Page:United States Statutes at Large Volume 113 Part 2.djvu/854

 113 STAT. 1501A-336 PUBLIC LAW 106-113—APPENDIX F amount for such facility according to the methodology described in subsection (c) for such cost reporting periods in lieu of the pa3anent amount that would otherwise be established for such facility under section 1888(e)(1) of such Act (42 U.S.C. 1395yy(e)(l)). (b) FACILITY ELIGIBILITY CRITERIA.— For purposes of this subsection, a skilled nursing facility is one— (1) that began participation in the Medicare program under title XVIII of the Social Security Act before January 1, 1995; (2) for which at least 80 percent of the total inpatient days of the facility in the cost reporting period beginning in fiscal year 1998 were comprised of individuals entitled to benefits under such title; and (3) that is located in Baldwin or Mobile County, Alabama. (c) DETERMINATION OF PER DIEM AMOUNT. — For purposes of subsection (a), the per diem payment amount shall be equal to 100 percent of the amount determined under section 1888(e)(3) of the Social Security Act (42 U.S.C. 1395yy(e)(3)) except that, in determining such amount, the Secretary shall— (1) substitute the allowable costs of the facility for the cost reporting period beginning in fiscal year 1998 for those allowable costs of the cost reporting period beginning in fiscal year 1995; and (2) exclude the update to the first cost reporting period (from fiscal year 1995 to fiscal year 1998) described in section 1888(e)(3)(B)(i) of such Act (42 U.S.C. 1395yy(e)(3)(B)(i)). TITLE II—PROVISIONS RELATING TO PARTB Subtitle A—Hospital Outpatient Services SEC. 201. OUTLIER ADJUSTMENT AND TRANSITIONAL PASS-THROUGH FOR CERTAIN MEDICAL DEVICES, DRUGS, AND BIOLOGICALS. (a) OUTLIER ADJUSTMENT.— Section 1833(t) (42 U.S.C. 13951(t)) is amended— (1) by redesignating paragraphs (5) through (9) as paragraphs (7) through (11), respectively; and (2) by inserting after paragraph (4) the following new paragraph: "(5) OUTLIER ADJUSTMENT.— " (A) IN GENERAL.—Subject to subparagraph (D), the Secretary shall provide for an additional payment for each covered OPD service (or group of services) for which a hospital's charges, adjusted to cost, exceed— "(i) a fixed multiple of the sum of— "(I) the applicable medicare OPD fee schedule amount determined under paragraph (3)(D), as adjusted under paragraph (4)(A) (other than for adjustments under this paragraph or paragraph (6)); and "(ID any transitional pass-through payment under paragraph (6); and "(ii) at the option of the Secretary, such fixed dollar amount as the Secretary may establish.

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