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PUBLIC LAW 103-66—AUG. 10, 1993 107 STAT. 589 note. 42 u s e 1395m note. £uid may not be less than 85 percent of the median of all local monthly pajrment rates computed for the item under such subparagraph for the year; and", (b) EFFECTIVE DATE.—The amendments made by this section 42 use i395m shall apply to items furnished on or after January 1,1994. SEC. 13543. TREATMENT OF NEBULIZERS, ASPIRATORS, AND CERTAIN VENTILATORS. (a) IN GENERAL.—Section 1834(aX3)(A) (42 U.S.C. 1395m(aX3XA)) is amended by striking 'Ventilators, aspirators, IPPB machines, and nebulizers" and inserting "IPPB machines and ventilators, excluding ventilators that are either continuous airway pressure devices or intermittent assist devices with continu- ous airway pressure devices". (b) PAYMENT FOR ACCESSORIES RELATING TO NEBULIZERS, ASPIRATORS, AND CERTAIN VENTILATORS.—Section 1834(aX2XA) (42 U.S.C. 1395m(a)) is amended— (1) by striking "or" at the end of clause (i), (2) by adding "or" at the end of clause (ii), and (3) by inserting after clause (ii) the following new clause: "(iii) which is an accessory used in com'imction with a nebulizer, aspirator, or a ventilator excluded under paragraj^ (3XA),". (c) EFFECTIVE DATE.—^e amendments made by this section shall apply to items furnished on or after January 1,1994. SEC. 13544. PAYMENT FOR OSTOMY SUPPLIES AND OTHER SUPPLIES. (a) OSTOMY SUPPUES, TRACHEOSTOMY SUPPLIES, AND UROLOGICALS.— (1) IN GENERAL.—Section 1834(hXl) (42 U.S.C. 1395m(hXl)) is amended by adding at the end the following new subparagraph: "(E) EXCEPTION FOR CERTAIN ITEMS.—Payment for ostomv supplies, tracheostomy supplies, and urologicals shall be made in accordance with subparagraphs (B) and (C) of section 1834(aX2).". (2) CONFORMING AMENDMENT.—Section 1834(hXlXB) (42 U.S.C. 1395m(hXlXB)) is amended by striking "subparagraph (C)," and inserting "subparagraphs (C) and (E), . (3) EFFECTIVE DATE.—^The amendments made by this sub- section shall apply to items furnished on or after January 1,1994. (b) SURGICAL DRESSINGS.— (1) IN GENERAL.—Section 1834 (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: "(i) PAYMENT FOR SURGICAL DRESSINGS.— "(1) IN GENERAL.—^Payment under this subsection for sur- gical dressings (described in section 1861(sX5)) shall be made m a lump sum amount for the purchase of the item in an amount equal to 80 percent of the lesser of— "(A) the actual charge for the item; or "(B) a payment amoimt determined in accordance with the methodology described in subparagraphs (B) and (C) of subsection (aX2) (except that in applying such methodol- ogy, the national limited payment amount referred to in such subparagraphs shall be initially computed based on local payment amounts using average reasonable charges for the 12-month period ending December 31, 1992, 42 u s e 1395m note.