Page:United States Statutes at Large Volume 101 Part 2.djvu/840

 101 STAT. 1330-46

PUBLIC LAW 100-203—DEC. 22, 1987 scribed in section 1886(b)(3)(B) of such Act were equal to the product of 2.7 percent and the ratio of 315 to 366; and (C) for cost reporting periods beginning on or after October 1, 1988, the applicable percentage increase (as so defined) with respect to the cost reporting period beginning during fiscal year 1988 shall be deemed to have been 2.7 percent.

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Effective date.

(4)

DEFINITION,

REGIONAL

FLOOR,

AND

TECHNICAL

AND

CONFORMING AMENDMENTS.—The amendments m a d e by subsections (b) and (d) and paragraph s (1) and (2) of subsection (0 shall

V >.

take effect on the date of the enactment of this Act. (5) TRANSITION FOR LARGE URBAN AREA RATES.—In computing

the average standardized amount for hospitals located in a large urban area or other urban area under section 1886(d)(3)(A)(ii) of the Social Security Act (as amended by subsection (c)) for fiscal year 1988, the reference to "the respective average standardized amount computed for the previous fiscal year under this subparagraph" is deemed a reference to the average standardized amount computed for hospitals located in an urban area for the 51-day period beginning on October 1, 1987. (6) DEFINITION.—In this subsection, the term "subsection (d) hospital" has the meaning given such term in section 1886(d)(10XB) of the Social Security Act.

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SEC. 4003. INCREASE IN DISPROPORTIONATE SHARE ADJUSTMENT AND REDUCTION IN INDIRECT MEDICAL EDUCATION PAYMENTS. (a) REDUCTION I N INDIRECT M E D I C A L EDUCATION P A Y M E N T S. —

(1) Section 1886(d)(5)(B)(ii) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended—

(A) in subclause (I), by striking "2" and inserting in lieu thereof "1.89"; and (B) in subclause (II), by striking "1.5" and inserting in lieu thereof "1.43". (2) Section 1886(d)(3)(C)(ii) of such Act (42 U.S.C. after "1985" each place it appears in subclauses (I) and (II). (b) INCREASE I N DISPROPORTIONATE S H A R E ADJUSTMENT. — S e c t i o n
 * , 1395ww(d)(3)(C)(ii)) is amended by inserting "and by section
 * "'' 4003(a)(l) of the Omnibus Budget Reconciliation Act of 1987"

1886(d)(5)(F) of such Act (42 U.S.C. 1395ww(d)(5)(B))—

(1) in clause (iii), by striking "15 percent" and inserting "25 percent", and (2) in clause (ivXD, by striking " the lesser of 15 percent, or". (c)

EXTENSION

OF DISPROPORTIONATE SHARE ADJUSTMENT.—Sec-

tions 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)), 1886(d)(3)(C)(iiXI) (42 U.S.C. 1395ww(d)(3)(C)(iiXI)), 1886(d)(3)(C)(iiXII) (42 U.S.C. 1395ww(d)(3)(C)(iiXII)), 1886(d)(5)(B)(iiXI) (42 U.S.C. 1395ww(d)(5)(B)(iiXI)), 1886(d)(5)(B)(iiXII) (42 U.S.C. 1395ww(d)(5)(B)(iiXII)), and 1886(d)(5)(F)(i) (42 U.S.C. 1395ww(d)(5)(F)(i)) of the Social Security Act are each amended by striking "1989" and inserting in lieu thereof "1990". (d) SPECIAL RULE.—In the case of a hospital which— (1) consists of 2 inpatient hospital facilities which are more than 4 miles apart and each of which is in a separate political jurisdiction within the same State and one of which meets the criteria under section 1886(d)(5)(F) of the Social Security Act for serving a significantly disproportionate number of low-income patients as if that facility were a separate hospital; and

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