Page:United States Statutes at Large Volume 100 Part 1.djvu/195

 PUBLIC LAW 99-272—APR. 7, 1986

100 STAT. 159

"(ii) The amount of such payment for each discharge shall be determined by multiplying (I) the sum of the amount determined under paragraph (IXAXiiXII) (or, if applicable, the amount determined under paragraph (IXAXiii)) and the amount paid to the hospital under subparagraph (A) for that discharge, by (II) the disproportionate share adjustment percentage established under clause (iii) or (iv) for the cost reporting period in which the discharge occurs. "(iii) The disproportionate share adjustment percentage for a cost reporting period for a hospital described in clause (i)(II) is equal to 15 percent. "(iv) The disproportionate share adjustment percentage for a cost Rural areas. reporting period for a hospital that is not described in clause (i)(II) and that— "(I) is located in an urban area and has 100 or more beds, is equal to the lesser of 15 percent, or the percent determined in accordance with the following formula: (P—15X.5) + 2.5, where 'P' is the hospital's disproportionate patient percentage (as defined in clause (vi)); "(II) is located in an urban area and has less than 100 beds, is equal to 5 percent; or "(III) is located in a rural area, is equal to 4 percent. "(v) In this subparagraph, a hospital 'serves a significantly dis- Rural areas. proportionate number of low income patients' for a cost reporting period if the hospital has a disproportionate patient percentage (as defined in clause (vi)) for that period which equals, or exceeds— "(I) 15 percent, if the hospital is located in an urban area and has 100 or more beds, "(II) 40 percent, if the hospital is located in an urban area and has less than 100 beds, or "(III) 45 percent, if the hospital is located in a rural area. "(vi) In this subparagraph, the term 'disproportionate patient percentage' means, with respect to a cost reporting period of a hospital, the sum of— "(I) the fraction (expressed as a percentage), the numerator of which is the number of such hospital's patient days for such period which were made up of patients who (for such days) were entitled to benefits under part A of this title and were entitled to supplementary security income benefits (excluding any State supplementation) under title XVI of this Act, and the denominator of which is the number of such hospital's patient days for such fiscal year which were made up of patients who (for such days) were entitled to benefits under part A of this title, and (II) the fraction (expressed as a percentage), the numerator of which is the number of the hospital's patient days for such period which consist of patients who (for such days) were eligible for medical assistance under a State plan approved under title XIX, but who were not entitled to benefits under part A of this title, and the denominator of which is the total number of the hospital's patient days for such period.". (b) RESTANDARDIZING D R G PAYMENT AMOUNTS TO REFLECT DIS- 42 USC I395ww. PROPORTIONATE SHARE PAYMENTS.—Section 1886(d)(2)(C) of such Act is amended— (1) by striking out "and" at the end of clause (ii), (2) by striking out the period at the end of clause (iii) and inserting in lieu thereof ", and", and (3) by adding at the end the following new clause:

