Page:United States Statutes at Large Volume 105 Part 2.djvu/847

 PUBLIC LAW 102-234—DEC. 12, 1991 105 STAT. 1799 imposed in lieu of or instead of a fee, assessment, or other mandatory payment). "(G) The term 'unit of local government' means, with respect to a State, a city, county, special purpose district, or other governmental unit in the State.". (b) CONFORMING AMENDMENTS.— (1) Section 1902(t) of such Act (42 U.S.C. 1396a(t)) is amended— (A) by striking "Except as provided in section 1903(i), nothing" and inserting "Nothing", and (B) by striking "taxes (whether or not of general applicability)" and inserting "taxes of general applicability". (2) Section 1903(i) of such Act (42 U.S.C. 1396b(i)) is amended by striking paragraph (10) inserted by section 4701(b)(2)(B) of the Omnibus Budget Reconciliation Act of 1990. (c) EFFECTIVE DATE. — (1) The amendments made by this section shall take effect January 1, 1992, without regard to whether or not regulations have been promulgated to carry out such amendments by such date. (2) Except as specifically provided in section 1903(w) of the Social Security Act and notwithstanding any other provision of such Act, the Secretary of Health and Human Services shall not, with respect to expenditures prior to the effective date specified in section 1903(w)(l)(F) of such Act, disallow any claim submitted by a State for, or otherwise withhold Federal financial participation with respect to, amounts expended for medical assistance under title XIX of the Social Security Act by reason of the fact that the source of the funds used to constitute the non-Federal share of such expenditures is a tax imposed on, or a donation received from, a health care provider, or on the ground that the amount of any donation or tax proceeds must be credited against the amount of the expenditure. (3) The interim final rule promulgated by the Secretary of Health and Human Services on October 31, 1991 (56 Federal Register 56132), relating to the State share of financial participation under the medicaid program, is hereby nullified and is of no effect. No part of such rule shall be effective except pursuant to a rule promulgated after the date of the enactment of this Act and consistent with this section (and the amendments made by this section). SEC. 3. RESTRICTIONS ON AGGREGATE PAYMENTS FOR DISPROPORTION- ATE SHARE HOSPITALS. (a) REPEAL OF PROHIBITION OF UPPER PAYMENT LIMIT FOR DIS- PROPORTIONATE SHARE HOSPITALS.— Section 1902(h) of the Social Security Act (42 U.S.C. 1396a(h)) is amended by striking "to limit" the first place it appears and all that follows through "special needs or". 03) LIMITATION ON AGGREGATE PAYMENT ADJUSTMENTS. — (1) IN GENERAL.— Section 1923 of such Act (42 U.S.C. 1396r-4) is amended by adding at the end the following new subsection: " (f) DENIAL OF FEDERAL FINANCIAL PARTICIPATION FOR PAYMENTS IN EXCESS OF CERTAIN LIMITS.— "(1) IN GENERAL. — "(A) APPLICATION OF STATE-SPECIFIC LIMITS.—Except as provided in subparagraph (D), payment under section 1903(a) shall not be made with respect to any payment adjustment made under this section for hospitals in a State (as defined in paragraph (4)(B)) for quarters— 42 USC 1396a note. 42 USC 1396b note.

