Page:United States Statutes at Large Volume 100 Part 3.djvu/1124

 100 STAT. 2932

PUBLIC LAW 99-514—OCT. 22, 1986 "(ii) REDUCING FOR SAVINGS FROM AMENDMENT TO INDIRECT TEACHING ADJUSTMENT FOR DISCHARGES AFTER SEPTEMBER 30,

1986.—The Secretary shall further reduce each of the average standardized amounts by a proportion equal to the proportion (estimated by the Secretary) of the amount of payments under this subsection based on DRG prospective payment amounts which is the difference between— "(I) the sum of the additional payment amounts under paragraph (5)(B) (relating to indirect costs of medical education) if the indirect teaching adjustment factor were equal to 1.159r (as *r' is defined in paragraph (5)(B)(ii)), and "(11) that sum using the factor specified in paragraph (5)(B)(ii)(II).". (D)(i) Except as provided in clause (ii), the amendments made by this paragraph apply to discharges occurring on or after October 1, 1986. (ii) The amendments made by this paragraph shall not be first applied to discharges occurring as of a date unless, for discharges occurring on that date, the amendments made by section 9105(a) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (incorporating the amendments made by paragraph (2) of this subsection) are also being applied. (2) DISPROPORTIONATE SHARE.—(A) Paragraph (2)(C) of subsection (d) of section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by section 9105(b) of the (Consolidated Omnibus Budget Reconciliation Act of 1985 (in this section referred to as "COBRA") is amended— (i) by adding "and" at the end of clause (ii), (ii) by striking out ", and" at the end of clause (iii) and inserting in lieu thereof a period, and (iii) by striking out clause (iv). (B) Paragraph (3)(C) of such subsection is amended by adding at the end the following: "(iii) REDUCING FOR DISPROPORTIONATE SHARE PAYMENTS.—The Secretary shall further reduce each of the average standardized amounts by reducing the standardized amount for each hospital (as previously determined without regard to this clause) by a proportion equal to the proportion (established by the Secretary) of the amount of payments under this subsection based on DRG prospective payment amounts which are additional payments described in paragraph (5)(F) (relating to disproportionate share payments) for subsection (d) hospitals.". (C) Paragraph (5)(F)(vi)(I) of such subsection is amended— (i) by striking out "supplementary" and inserting in lieu thereof "supplemental", and (ii) by striking out "fiscal year" and inserting in lieu thereof "period". (D) The amendments made by subparagraph (C) apply to discharges occurring on or after May 1, 1986, and the amendments made by subparagraphs (A) and (B) apply to discharges occurring on or after October 1, 1986. (3) AuGNMENT CORRECTION.—Subparagraph (B) of section 1886(g)(2) of the Social Security Act (as added by section 9107(a)(l)(C) of the (Donsolidated Omnibus Budget Reconciliation Act of 1985) is amended by moving its alignment (and the alignment of each of its clauses) two additional ems to the left.

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