Page:United States Statutes at Large Volume 108 Part 5.djvu/914

 108 STAT. 4404 PUBLIC LAW 103-432—OCT. 31, 1994 42 USC 1395d note. 42 USC 1395WW note. (A) in paragraph (1), by striking "during a year before 1993" and inserting "during a year before Qie prospective payment system described in paragraph (2) is in effect"; and (B) in paragraph (2), by striking "January 1, 1993," and inserting "January 1, 1996,". (2) No USE OF CUSTOMARY CHARGE IN DETERMINING PAY- MENT. —Section 1834(g)(1) (42 U.S.C. 1395m(g)(l)) is amended by adding at the end the following new flush sentence: "The amount of payment shall be determined under either method without regard to the amount of the customary or other charge.". if) CLARIFICATION OF PHYSICIAN STAFFING REQUIREMENT FOR RURAL PRIMARY CARE HOSPITALS.— Section 1820(f)(1)(H) (42 U.S.C. 1395i-4(f)(l)(H)) is amended by striking the period and inserting the following: ", except that in determining whether a facihty meets the requirements of this subparagraph, subparagraphs (E) and (F) of that paragraph shall be applied as if any reference to a ^physician' is a reference to a physician as defined in section 1861(r)(l).". (g) TECHNICAL AMENDMENTS RELATING TO PART A DEDUCTIBLE, COINSURANCE, AND SPELL OF ILLNESS.—(1) Section 1812(a)(1) (42 U.S.C. 1395d(a)(l)) is amended— (A) by striking "inpatient hospital services" the first place it appears and inserting "inpatient hospital services or inpatient rural primary care hospital services"; (B) by striking *4npatient hospital services" the second place it appears and inserting "such services"; and (C) by striking "and inpatient rural primary care hospital services". (2) Sections 1813(a) and 1813(b)(3)(A) (42 U.S.C. 1395e(a), 1395e(b)(3)(A)) are each amended by striking "inpatient hospital services" each place it appears and inserting "inpatient hospital services or inpatient rural primary care hospital services". (3) Section 1813(b)(3)(B) (42 U.S.C. 1395e(b)(3)(B)) is amended by striking "inpatient hospital services" and inserting "inpatient hospital services, inpatient rural primary care hospital services". (4) Section 1861(a) (42 U.S.C. 1395x(a)) is amended— (A) in paragraph (1), by striking "inpatient hospital services" and inserting "inpatient hospital services, inpatient rural primary care hospital services"; and (B) in paragraph (2), by striking "hospital" and inserting hospital or rural primary care hospital". (h) AUTHORIZATION OF APPROPRIATIONS.—Section 1820(1) (42 U.S.C. 1395i-4(l)), as redesignated by subsection (b)(2)(A), is amended by striking "1990, 1991, and 1992" and inserting "1990 through 1997". (i) EFFECTIVE DATE. —The amendments made by this section shall take effect on the date of the enactment of this Act. SEC. 103. PROVISIONS RELATING TO RURAL HEALTH TRANSITION GRANT PROGRAM. (a) ELIGIBILITY OF RURAL PRIMARY CARE HOSPITALS FOR GRANTS.— (1) IN GENERAL.— Section 4005(e)(2) of OBRA-1987 is amended in the matter preceding subparagraph (A) by inserting "any rural primary care hospital designated by the Secretary

