Page:United States Statutes at Large Volume 105 Part 2.djvu/851

 PUBLIC LAW 102-234—DEC. 12, 1991 105 STAT. 1803 (i) in subsection (a)(2)(B), by striking "subsection (c)," and inserting "subsections (c) and (f),"; and (ii) in subsection (c), by striking "In order" and inserting "Subject to subsection (f), in order". (B) Section 1903(a)(1) of such Act (42 U.S.C. 1396b(a)(l)) is amended by inserting "and section 1923(f)" after "of this section". (c) LIMITS ON AuTHORitY To RESTRICT DSH DESIGNATIONS.— 42 USC l396r-4. Subsection (b) of such section is amended by adding at the end the following new paragraph: "(4) The Secretary may not restrict a State's authority to designate hospitals as disproportionate share hospitals under this section. The previous sentence shall not be construed to affect the authority of the Secretary to reduce payments pursuant to section 1903(w)(l)(A)(iii) if the Secretary determines that, as a result of such designations, there is in effect a hold harmless provision described in section 1903(w)(4).". (d) STUDY OF DSH PAYMENT ADJUSTMENTS.— 42 USC i396r-4 (1) IN GENERAL.—The Prospective Pajment Assessment "°*®- Commission shall conduct a study concerning— (A) the feasibility and desirability of establishing maximum and minimum payment adjustments under section 1923(c) of the Social Security Act for hospitals deemed disproportionate share hospitals under State medicaid plans, and (B) criteria (other than criteria described in clause (i) or (ii) of section 1923(f)(l)(D) of such Act) that are appropriate for the designation of disproportionate share hospitals under section 1923 of such Act. (2) ITEMS INCLUDED IN STUDY. —The Commission shall include in the study— (A) a comparison of the payment adjustments for hospitals made under such section and the additional pay- ments made under title XVIII of such Act for hospitals serving a significantly disproportionate number of low income patients under the medicare program; and (B) an analysis of the effect the establishment of limits on such payment adjustments will have on the ability of the hospitals to be reimbursed for the resource costs incurred by the hospitals in treating individuals entitled to medical assistance under State medicaid plans and other lowincome patients. (3) REPORT.— Not later than January 1, 1994, the Commission shall submit a report on the study conducted under paragraph (1) to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives. Such report shall include such recommendations respecting the designation of disproportionate share hospitals and the establishment of maximum and minimum payment adjustments for such hospitals under section 1923 of the Social Security Act as may be appropriate. (e) EFFECTIVE DATE. —(1) The amendments made by this section 42 USC 1396a shall take effect January 1, 1992. ^°^- (2) The proposed rule promulgated by the Secretary of Health and Human Services on October 31, 1991 (56 Federal Register 56141), relating to the standards for defining disproportionate share hospitals under the medicaid program, shall be withdrawn and can-

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