> > > >
NOTES:
Source
(Aug. 14, 1935, ch. 531, title XVIII, § 1886, as added and amended , title I, §§ 101(a)(1),
, Sept. 3, 1982, , 339; , title III, § 309(b)(13)–(15), Jan. 12, 1983, ; , title VI, § 601(a)(1), (2), (b), (c), (d)(2), (e), Apr. 20, 1983, , 150, 152; , div. B, title III, §§ 2307(b)(1),
,
–(c), 2312(a), (b), 2313(a), (b), (d), 2315(a)–(c), 2354(b)(42)–(44), July 18, 1984, , 1075–1080, 1102; , § 3(b)(9), Nov. 8, 1984, ; , title IX, §§ 9101(b), (c),
–(c), 9104(a), (b), 9105(a)–(c), 9106(a), 9107(a), 9109(a), 9111(a), 9127(a), 9202(a), Apr. 7, 1986, , 157–162, 170, 171; , title II, § 206, July 2, 1986, ; , title IX, §§ 9302(a)(1), (2), (b)(1), (c), (d)(1)(A), (e),
,
–(c), 9306(a)–(c), 9307(c)(1), 9314(a), 9320(g), 9321(e)(2), Oct. 21, 1986, , 1988, 1995, 2005, 2015, 2018; , § 2, title XVIII, § 1895(b)(1)(A)–(C), (2)(A)–(C), (3), (9), Oct. 22, 1986, , 2931–2933; , § 8(c)(4), Aug. 18, 1987, ; , title IV, §§ 4002(a)–(f)(1), 4003(a)–(c), 4004(a), 4005(a)(1), (c)(1), (d)(1)(A), 4006(a)–(b)(2), 4007(b)(1), 4009(d)(1), (j)(1)–(6)(B), 4083(b)(1), Dec. 22, 1987, to 1330–44, 1330–46, 1330–47, 1330–49, 1330–52, 1330–53, 1330–57 to 1330–59, 1330–129, as amended , title IV, § 411(b)(1)(E), (3), (4)(C)(i), (5)(B), (6)(B), (8)(B), July 1, 1988, , 770, 772; , title IV, § 411(b)(1)(A)–(D), (F)–(H)(i), (4)(A), (B), (5)(A), July 1, 1988, ; , title VI, § 608(d)(18)(A), (B), Oct. 13, 1988, ; , title I, § 1018(r)(1), title VIII, §§ 8401,
8403
(a), Nov. 10, 1988, , 3798; , title III, § 301(b)(3), (c)(3), Dec. 13, 1989, , 1986; , title VI, §§ 6002,
, (b)–(c)(3), (e)(1), (2)(B)–(E), (f), (g)(2), (4)–(h)(4), (6), 6004(a)(1), (2), (b)(1), 6011(a), 6015(a), 6022, Dec. 19, 1989, , 2151, 2154–2157, 2159–2161, 2164, 2167; , title I, § 115(b)(1), Oct. 1, 1990, ; , title IV, §§ 4001,
, (b)(1)–(4), (c)(1), (2), (e)(1), (g)(1), (2), (h)(1)(A), (2)(B), 4003(a), 4005(a)(1), (c)(1)(B), (2), 4008(f)(1), (m)(2)(A), Nov. 5, 1990, to 1388–38, 1388–40, 1388–42, 1388–45, 1388–53; , title XIII, §§ 13501(a), (b)(1), (c), (e)(1), (f),
,
,
13563
(a), (b)(1), (c)(1), Aug. 10, 1993, , 574, 575, 577, 579, 605; , title I, §§ 101(a)(1), (b), (c),
,
,
108–110
(a), (c),
153
(a), Oct. 31, 1994, , 4405, 4407, 4408, 4437; , title IV, §§ 4022(b)(1)(A),
, (4),
4202
(a),
4204
(a)(1), (2),
,
,
4403
(a),
4405
(a)–(c), 4406, 4407, 4411–4415(c), 4416, 4417(a)(1), (b)(1), 4418(a), 4419(a)(1), 4421(a), (b), 4621–4626(a), 4627(a), 4644(a)(1), (b)(1), (c)(1), Aug. 5, 1997, , 373–375, 397, 398, 400, 401, 403–410, 413, 475–480, 483, 488; , div. B, § 1000(a)(6) [title I, §§ 111(a), (c),
,
,
,
, title III, §§ 311,
312
(a),
321
(b), (e), (f), (h), (k)(15)–(17), title IV, §§ 401(a),
,
, (b)(1),
405–407
(a)(2), (b)(1), (2), (c)(1), title V, § 541], Nov. 29, 1999, , 1501A–329 to 1501A–332, 1501A–362 to 150A–366, 1501A–368, 1501A–369, 1501A–372 to 1501A–374, 1501A–391; , § 1(a)(4) [div. B, title I, § 152(a), (b)], § 1(a)(6) [title II, §§ 211,
,
, title III, §§ 301(a), (e)(1),
, (c), (d),
, (c), (d)(1),
, (c)(2),
, (b),
307
(a)(1), title V, §§ 511,
512
(a),
533
(b)(1), (3)], Dec. 21, 2000, , 2763A–251, 2763A–252, 2763A–483, 2763A–485, 2763A–491 to 2763A–496, 2763A–533, 2763A–548, 2763A–550.)
