Page:United States Statutes at Large Volume 114 Part 5.djvu/589

 PUBLIC LAW 106-554—APPENDIX F 114 STAT. 2763A-549 diagnosis-related group with a weighting factor under paragraph (4)(B) that is derived from cost data collected with respect to cUscharges occurring during such period. "(iii) For purposes of clause (ii)(II), the term 'inpatient hospital code' means any code that is used with respect to inpatient hospital services for which payment may be made under this subsection and includes an alphanumeric code issued under the International Classification of Diseases, 9th Revision, Clinical Modification CICD- 9-CM') and its subsequent revisions. "(iv) For purposes of clause (ii)(III), the term 'additional pay- ment' means, with respect to a discharge for a new medical service or technology described in clause (iiXD, an amount that exceeds the prospective payment rate otherwise applicable under this subsection to discharges involving such service or technology that would be made but for this subparagraph. "(v) The requirement under clause (iiXIII) for an additional pa5anent may be satisfied by means of a new-technology group (described in subparagraph (L)), an add-on payment, a payment adjustment, or any other similar mechanism for increasing the amount otherwise payable with respect to a discharge under this subsection. The Secretary may not establish a separate fee schedule for such additional payment for such services and technologies, by utilizing a methodology established under subsection (a) or (h) of section 1834 to determine the amount of such additional payment, or by other similar mechanisms or methodologies. "(vi) For purposes of this subparagraph and subparagraph (L), a medical service or technology will be considered a 'new medical service or technology* if the service or technology meets criteria established by the Secretary after notice and an opportunity for public comment. "(L)(i) In establishing the mechanism under subparagraph (K), the Secretary may establish new-technology groups into which a new medical service or technology will be classified if, based on the estimated average costs incurred with respect to discharges involving such service or technology, the DRG prospective payment rate otherwise applicable to such discharges under this subsection is inadequate. "(ii) Such groups— "(I) shall not be based on the costs associated with a specific new medical service or technology; but " (II) shall, in combination with the applicable standardized amounts and the weighting factors assigned to such groups under paragraph (4)(B), reflect such cost cohorts as the Secretary determines are appropriate for all new medical services and technologies that are likely to be provided as inpatient hospital services in a fiscal year. "(iii) The methodology for classifying specific hospital discharges within a diagnosis-related group under paragraph (4)(A) or a newtechnology group shall provide that a specific hospital discharge may not be classified within both a diagnosis-related group and a new-technology group.". (2) PRIOR CONSULTATION.—The Secretary of Health and Human Services shall consult with groups representing hospitals, physicians, and manufacturers of new medical technologies before publishing the notice of proposed rulemaking required by section 1886(d)(5)(K)(i) of the Social Security Act (as added by paragraph (1)).

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