; (ii) the individual is not meeting appropriate clinical outcomes (as determined by such physician or qualified nonphysician practitioner) for such condition; or (iii) the individual meets other criteria that necessitates such additional number of hours, as determined by the Secretary. (4) For purposes of this section, the term qualified nonphysician practitioner means a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)). . (b) Medical nutrition therapy services Section 1861(s)(2)(V) of such Act ( 42 U.S.C. 1395x(s)(2)(V) ) is amended— (1) by striking clause (i); (2) by redesignating clauses (ii) and (iii) as clauses (i) and (ii), respectively; and (3) in clause (ii), as so redesignated, by striking after consideration of and inserting consistent with . (c) Cost-sharing Section 1833 of such Act ( 42 U.S.C. 1395l ) is amended— (1) in subsection (a)(1)— (A) by striking and (BB) and inserting (BB) ; and (B) by striking the semicolon at the end and inserting , and (CC) with respect to diabetes outpatient self-management training services (as defined in section 1861(qq)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part; ; and (2) in subsection (b)— (A) by striking and (10) and inserting (10)