References in Text
Parts A, B, and C of this subchapter, referred to in text, are classified to sections
et seq., 1395j et seq., and 1395w–21 et seq., respectively, of this title.
The Internal Revenue Code of 1986, referred to in subsec. (b)(6), is classified generally to Title 26, Internal Revenue Code.
Section 222(a) of the Social Security Amendments of 1972, referred to in subsec. (c)(4)(B), is section 222(a) of , Oct. 30, 1972, , which is set out as a note under section
of this title.
Section 9104(a) of the Medicare and Medicaid Budget Reconciliation Amendments of 1985, referred to in subsec. (d)(2)(C)(i), is section 9104(a) of , which amended subsec. (d)(5)(B) of this section.
Section 4621(a)(1) of the Balanced Budget Act of 1997, referred to in subsec. (d)(2)(C)(i), is section 4621(a)(1) of , which amended subsec. (d)(5)(B)(ii) of this section.
Section 111 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, referred to in subsec. (d)(2)(C)(i), is section
1000
(a)(6) [title I, § 111] of , which amended this section and enacted provisions set out as a note under this section.
Section 302 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, referred to in subsec. (d)(2)(C)(i), is section
[title III, § 302] of , which amended this section and enacted provisions set out as a note under this section.
Section 6003(c) of the Omnibus Budget Reconciliation Act of 1989, referred to in subsec. (d)(2)(C)(iv), is section 6003(c) of , which amended this section and enacted provisions set out below.
Section 4002(b) of the Omnibus Budget Reconciliation Act of 1990, referred to in subsec. (d)(2)(C)(iv), is section 4002(b) of , which amended this section and enacted provisions set out below.
Section 303 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, referred to in subsec. (d)(2)(C)(iv), is section
[title III, § 303] of , which amended this section and enacted provisions set out as notes under this section.
Section 9104 of the Medicare and Medicaid Budget Reconciliation Amendments of 1985, referred to in subsec. (d)(3)(C)(ii), is section 9104 of , which amended subsec. (d)(2)(C)(i), (3)(C), (D)(i)(I), (ii)(I), and (5)(B) of this section.
Section 4003(a)(1) of the Omnibus Budget Reconciliation Act of 1987, referred to in subsec. (d)(3)(C)(ii), is section 4003(a)(1) of , which amended subsec. (d)(5)(B)(ii) of this section.
The Omnibus Budget Reconciliation Act of 1990, referred to in subsec. (d)(3)(C)(ii), is , Nov. 5, 1990, . For complete classification of this Act to the Code, see Tables.
Subsec. (e)(3)(B) of this section, referred to in subsec. (d)(4)(C)(iv), was redesignated subsec. (e)(3) of this section by section 4022(b)(1)(A)(ii) of .
The provisions of title 5 governing appointments in the competitive service, referred to in subsec. (d)(10)(B)(i), are classified generally to section
et seq. of Title 5, Government Organization and Employees.
Section 9304 of the Omnibus Budget Reconciliation Act of 1986, referred to in subsec. (e)(1)(C)(ii), is section 9304 of , which enacted subsecs. (d)(9) and (e)(1)(C) of this section and amended subsec. (d)(5)(C)(i)(I), (ii) of this section.
Part B of subchapter XI of this chapter, referred to in subsec. (f)(2), is classified to section
et seq. of this title.
Section 4628 of the Balanced Budget Act of 1997, referred to in subsec. (h)(6)(C)(iii), is section 4628 of , which is set out as a note below.
