Title IV, SEC. 4134. IMPOSITION OF COPAYMENT FOR CERTAIN HOME HEALTH VISITS. (a) In General. (1) Part a. Section 1813(a) (42 U.S.C. 1395e(a)) is amended by adding at the end the following new paragraph: ``(5) The amount payable for home health services furnished to an individual under this part shall be reduced by a copayment amount equal to 10 percent of the average of all per visit costs for home health services furnished under this title determined under section 1861(v)(1)(L) (as determined by the Secretary on a prospective basis for services furnished during a calendar year), unless such services were furnished to the individual during the 30-day period that begins on the date the individual is discharged as an inpatient from a hospital.''. (2) Part b. Section 1833(a)(2) (42 U.S.C. 1395l(a)(2)) is amended (A) in subparagraph (A), by striking ``to home health services,'' and by striking the comma after ``opinion)''; (B) in subparagraph (D), by striking ``and'' at the end; (C) in subparagraph (E), by striking the semicolon at the end and inserting ``; and''; and (D) by adding at the end the following new subparagraph: ``(F) with respect to home health services ``(i) the lesser of ``(I) the reasonable cost of such services, as determined under section 1861(v), or ``(II) the customary charges with respect to such services, ``less the amount a provider may charge as described in clause (ii) of section 1866(a)(2)(A), ``(ii) if such services are furnished by a public provider of services, or by another provider which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low-income (and requests that payment be made under this clause), free of charge or at nominal charges to the public, the amount determined in accordance with section 1814(b)(2), or ``(iii) if (and for so long as) the conditions described in section 1814(b)(3) are met, the amounts determined under the reimbursement system described in such section, ``less a copayment amount equal to 10 percent of the average of all per visit costs for home health services furnished under this title determined under section 1861(v)(1)(L) (as determined by the Secretary on a prospective basis for services furnished during a calendar year), unless such services were furnished to the individual during the 30-day period that begins on the date the individual is discharged as an inpatient from a hospital;''. (3) Provider charges. Section 1866(a)(2)(A)(i) (42 U.S.C. 1395cc(a)(2)(A)(i)) is amended (A) by striking ``deduction or coinsurance'' and inserting ``deduction, coinsurance, or copayment''; and (B) by striking ``or (a)(4)'' and inserting ``(a)(4), or (a)(5)''. (b) Effective Date. The amendments made by subsection (a) shall apply to home health services furnished on or after July 1, 1995.