Page:United States Statutes at Large Volume 98 Part 1.djvu/1130

 98 STAT. 1082

Ante, p. 1081.

Effective date. 42 USC 1395x note.

PUBLIC LAW 98-369—JULY 18, 1984

"(I) placing the patient's health in serious jeopardy; "(11) serious impairment to bodily functions; or "(III) serious dysfunction of any bodily organ or part.". (b) Section 1861(v)(l)(K)(i) of such Act as so designated is amended by striking out "provided in an emergency room" and inserting in lieu thereof "as defined in clause (ii)". (c) The amendments made by this section shall apply to services furnished on or after the date of the enactment of this Act. SKILLED NURSING FACILITY REIMBURSEMENT

42 USC 1395x.

Infra.

SEC. 2319. (a)(1) Section 1861(v)(l)(E) of the Social Security Act is amended by striking out clause (i) thereof, and by striking out "(ii)", (2) Section 1861(v)(7) of such Act is amended by adding at the end thereof the following new subparagraph: "(D) For further limitations on reasonable cost and determination of payment amounts for routine service costs of skilled nursing facilities, see section 1888.". (b) Title XVIII of the Social Security Act is amended by adding at the end thereof the following new section: PAYMENT TO SKILLED NURSING FACILITIES FOR ROUTINE SERVICE COSTS

42 USC I395yy.

"SEC. 1888. (a) The Secretary, in determining the amount of the payments which may be made under this title with respect to routine service costs of extended care services shall not recognize as reasonable (in the efficient delivery of health services) per diem costs of such services to the extent that such per diem costs exceed the following per diem limits, except as otherwise provided in this section: "(1) With respect to freestanding skilled nursing facilities located in urban areas, the limit shall be equal to 112 percent of the mean per diem routine service costs for freestanding skilled nursing facilities located in urban areas. "(2) With respect to freestanding skilled nursing facilities located in rural areas, the limit shall be equal to 112 percent of the mean per diem routine service costs for freestanding skilled nursing facilities located in rural areas. "(3) With respect to hospital-based skilled nursing facilities located in urban areas, the limit shall be equal to the sum of the limit for freestanding skilled nursing facilities located in urban areas, plus 50 percent of the amount by which 112 percent of the mean per diem routine service costs for hospital-based skilled nursing facilities located in urban areas exceeds the limit for freestanding skilled nursing facilities located in urban areas. "(4) With respect to hospital-based skilled nursing facilities located in rural areas, the limit shall be equal to the sum of the limit for freestanding skilled nursing facilities located in rural areas, plus 50 percent of the amount by which 112 percent of the mean per diem routine service costs for hospital-based skilled nursing facilities located in rural areas exceeds the limit for freestanding skilled nursing facilities located in rural areas. In applying this subsection the Secretary shall make appropriate adjustments to the labor related portion of the costs based upon an appropriate wage index.

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