Page:United States Statutes at Large Volume 103 Part 3.djvu/75

 PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2143 period in providing inpatient hospital services, including the reason- able cost of maintaining necessary core staff and services, "(iii) The term 'sole community hospital' means any hospital— "(I) that the Secretary determines is located more than 35 road miles from another hospital, or "(11) that, by reason of factors such as the time required for an individual to travel to the nearest alternative source of appro- priate inpatient care (in accordance with standards promul- gated by the Secretary), location, weather conditions, travel conditions, or absence of other like hospitals (as determined by the Secretary), is the sole source of inpatient hospital services reasonably available to individuals in a geographic area who are entitled to benefits under part A. "(iv) The Secretary shall promulgate a standard for determining whether a hospital meets the criteria for classification as a sole community hospital under clause (iii)(II) because of the time re- quired for an individual to travel to the nearest alternative source of appropriate inpatient care.". ' (B) Section 1886(b)(3) of such Act (42 U.S.C. 1395ww(b)(3)) is amended— (i) in subparagraph (A), by striking "(A) For purposes of this subsection" and inserting "(A) Except as provided in subparagraph (C), for purposes of this subsection", and (ii) by adding at the end the following new subparagraph: "(C) In the case of a hospital that is a sole community hospital (as defined in subsection (d)(5)(D)(iii)), the term 'target amount' means— "(i) with respect to the first 12-month cost reporting period in which this subparagraph is applied to the hospital— "(I) the allowable operating costs of inpatient hospital services (as defined in subsection (a)(4)) recognized under this title for the hospital for the 12-month cost reporting period (in this subparagraph referred to as the 'base cost reporting period') preceding the first cost reporting period for which this subsection was in effect with respect to such hospital, increased (in a compounded manner) by— "(II) the applicable percentage increases applied to such hospital under this paragraph for cost reporting periods after the base cost reporting period and up to and including such first 12-month cost reporting period, or "(ii) with respect to a later cost reporting period, the target amount for the preceding 12-month cost reporting period, in- creased by the applicable percentage increase under subpara- graph (B)(i) for discharges occurrii^ in the fiscal year in which that later cost reporting period begins. There shall be substituted for the base cost reporting period de- scribed in clause (i) a hospital's cost reporting period (if any) begin- ning during fiscal year 1987 if such substitution results in an increase in the tai^et amount for the hospital.". (2) CONFORMING AMENDMENTS. — Such Act is further amended— (A) in section 1833(h)(l)(D), by striking "the last sentence 42 USC 1395/. of section 1886(d)(5)(C)(ii)" and inserting "section 1886(d)(5)(D)(iii)"; -3. (B) in section 1886(d)(5)(C)(i)— 42 USC i395ww. (i) by striking "(C)(i)(I)" and inserting "(C)(i)", and

