Page:United States Statutes at Large Volume 117.djvu/2281

 117 STAT. 2262

PUBLIC LAW 108–173—DEC. 8, 2003 the list of facilities or providers under subparagraph (A) (on a phased-in basis or otherwise) to include such other facilities or providers of long-term care services under such titles as the participating State determines appropriate. (C) EXCEPTIONS.—Such term does not include— (i) any facility or entity that provides, or is a provider of, services described in subparagraph (A) that are exclusively provided to an individual pursuant to a self-directed arrangement that meets such requirements as the participating State may establish in accordance with guidance from the Secretary; or (ii) any such arrangement that is obtained by a patient or resident functioning as an employer. (6) PARTICIPATING STATE.—The term ‘‘participating State’’ means a State with an agreement under subsection (c)(1).

TITLE IV—RURAL PROVISIONS Subtitle A—Provisions Relating to Part A Only SEC. 401. EQUALIZING URBAN AND RURAL STANDARDIZED PAYMENT AMOUNTS UNDER THE MEDICARE INPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.

(a) IN GENERAL.—Section 1886(d)(3)(A)(iv) (42 U.S.C. 1395ww(d)(3)(A)(iv)) is amended— (1) by striking ‘‘(iv) For discharges’’ and inserting ‘‘(iv)(I) Subject to subclause (II), for discharges’’; and (2) by adding at the end the following new subclause: ‘‘(II) For discharges occurring in a fiscal year (beginning with fiscal year 2004), the Secretary shall compute a standardized amount for hospitals located in any area within the United States and within each region equal to the standardized amount computed for the previous fiscal year under this subparagraph for hospitals located in a large urban area (or, beginning with fiscal year 2005, for all hospitals in the previous fiscal year) increased by the applicable percentage increase under subsection (b)(3)(B)(i) for the fiscal year involved.’’. (b) CONFORMING AMENDMENTS.— (1) COMPUTING DRG-SPECIFIC RATES.—Section 1886(d)(3)(D) (42 U.S.C. 1395ww(d)(3)(D)) is amended— (A) in the heading, by striking ‘‘IN DIFFERENT AREAS’’; (B) in the matter preceding clause (i), by striking ‘‘, each of’’; (C) in clause (i)— (i) in the matter preceding subclause (I), by inserting ‘‘for fiscal years before fiscal year 2004,’’ before ‘‘for hospitals’’; and (ii) in subclause (II), by striking ‘‘and’’ after the semicolon at the end; (D) in clause (ii)— (i) in the matter preceding subclause (I), by inserting ‘‘for fiscal years before fiscal year 2004,’’ before ‘‘for hospitals’’; and

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