Page:United States Statutes at Large Volume 94 Part 2.djvu/1335

 PUBLIC LAW 96-499—DEC. 5, 1980

94 STAT. 2613

(2) For amendment to section 1158(a) of the Social Security Act relating to these provisions, see section 931(h) of this title. (3) Section 1158(d) of such Act is amended by adding at the end the following new sentence: "In the case of disapproval of inpatient hospital services where payment for inpatient services is continued under section 1861(v)(l)(G) or section 1902(h), the previous sentence shall not apply with respect to such disapproval,". (b)(1) Section 1902(a)(13)(D) of such Act is amended— (A) by inserting "(i)" after "(D)", (B) by striking out the semicolon and inserting in lieu thereof a comma, and (C) by inserting at the end thereof the following new clause: "(ii) for payment of the reasonable cost of inappropriate inpatient services (described in subsection (h)(1)) for which payment is provided only because of subsection (h) at the rate of payment for such services provided for under such subsection, and". (2) Section 1902 of such Act is further amended by adding at the end the following new subsection: "(h)(1) In any case in which a hospital provides inpatient services to an individual that would constitute skilled nursing facility services if provided by a skilled nursing facility or that would constitute intermediate care facility services if provided by an intermediate care facility and a Professional Standards Review Organization (or, in the absence of such a qualified organization, an organization or agency with review responsibility as is otherwise provided for under part A of title XI) determines that inpatient hospital services for the individual are not medically necessary but skilled nursing facility services or intermediate care facility services, respectively, for the individual are medically necessary and such type of facility services are not otherwise available to the individual (as determined in accordance with criteria established by the Secretary) at the time of such determination, payment for inpatient hospital services shall continue to be made under the State plan approved under this title at the payment rate described in paragraph (2) for such type of services during the period in which— "(A) such skilled nursing facility services or intermediate care facility services (as the case may be) for the individual are medically necessary and not otherwise available to the individual (as so determined), "(B) inpatient hospital services for the individual are not medically necessary, and "(C) the individual is entitled to receive medical assistance with respect to such facility services under the State plan, except that if the Secretary determines that the hospital had (during the immediately preceding calendar year) an average daily occupancy rate of 80 percent or more, such payment shall be made (during such period) on the same basis as otherwise used under the State's plan for payments for providing inpatient hospital services. "(2)(A) Except as provided in subparagraph (B), the payment rate referred to in paragraph (1), in the case of skilled nursing facility services or intermediate care facility services, is the estimated adjusted State-wide average rate per patient-day paid for such respective type of services provided under the State plan. (B) If a hospital has a unit which is a skilled nursing facility or intermediate care facility, the payment rate referred to in paragraph (1), in the case of inpatient services which constitute skilled nursing facility services or intermediate care facility services, is a rate equal to the lesser of the rate described in subparagraph (A) or the

Post, p. 2633. 42 USC 1320-7. Ante, p. 2612, infra.. 42 USC 1396a.

42 USC 1396a.

42 USC 1301.

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