Page:United States Statutes at Large Volume 100 Part 3.djvu/178

 100 STAT. 1986 42 USC 1395f. 42 USC 1395e.

Rural areas.

Rural areas. Urban areas.

PUBLIC LAW 99-509-OCT. 21, 1986

"(9)(A) Notwithstanding section 1814(b) but subject to the provisions of section 1813, the amount of the payment with respect to the operating costs of inpatient hospital services of a subsection (d) Puerto Rico hospital for inpatient hospital discharges in a fiscal year beginning on or after October 1, 1987, is equal to the sum of— "(i) 75 percent of the Puerto Rico adjusted DRG prospective payment rate (determined under subparagraph (B) or (C)) for such discharges, and "(ii) 25 percent of the discharge-weighted average of— "(I) the national adjusted DRG prospective payment rate (determined under paragraph (3)(D)) for hospitals located in h • an urban area, and "(II) such rate for hospitals located in a rural area, for such discharges, adjusted in the manner provided in paragraph (3)(E) for different area wage levels. As used in this section, the term 'subsection (d) Puerto Rico hospital' means a hospital that is located in Puerto Rico and that would be a subsection (d) hospital (as defined in paragraph (1)(B)) if it were located in one of the fifty States. a "(B) The Secretary shall determine a Puerto Rico adjusted DRG prospective payment rate, for each inpatient hospital discharge in fiscal year 1988 involving inpatient hospital services of a subsection (d) Puerto Rico hospital for which payment may be made under part A of this title. Such rate shall be js'.; determined for such hospitals located in urban or rural areas «I. within Puerto Rico, as follows: "(i) The Secretary shall determine the target amount (as 3 f defined in subsection (b)(3)(A)) for the hospital for the cost reporting period beginning in fiscal year 1987 and increase such amount by prorating the applicable percentage increase (as defined in subsection (b)(3)(B)) to update the amount to the midpoint in fiscal year 1988. "(ii) The Secretary shall standardize the amount determined under clause (i) for each hospital by— "(I) excluding an estimate of indirect medical education costs, "(II) adjusting for variations among hospitals by area in the average hospital wage level, "(III) adjusting for variations in case mix among hospitals, and "(IV) excluding an estimate of the additional payments to certain subsection (d) Puerto Rico hospitals to be made under subparagraph (D)(v) (relating to disproportionate share payments). "(iii) The Secretary shall compute a discharge weighted average of the standardized amounts determined under clause (ii) for all hospitals located in an urban area and for all hospitals located in a rural area (as such terms are defined in paragraph (2)(D)). "(iv) The Secretary shall reduce the average standardized amount by a proportion equal to the proportion (estimated by ^' the Secretary) of the amount of payments under this paragraph which are additional payments described in subparagraph (D)(i) (relating to outlier payments). "(v) For each discharge classified within a diagnosis-related group for hospitals located in an urban or rural area, respec-

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