Page:United States Statutes at Large Volume 100 Part 3.djvu/180

 100 STAT. 1988

PUBLIC LAW 99-509—OCT. 21, 1986

"(i) Subparagraph (A) (relating to outlier payments). "(ii) Subparagraph (B) (relating to payments for indirect medical education costs), except that for this purpose the sum of the amount determined under subparagraph (A) of this paragraph and the amount paid to the hospital under clause (i) of this subparagraph shall be substituted for the sum referred to in paragraph (5)(B)(i)(I). "(iii) Subparagraph (C)(iii) (relating to exceptions and adjustments). "(iv) Subparagraph (E) (relating to payments for costs of certified registered nurse anesthetists). "(v) Subparagraph (F) (relating to disproportionate share payments), except that for this purpose the sum described in clause (ii) of this subparagraph shall be substituted for the sum referred to in paragraph (5)(F)(ii)(I).". (b) CONFORMING AMENDMENTS.—(1) The first sentence of subclause (I) of section 1886(d)(5)(C)(i)(I) of such Act, as redesignated by section 42 USC I395ww. 9302(d), is amended by inserting "(other than under paragraph (9))" after "established under this subsection". (2) The second and third sentences of section 1886(d)(5)(C)(ii) of such Act are each amended by inserting "(other than under paragraph (9))" after "payment amounts under this subsection". (c) BUDGET NEUTRALITY.—Section 1886(e)(1) of the Social Security Act is amended by adding at the end the following new subparagraph: "(C) For discharges occurring in fiscal year 1988, the Secretary shall provide for such equal proportional adjustment in each of the average standardized amounts otherwise computed under subsection (d)(3) for that fiscal year as may be necessary to assure that— "(i) the aggregate payment amounts otherwise provided under subsections (d)(l)(A)(iii), (d)(5), and (d)(9) for that fiscal year for operating costs of inpatient hospital services of subsection (d) hospitals and subsection (d) Puerto Rico hospitals, are not greater or less than— "(ii) the payment amounts that would have been payable for such services for those same hospitals for that fiscal year but for the enactment of the amendments made by section 9304 of the Omnibus Budget Reconciliation Act of 1986.". 42 USC I395ww (d) EFFECTIVE DATE.—The amendments made by this section shall note. apply to discharges occurring on or after October 1, 1987, SEC. 9305. IMPROVING QUALITY OF CARE WITH RESPECT TO PART A SERVICES. (a) REFINEMENT OF PROSPECTIVE PAYMENT SYSTEM.— (1) DEVELOPMENT OF LEGISLATIVE PROPOSAL.—The Secretary of

Ante, p. 1985.

Health and Human Services shall develop and submit to Congress a specific legislative proposal to improve the classification and payment system under section 1886(d) of the Social Security Act (and, as appropriate, the system for payment of outliers under section 1886(d)(5)(A) of such Act) in order to assure that the amount of payment per discharge approximates the cost of medically necessary care provided in an efficient manner for individual patients or classes of patients with similar conditions. (2) ACCOUNTING FOR SEVERITY OF ILLNESS.—In developing the proposal, the Secretary shall account for variations in severity

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