Page:United States Statutes at Large Volume 101 Part 2.djvu/837

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-43

0>) LARGE URBAN AREA DEFINED.—The second sentence of section

1886(d)(2)(D) of such Act (42 U.S.C. 1395ww(d)(2)(D)) ** is amended by inserting after "under subsection (a) by regulation;" the following: "the term 'large urban area' means, with respect to a fiscal year, such an urban area which the Secretary determines (in the publication described in subsection (e)(5)(B) before the fiscal year) has a population of more than 1,000,000 (as determined by the Secretary based on the most recent available population data published by the Bureau of the Census);". (c) ADJUSTMENT FOR HOSPITALS IN LARGE URBAN AREAS OR IN RURAL AREAS.—

(1) IN GENERAL.—Section 1886(d)(3) of such Act (42 U.S.C. 1395ww(d)(3)) is amended— (A) in the matter before subparagraph (A), by striking "urban or rural areas" and inserting "large urban, other urban, or rural areas"; (B) in first sentence of subparagraph (A)— (i) by striking "The Secretary" and inserting "(i) For discharges occuring in a Hscal year beginning before October 1, 1987, the Secretary", (ii) by striking "each of fiscal years 1985, 1986, 1987, and 1988" and inserting "the fiscal year involved", and (iii) by striking ", and adjusted for subsequent fiscal years in accordance with the final determination of the Secretary under subsection (e)(4), and adjusted to reflect the most recent case-mix data available,"; (C) by adding at the end of subparagraph (A) the following new clauses: "(ii) For discharges occurring in a fiscal year beginning on or after October 1, 1987, the Secretary shall compute an average standardized amount for hospitals located in a large urban area, for hospitals located in a rural area, and for hospitals located in urban areas, within the United States and within each region, equal to the respective average standardized amount computed for the previous fiscal year under this subparagraph increased by the applicable percentage increase under subsection (b)(3)(B)(i) with respect to hospitals located in the respective areas for the fiscal year involved. "(iii) Average standardized amounts computed under this paragraph shall be adjusted to reflect the most recent case-mix data available."; and (D) in subparagraph (D)— (i) by striking "URBAN AND RURAL HOSPITALS" in the heading and inserting "HOSPITALS IN DIFFERENT AREAS",
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(ii) in clause (i), by inserting "(or, for discharges occurring on or after April 1, 1988, in a large urban area or other urban area)" after "urbsm area" the first place it appears, and (iii) in clause (i), by inserting "such" before "an urban area" the second place it appears. (2) CONFORMING AMENDMENTS.—Section 1886(d)(9)(A) of such Act (42 U.S.C. 1395ww(d)(9)(A)) is amended— (A) in clause (ii)(I), by striking "an urban area, and" and inserting "a large urban area,"; '""Copy read "(42 U.S.C. 1395www(d)(2)(D))".

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