Page:United States Statutes at Large Volume 111 Part 1.djvu/462

 Ill STAT. 438 PUBLIC LAW 105-33 —AUG. 5, 1997 (B) whether the hospital-specific relative value is projected to be excessive (as determined based on such value represented as a percentage of the median of hospitalspecific per discharge relative values determined under subsection (b)). (2) NOTICE TO SUBSET OF MEDICAL STAFFS; EVALUATION OF RESPONSES. —The Secretary shall notify the medical executive committee of a subset of the hospitals identified under paragraph (1)(B) as having an excessive hospital-specific relative value, of the determinations made with respect to the medical staff under paragraph (1). The Secretary shall evaluate the responses of the hospitals so notified with the responses of other hospitals so identified that were not so notified. (b) DETERMINATION OF HOSPITAL-SPECIFIC PER DISCHARGE REL- ATIVE VALUES.— (1) IN GENERAL.— For purposes of this section, the hospitalspecific per discharge relative value for the medical staff of a hospital (other than a teaching hospital) for a year shall be equal to the average per discharge relative value (as determined under section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w-4(c)(2)) for physicians' services furnished to inpatients of the hospital by the hospital's medical staff (excluding interns and residents) during the second year preceding that calendar year, adjusted for variations in case-mix among hospitals and disproportionate share status and teaching status among hospitals (as determined by the Secretary under paragraph (3)). (2) SPECIAL RULE FOR TEACHING HOSPITALS.— The hospitalspecific relative value projected for a teaching hospital in a year shall be equal to the sum of— (A) the average per discharge relative value (as determined under section 1848(c)(2) of such Act) for physicians' services furnished to inpatients of the hospital by the hospital's medical staff (excluding interns and residents) during the second year preceding that calendar year, and (B) the equivalent per discharge relative value (as determined under such section) for physicians' services furnished to inpatients of the hospital by interns and residents of the hospital during the second year preceding that calendar year, adjusted for variations in case-mix among hospitals, and in disproportionate share status and teaching status among hospitals (as determined by the Secretary under paragraph (3)). The Secretary shall determine the equivalent relative value unit per discharge for interns and residents based on the best available data and may make such adjustment in the aggregate. (3) ADJUSTMENT FOR TEACHING AND DISPROPORTIONATE SHARE HOSPITALS.—The Secretary shall adjust the allowable per discharge relative values otherwise determined under this subsection to take into account the needs of teaching hospitals and hospitals receiving additional payments under subparagraphs (F) and (G) of section 1886(d)(5) of the Social Security Act (42 U.S.C. 1395ww(d)(5)). The adjustment for teaching status or disproportionate share shall not be less than zero. (c) DEFINITIONS. —For purposes of this section:

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