Page:United States Statutes at Large Volume 105 Part 2.djvu/849

 PUBLIC LAW 102-234—DEC. 12, 1991 105 STAT. 1801 equal to at leeist 1 percent of the total number of such days for all hospitals in the State. "(iv) The hospital meets such alternative requirements as the Secretary may establish by regulation, taking into account the special circumstances of children's hospitals, hospitals located in rural areas, and sole community hospitals. "(E) CONDITION FOR OPTION.—The option specified in subparagraph (D) shall not apply for payments for a quarter beginning before the date of enactment of legislation establishing a limit on payment adjustments under this section which would apply in the case of a state exercising such option. " (2) DETERMINATION OF STATE DSH ALLOTMENTS.— "(A) IN GENERAL.— Subject to subparagraph (B), the State DSH allotment for a fiscal year is equal to the State DSH allotment for the previous fiscal year (or, for fiscal year 1993, the State base allotment as defined in paragraph (4)(C)), increased by— "(i) the State growth factor (as defined in paragraph (4)(E)) for the fiscal year, and "(ii) the State supplemental amount for the fiscal year (as determined under paragraph (3)). "(B) EXCEPTIONS. — " (i) LIMIT TO 12 PERCENT OR BASE ALLOTMENT.— A State DSH allotment under subparagraph (A) for a fiscal year shall not exceed 12 percent of the total amount of expenditures under the State plan for medical assistance during the fiscal year, except that, in the case of a high DSH State (as defined in paragraph (4)(A)), the State DSH allotment shall equal the State based allotment. "(ii) EXCEPTION FOR MINIMUM REQUIRED ADJUST- MENT.—No State DSH allotment shall be less than the minimum amount of payment adjustments the State is required to make in the fiscal year to meet the requirements of subsection (c)(1). "(3) STATE SUPPLEMENTAL AMOUNTS. —The Secretary shall determine a supplemental amount for each State that is not a high DSH State ior a fiscal year as follows: "(A) DETERMINATION OF REDISTRIBUTION POOL. — The Secretary shall subtract from the national DSH payment limit (specified in paragraph (1)(B)) for the fiscal year the following: "(i) the total of the State base allotments for high DSH States; "(ii) the total of State DSH allotments for the previous fiscal year (or, in the case of fiscal year 1993, the total of State base allotments) for all States other than high DSH States; "(iii) the total of the State growth amounts for all States other than high DSH States for the fiscal year; and "(iv) the total additions to State DSH allotments the Secretary estimates will be attributable to paragraph (2)(B)(ii).

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