Page:United States Statutes at Large Volume 111 Part 1.djvu/443

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 419 "(G) DETERMINATION OF FEDERAL RATE.— The Secretary shall compute for each skilled nursing facility for each fiscal year (beginning with the initial period described in subparagraph (E)(i)) an adjusted Federal per diem rate equal to the unadjusted Federal per diem rate determined under subparagraph (E), as adjusted under subparagraph (F), and as further adjusted as follows: "(i) ADJUSTMENT FOR CASE MIX.—The Secretary shall provide for an appropriate adjustment to account for case mix. Such adjustment shall be based on a resident classification system, established by the Secretary, that accounts for the relative resource utilization of different patient types. The case mix adjustment shall be based on resident assessment data and other data that the Secretary considers appropriate. "(ii) ADJUSTMENT FOR GEOGRAPHIC VARIATIONS IN LABOR COSTS.— The Secretary shall adjust the portion of such per diem rate attributable to wages and wagerelated costs for the area in which the facility is located compared to the national average of such costs using an appropriate wage index as determined by the Secretary. Such adjustment shall be done in a manner that does not result in aggregate pa3m(ients under this subsection that are greater or less than those that would otherwise be made if such adjustment had not been made. "(H) PUBLICATION OF INFORMATION ON PER DIEM Federal Register, RATES.— The Secretary shall provide for publication in the publication. Federal Register, before May 1, 1998 (with respect to fiscal period described in subparagraph (E)(i)) and before the August 1 preceding each succeeding fiscal year (with respect to that succeeding fiscal year), of— "(i) the unadjusted Federal per diem rates to be applied to days of covered skilled nursing facility services furnished during the fiscal year, "(ii) the case mix classification system to be applied under subparagraph (G)(i) with respect to such services during the fiscal year, and "(iii) the factors to be applied in making the area wage adjustment under subparagraph (G)(ii) with respect to such services. "(5) SKILLED NURSING FACILITY MARKET BASKET INDEX AND PERCENTAGE. —For purposes of this subsection: "(A) SKILLED NURSING FACILITY MARKET BASKET INDEX. — The Secretary shall establish a skilled nursing facility market basket index that reflects changes over time in the prices of an appropriate mix of goods and services included in covered skilled nursing facility services. "(B) SKILLED NURSING FACILITY MARKET BASKET PERCENTAGE. — The term 'skilled nursing facility market basket percentage' means, for a fiscal year or other annual period and as calculated by the Secretary, the percentage change in the skilled nursing facility market basket index (established under subparagraph (A)) from the midpoint of the prior fiscal year (or period) to the midpoint of the fiscal year (or other period) involved.

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