Section 4005(e) of the Omnibus Budget Reconciliation Act of 1987, referred to in subsec. (i), is section 4005(e) of , which is set out below.
Amendments
2000—Subsec. (b)(3)(B)(i)(XVI). , § 1(a)(6) [title III, § 301(a)(1)], substituted “for hospitals in all areas,” for “minus 1.1 percentage points for hospitals (other than sole community hospitals) in all areas, and the market basket percentage increase for sole community hospitals,”.
Subsec. (b)(3)(B)(i)(XVII). , § 1(a)(6) [title III, § 301(a)(2)(B)], struck out “and” at end.
, § 1(a)(6) [title III, § 301(a)(2)(A)], which directed amendment of subcl. (XVII) by “striking ‘minus 1.1 percentage points’ and inserting ‘minus 0.55 percentage points; and”, was executed as if an end quotation mark for the inserted material followed “points”, to reflect the probable intent of Congress.
Subsec. (b)(3)(B)(i)(XVIII). , § 1(a)(6) [title III, § 301(a)(5)], added subcl. (XVIII). Former subcl. (XVIII) redesignated (XIX).
Subsec. (b)(3)(B)(i)(XIX). , § 1(a)(6) [title III, § 301(a)(3), (4)], redesignated subcl. (XVIII) as (XIX) and substituted “fiscal year 2004” for “fiscal year 2003”.
Subsec. (b)(3)(H)(ii)(III). , § 1(a)(6) [title III, § 307(a)(1)(A)], inserted “subject to subparagraph (J),” after “2002,”.
Subsec. (b)(3)(I)(i). , § 1(a)(6) [title II, § 213(a)(1)], in introductory provisions, substituted “there shall be substituted for the amount otherwise determined under subsection (d)(5)(D)(i) of this section, if such substitution results in a greater amount of payment under this section for the hospital” for “that for its cost reporting period beginning during 1999 is paid on the basis of the target amount applicable to the hospital under subparagraph (C) and that elects (in a form and manner determined by the Secretary) this subparagraph to apply to the hospital, there shall be substituted for such target amount”.
Subsec. (b)(3)(I)(i)(I). , § 1(a)(6) [title II, § 213(a)(2)], substituted “the amount otherwise applicable to the hospital under subsection (d)(5)(D)(i) of this section (referred to in this clause as the ‘subsection (d)(5)(D)(i) amount’)” for “target amount otherwise applicable to the hospital under subparagraph (C) (referred to in this clause as the ‘subparagraph (C) target amount’)”.
Subsec. (b)(3)(I)(i)(II), (III). , § 1(a)(6) [title II, § 213(a)(3)], substituted “subsection (d)(5)(D)(i) amount” for “subparagraph (C) target amount”.
Subsec. (b)(3)(J). , § 1(a)(6) [title III, § 307(a)(1)(B)], added subpar. (J).
Subsec. (d)(1)(B)(v)(III). , § 1(a)(4) [div. B, title I, § 152(a)], added subcl. (III).
Subsec. (d)(1)(E). , § 1(a)(4) [div. B, title I, § 152(b)], substituted “For purposes of subclauses (II) and (III) of subparagraph (B)(v)” for “For purposes of subparagraph (B)(v)(II)”.
Subsec. (d)(2)(C)(i). , § 1(a)(6) [title III, § 302(c)], inserted “or of section 302 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000” after “Balanced Budget Refinement Act of 1999”.
Subsec. (d)(2)(C)(iv). , § 1(a)(6) [title III, § 303(c)], substituted “1989,” for “1989 or” and inserted “, or the enactment of section 303 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000” after “Omnibus Budget Reconciliation Act of 1990”.
Subsec. (d)(3)(A)(vi). , § 1(a)(6) [title III, § 301(e)(1)], added cl. (vi).
Subsec. (d)(3)(E). , § 1(a)(6) [title III, § 304(c)(2)], in third sentence, substituted “Not less often than once every 3 years the Secretary (through such survey or otherwise) shall measure” for “To the extent determined feasible by the Secretary, such survey shall measure”.
Subsec. (d)(4)(C)(i). , § 1(a)(6) [title V, § 533(b)(3)], substituted “technology (including a new medical service or technology under paragraph (5)(K)),” for “technology,”.
Subsec. (d)(5)(B). , § 1(a)(6) [title III, § 302(d)], realigned margins.
