Page:United States Statutes at Large Volume 103 Part 3.djvu/73

 PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2141 "(ii) For discharges in Hscal year 1990, the Secretary shall reduce the weighting factor for each diagnosis-related group by 1.22 percent. "(iii) Any such adjustment under clause (i) for discharges in a fiscal year Gieginning with fiscal year 1991) shall be made in a manner that assures that the aggregate payments under this subsec- tion for discharges in the fiscal year are not greater or less than those that would have been made for discharges in the year without such adjustment. "(iv) The Secretary shall include recommendations with respect to Reports, adjustments to weighting factors under clause (i) in the annual report to Congress required under subsection (e)(3)(B).". (c) INCREASE IN DISPROPORTIONATE SHARE ADJUSTMENT. — (1) CHANGE IN FORMULA. —Section 1886(d)(5)(F) of such Act (42 U.S.C. 1395ww(d)(5)(F)) is amended— (A) in clause (ivXD, by striking "the following formula" and all that follows through "(as defined in clause (vi));" and inserting "the applicable formula described in clause (vii);", and (B) by adding at the end the following new clause: "(vii) The formula used to determine the disproportionate share adjustment percentage for a cost reporting period for a hospital described in clause (iv)(I) is— "(I) in the case of such a hospital with a disproportionate patient percentage (as defined in clause (vi)) greater than 20.2, (P-20.2X.65)+5.62,or "(II) in the case of any other such hospital, (P-15X.6)+2.5, where *P' is the hospital's disproportionate patient percentage (as defined in clause (vi)).". (2) TREATMENT OP RURAL HOSPITALS FOR DISPROPORTIONATE SHARE CALCULATION.— Section 1886(d)(5)(F) of such Act (42 U.S.C. 1395ww(d)(5)(F)), as amended by paragraph (1), is amended— (A) in clause (iv)— (i) in subclause (II), by striking "or", (ii) in subclause (III), by inserting "in subclause (TV) or (V) or" after "described", (iii) by striking the period at the end of subclause (III) and inserting a semicolon, and (iv) by adding at the end the following new subclauses: "(IV) is located in a rural area, is classified as a rural referral center under subparagraph (C), and is classified as a sole community hospital under subparagraph (D), is equal to 10 percent or, if greater, the percent determined in accordance with the applicable formula described in clause (viii); "(V) is located in a rural area, is classified as a rural referral center under subparagraph (C), and is not classified as a sole community hospital under subparagraph (D), is equal to the percent determined in accordance with the applicable formula described in clause (viii); or "(VI) is located in a rural area, is classified as a sole commu- nity hospital under subparagraph (D), and is not classified as a ^ rural referral center under subparagraph (C), is 10 percent.", (B) in clause (v)— (i) in subclause (III), by striking "area" and inserting "area and is not described in subclause (II)",

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