Page:United States Statutes at Large Volume 117.djvu/2284

 PUBLIC LAW 108–173—DEC. 8, 2003

117 STAT. 2265

(b) CONFORMING AMENDMENTS.—Section 1886(d) (42 U.S.C. 1395ww(d)) is amended— (1) in paragraph (5)(F)— (A) in each of subclauses (II), (III), (IV), (V), and (VI) of clause (iv), by inserting ‘‘subject to clause (xiv) and’’ before ‘‘for discharges occurring’’; (B) in clause (viii), by striking ‘‘The formula’’ and inserting ‘‘Subject to clause (xiv), the formula’’; and (C) in each of clauses (x), (xi), (xii), and (xiii), by striking ‘‘For purposes’’ and inserting ‘‘Subject to clause (xiv), for purposes’’; and (2) in paragraph (2)(C)(iv)— (A) by striking ‘‘or’’ before ‘‘the enactment of section 303’’; and (B) by inserting before the period at the end the following: ‘‘, or the enactment of section 402(a)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003’’. SEC. 403. ADJUSTMENT TO THE MEDICARE INPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM WAGE INDEX TO REVISE THE LABOR-RELATED SHARE OF SUCH INDEX.

(a) ADJUSTMENT.— (1) IN GENERAL.—Section 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)) is amended— (A) by striking ‘‘WAGE LEVELS.—The Secretary’’ and inserting ‘‘WAGE LEVELS.— ‘‘(i) IN GENERAL.—Except as provided in clause (ii), the Secretary’’; and (B) by adding at the end the following new clause: ‘‘(ii) ALTERNATIVE PROPORTION TO BE ADJUSTED BEGINNING IN FISCAL YEAR 2005.—For discharges occurring on or after October 1, 2004, the Secretary shall substitute ‘62 percent’ for the proportion described in the first sentence of clause (i), unless the application of this clause would result in lower payments to a hospital than would otherwise be made.’’. (2) WAIVING BUDGET NEUTRALITY.—Section 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)), as amended by subsection (a), is amended by adding at the end of clause (i) the following new sentence: ‘‘The Secretary shall apply the previous sentence for any period as if the amendments made by section 403(a)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 had not been enacted.’’. (b) APPLICATION TO PUERTO RICO HOSPITALS.—Section 1886(d)(9)(C)(iv) (42 U.S.C. 1395ww(d)(9)(C)(iv)) is amended— (1) by inserting ‘‘(I)’’ after ‘‘(iv)’’; (2) by striking ‘‘paragraph (3)(E)’’ and inserting ‘‘paragraph (3)(E)(i)’’; and (3) by adding at the end the following new subclause: ‘‘(II) For discharges occurring on or after October 1, 2004, the Secretary shall substitute ‘62 percent’ for the proportion described in the first sentence of clause (i), unless the application of this subclause would result in lower payments to a hospital than would otherwise be made.’’.

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