Subsec. (d)(5)(B)(ii)(V). , § 1(a)(6) [title III, § 302(a)(1)], struck out “and” at end.
Subsec. (d)(5)(B)(ii)(VI). , § 1(a)(6) [title III, § 302(a)(4)], added subcl. (VI). Former subcl. (VI) redesignated (VII).
Subsec. (d)(5)(B)(ii)(VII). , § 1(a)(6) [title III, § 302(a)(2), (3)], redesignated subcl. (VI) as (VII) and substituted “2002” for “2001”.
Subsec. (d)(5)(F)(i). , § 1(a)(6) [title III, § 303(d)(1)], struck out “and before October 1, 1997,” before “the Secretary shall provide” in introductory provisions.
Subsec. (d)(5)(F)(iv)(II). , § 1(a)(6) [title II, § 211(b)(5)(A)], inserted “or, for discharges occurring on or after April 1, 2001, is equal to the percent determined in accordance with clause (xiii)” after “5 percent”.
Subsec. (d)(5)(F)(iv)(III). , § 1(a)(6) [title II, § 211(b)(3)(A)], inserted “or, for discharges occurring on or after April 1, 2001, is equal to the percent determined in accordance with clause (xii)” after “4 percent”.
Subsec. (d)(5)(F)(iv)(IV). , § 1(a)(6) [title II, § 211(b)(4)], inserted “or, for discharges occurring on or after April 1, 2001, the greater of the percentages determined under clause (x) or (xi)” after “clause (viii)”.
Subsec. (d)(5)(F)(iv)(V). , § 1(a)(6) [title II, § 211(b)(2)(A)], inserted “or, for discharges occurring on or after April 1, 2001, is equal to the percent determined in accordance with clause (xi)” after “clause (viii)”.
Subsec. (d)(5)(F)(iv)(VI). , § 1(a)(6) [title II, § 211(b)(1)(A)], inserted “or, for discharges occurring on or after April 1, 2001, is equal to the percent determined in accordance with clause (x)” after “10 percent”.
Subsec. (d)(5)(F)(v)(II). , § 1(a)(6) [title II, § 211(a)(1)], inserted “(or 15 percent, for discharges occurring on or after April 1, 2001)” after “30 percent”.
Subsec. (d)(5)(F)(v)(III). , § 1(a)(6) [title II, § 211(a)(2)], inserted “(or 15 percent, for discharges occurring on or after April 1, 2001)” after “40 percent”.
Subsec. (d)(5)(F)(v)(IV). , § 1(a)(6) [title II, § 211(a)(3)], inserted “(or 15 percent, for discharges occurring on or after April 1, 2001)” after “45 percent”.
Subsec. (d)(5)(F)(ix)(III). , § 1(a)(6) [title III, § 303(a)(1)], struck out “each of” after “during” and inserted “and 2 percent, respectively” after “3 percent”.
Subsec. (d)(5)(F)(ix)(IV). , § 1(a)(6) [title III, § 303(a)(2)], substituted “3 percent” for “4 percent”.
Subsec. (d)(5)(F)(x). , § 1(a)(6) [title II, § 211(b)(1)(B)], added cl. (x).
Subsec. (d)(5)(F)(xi). , § 1(a)(6) [title II, § 211(b)(2)(B)], added cl. (xi).
Subsec. (d)(5)(F)(xii). , § 1(a)(6) [title II, § 211(b)(3)(B)], added cl. (xii).
Subsec. (d)(5)(F)(xiii). , § 1(a)(6) [title II, § 211(b)(5)(B)], added cl. (xiii).
Subsec. (d)(5)(G)(iv)(IV). , § 1(a)(6) [title II, § 212(a)], inserted “, or two of the three most recently audited cost reporting periods for which the Secretary has a settled cost report,” after “1987”.
Subsec. (d)(5)(K), (L). , § 1(a)(6) [title V, § 533(b)(1)], added subpars. (K) and (L).
Subsec. (d)(10)(D)(v), (vi). , § 1(a)(6) [title III, § 304(a)], added cls. (v) and (vi).
Subsec. (h)(2)(D)(iii). , § 1(a)(6) [title V, § 511], in heading substituted “for” for “in fiscal year 2001 at 70 percent of” and in text inserted “, and for the cost reporting period beginning during fiscal year 2002 shall not be less than 85 percent,” after “70 percent”.
