Page:United States Statutes at Large Volume 97.djvu/188

 97 STAT. 156 PUBLIC LAW 98-21 —APR. 20, 1983 area within the United States and for hospitals located in an urban area and for hospitals located in a rural area within each region, equal to the respective average standardized amount computed for the previous fiscal year under paragraph (2KD) or under this subparagraph, increased for fiscal year 1985 by the applicable percentage increase under subsection (b)(3)(B), and adjusted for subsequent fiscal years in accordance with the final determination of the Secretary under subsection (e)(4), and adjusted to reflect the most recent case-mix data available. (B) REDUCING FOR VALUE OF OUTLIER PAYMENTS. —The Secre- tary shall reduce each of the average standardized amounts determined under subparagraph (A) by a proportion equal to the proportion (estimated by the Secretary) of the amount of payments under this subsection based on DRG prospective pay- ment amounts which are additional payments described in paragraph (5)(A) (relating to outlier payments). "(C) MAINTAINING BUDGET NEUTRALITY.— The Secretary shall adjust each of such average standardized amounts as may be required under subsection (e)(l)(B) for that fiscal year. "(D) COMPUTING DRG-SPECIFIC RATES FOR URBAN AND RURAL HOSPITALS.— For each discharge classified within a diagnosis- related group, the Secretary shall establish for the fiscal year a national DRG prospective payment rate and shall establish a regional DRG prospective payment rate for each region, each of which is equal— "(i) for hospitals located in an urban area in the United States or that region (respectively), to the product of— "(I) the average standardized amount (computed under subparagraph (A), reduced under subparagraph (B), and adjusted under subparagraph (C), for the fiscal year for hospitals located in an urban area in the United States or that region, and "(II) the weighting factor (determined under para- graph (4)(B)) for that diagnosis-related group; and "(ii) for hospitals located in a rural area in the United States or that region (respectively), to the product of— "(I) the average standardized amount (computed under subparagraph (A), reduced under subparagraph (B), and adjusted under subparagraph (O) for the fiscal year for hospitals located in a rural area in the United States or that region, and "(II) the weighting factor (determined under para- graph (4)(B)) for that diagnosis-related group. "(E) ADJUSTING FOR DIFFERENT AREA WAGE LEVELS. — The Sec- retary shall adjust the proportion, (as estimated by the Secre- tary from time to time) of hospitals' costs which are attributable to wages and wage-related costs, of the DRG prospective pay- ment rates computed under subparagraph (D) for area differ- ences in hospital wage levels by a factor (established by the Secretary) reflecting the relative hospital wage level in the geographic area of the hospital compared to the national aver- age hospital wage level. "(4)(A) The Secretary shall establish a classification of inpatient hospital discharges by diagnosis-related groups and a methodology for classifying specific hospital discharges within these groups. "(B) For each such diagnosis-related group the Secretary shall assign an appropriate weighting factor which reflects the relative

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