthetist who is medically directed or medically supervised by a physician which are furnished on or after January 1, 1994, the fee schedvde amoimt shall be one-half of the amount described in section 1848(aX5XB) with respect to the physician.".