Page:United States Statutes at Large Volume 98 Part 1.djvu/1125

 PUBLIC LAW 98-369—JULY 18, 1984

98 STAT. 1077

(d)(1) Except as provided in paragraph (2), the amendments made Effective date. by subsections (b) and (c) shall be effective with respect to cost 42 USC 1395WW reporting periods beginning on or after October 1, 1983, and the note. amendment made by subsection (a) shall be effective with respect to cost reporting periods beginning on or after October 1, 1984. (2) The amendment made by subsection (b) shall not apply so as to reduce any payment under section 1886(d) of the Social Security Act 97 Stat. 152. to a hospital the region of which is deemed to be changed pursuant 42 USC 1395WW. to such amendment for discharges occurring in any cost reporting period beginning before October 1, 1984. (e) The Secretary of Health and Human Services shall conduct a Study. study of the distinction between urban and rural hospitals for purposes of the DRG payment provisions under section 1886(d) of the Social Security Act, and the effect which such distinction may have on rural hospitals in the case of those DRG's which have high fixed nonlabor components which do not vary significantly between urban and rural areas (such as those DRG's which involve expensive medical devices). The Secretary also shall conduct a study of the advisability and feasibility of varying by DRG the proportions of the labor and nonlabor components of the Federal payment amount instead of applying the average proportion of those components to all DRG's. The Secretary shall report the results of such studies to Report the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives within six months after the date of the enactment of this Act. (f) The Secretary of Health and Human Services shall conduct a Study. study of further refinements which may be appropriate in the inpatient hospital prospective payment provisions of title XVIII of the Social Security Act, in order to address the problems of differ- 42 USC 1395. ences in payment amounts to specific hospitals. The study shall include (but shall not be limited to) the degree of variation in inpatient hospital costs per discharge within each diagnosis-related group. The Secretary shall also present alternative methods of computing the amount of such payments. The study shall include a discussion of the relative merits of a method of payment under which a percentage of the payment amount (for discharges classified within a diagnosis-related group) could be determined on a regional basis. The Secretary shall report the result of the study, and any Report, recommended changes in the prospective payment system, to the Congress prior to September 1, 1984. PAYMENT FOR SERVICES OF A NURSE ANESTHETIST

SEC. 2312. (a) Section 1886(d)(5) of the Social Security Act is amended by adding at the end thereof the following new subparagraph: "(E) The Secretary shall provide for an additional payment amount for any subsection (d) hospital equal to the reasonable costs incurred by such hospital for anesthesia services provided by a certified registered nurse anesthetist. Payment under this subparagraph shall be the only payment made to such hospital with respect to such services.". (b) The second sentence of section 1886(a)(4) of such Act is amended by inserting ", costs of anesthesia services provided by a certified registered nurse anesthetist" after "approved educational activities".

97 Stat. 152. 42 USC I395ww.

97 Stat. 149. 42 USC I395ww.

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