Page:United States Statutes at Large Volume 101 Part 2.djvu/943

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-149

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(B) In order to be considered to have met such requirement of section 1902(a)(13)(A) as of July 1, 1990, the State must submit to the Secretary of Health and Human Services by not later than such date, the State plan amendment described in paragraph (1), consistent with subsection (c). The Secretary shall, not later than June 30 of each year in which the State is required to submit an amendment under this subsection, review each such amendment for compliance with such requirement and by such date shall approve or disapprove each such amendment. If the Secretary disapproves such an amendment, the State shall immediately submit a revised amendment which meets such requirement. The requirement of this subsection may not be waived under section 1915(b)(4) of the Social Security Act. (b) HOSPITALS DEEMED DISPROPORTIONATE SHARE.—

(1) For purposes of subsection (a)(1), a hospital which meets the requirement of subsection (d) is deemed to be a disproport tionate share hospital if— (A) the hospital's medicaid inpatient utilization rate (as defined in paragraph (2)) is at lesist one standard deviation above the mean medicaid inpatient utilization rate for hospitals receiving medicaid payments in the State; or (B) the hospital's low-income utilization rate (as defined 1 in paragraph (3)) exceeds 25 percent. (2) For purposes of paragraph (1)(A), the term "medicaid inpatient utilization rate" means, for a hospital, a fraction (expressed as a percentage), the numerator of which is the hospital's number of inpatient days attributable to patients who (for such days) were eligible for medical assistance under the State plan approved under title XIX of the Social Security Act i in a period, and the denominator of which is the total number of the hospital's inpatient days in that period. (3) For purposes of paragraph (1)(B), the term "low-income utilization rate" means, for a hospital, the sum of— (A) the fraction (expressed as a percentage)— 1 (i) the numerator of which is the sum (for a period) of (I) the total revenues paid the hospital for patient services under a State plan under title XIX of the . _ Social Security Act and (II) the amount of the cash subsidies for patient services received directly from t; ' State and local governments, and (ii) the denominator of which is the total amount of revenues of the hospital for patient services (including c the amount of such cash subsidies) in the period; and (B) a fraction (expressed as a percentage)— (i) the numerator of which is the total amount of the "^ hospital's charges for inpatient hospital services which are attributable to charity care in a period, and s^c;,v (ii) the denominator of which is the total amount of the hospital's charges for inpatient hospital services in the hospital in the period. The numerator under subparagraph (B)(i) shall not include contractual allowances and discounts (other than for indigent patients not eligible for medical assistance under a State plan approved under title XIX of the Social Security Act). (c) PAYMENT ADJUSTMENT.—In order to be consistent with this subsection, a payment adjustment for a disproportionate share hospital must either—

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