; and (ii) provided to such individual not later than four and a half hours (or such other clinically appropriate amount of time as is determined by the Secretary) after the onset of such symptoms with respect to such individual. . (b) No originating site facility fee for new sites Section 1834(m)(2)(B) of the Social Security Act ( 42 U.S.C. 1395m(m)(2)(B) ) is amended, in the matter preceding clause (i), by inserting (other than an originating site that is only described in clause (iii) of paragraph (4)(C), and does not meet the requirement for an originating site under clause (i) of such paragraph) after the originating site . (c) Effective date The amendments made by this section shall apply to services furnished on or after the date that is 18 months after the date of the enactment of this Act.