Subsec. (j)(1)(A). , § 1(a)(6) [title III, § 305(b)(1)(A)], inserted “other than a facility making an election under subparagraph (F)” before “in a cost reporting period” in introductory provisions.
Subsec. (j)(1)(B). , § 1(a)(6) [title III, § 305(b)(1)(B)], inserted “or, in the case of a facility making an election under subparagraph (F), for any cost reporting period described in such subparagraph,” after “2002,”.
Subsec. (j)(1)(F). , § 1(a)(6) [title III, § 305(b)(1)(C)], added subpar. (F).
Subsec. (j)(3)(B). , § 1(a)(6) [title III, § 305(b)(2)], inserted “but not taking into account any payment adjustment resulting from an election permitted under paragraph (1)(F)” after “paragraphs (4) and (6)”.
, § 1(a)(6) [title III, § 305(a)], substituted “98 percent for fiscal year 2001 and 100 percent for fiscal year 2002” for “98 percent”.
Subsec. (l)(2)(C). , § 1(a)(6) [title V, § 512(a)], substituted “the ratio of—” and cls. (i) and (ii) for “the Secretary’s estimate of the ratio of the amount of payments made under section
of this title to the hospital for nursing and allied health education activities for the hospital’s cost reporting period ending in the second preceding fiscal year to the total of such amounts for all hospitals for such cost reporting periods.”
1999—Subsec. (b)(1). , § 1000(a)(6) [title III, § 321(k)(15)(A)], inserted a comma after “paragraph (2)” in concluding provisions.
Subsec. (b)(2)(A). , § 1000(a)(6) [title I, § 122(1)], substituted “Except as provided in subparagraph (E), in addition to” for “In addition to”.
Subsec. (b)(2)(E). , § 1000(a)(6) [title I, § 122(2)], added subpar. (E).
Subsec. (b)(3)(B)(i)(XVI) to (XVIII). , § 1000(a)(6) [title IV, § 406], added subcls. (XVI) and (XVII), redesignated former subcl. (XVII) as (XVIII), and struck out former subcl. (XVI) which read as follows: “for each of fiscal years 2001 and 2002, the market basket percentage increase minus 1.1 percentage point for hospitals in all areas, and”.
Subsec. (b)(3)(B)(ii)(VI). , § 1000(a)(6) [title III, § 321(k)(15)(B)(i)], substituted comma for semicolon at end.
Subsec. (b)(3)(B)(ii)(VII). , § 1000(a)(6) [title III, § 321(k)(15)(B)(ii)], substituted “year,” for “year;”.
Subsec. (b)(3)(C). , § 1000(a)(6) [title IV, § 405(1)], inserted “subject to subparagraph (I),” before “the term ‘target amount’ means” in introductory provisions.
Subsec. (b)(3)(D). , § 1000(a)(6) [title IV, § 404(b)(1)(A)], substituted “and before October 1, 2006,” for “and before October 1, 2001,” in introductory provisions.
, § 1000(a)(6) [title III, § 321(b)(2)], substituted “and for discharges beginning on or after October 1, 1997, and before October 1, 2001,” for “and for cost reporting periods beginning on or after October 1, 1997, and before October 1, 2001,” in introductory provisions.
Subsec. (b)(3)(D)(iv). , § 1000(a)(6) [title IV, § 404(b)(1)(B)], substituted “fiscal year 2005” for “fiscal year 2000”.
Subsec. (b)(3)(H)(i) to (iii). , § 1000(a)(6) [title I, § 121(a)], added cl. (i), redesignated former cl. (i) as subcl. (I) of cl. (ii) and inserted “, as adjusted under clause (iii)” after “fiscal year 1996”, redesignated former cl. (ii) as subcl. (II) of cl. (ii) and substituted “subclause (I)” for “clause (i)” and “such subclause” for “such clause”, added cl. (iii), and redesignated former cl. (iii) as subcl. (III) of cl. (ii).
Subsec. (b)(3)(I). , § 1000(a)(6) [title IV, § 405(2)], added subpar. (I).
Subsec. (b)(4)(A)(i). , § 1000(a)(6) [title III, § 321(f)], struck out “or unit” after “(and in the case of a hospital”.
Subsec. (b)(7)(A)(i)(II). , § 1000(a)(6) [title III, § 321(h)], inserted “(as estimated by the Secretary)” after “median”.
Subsec. (d)(2)(C)(i). , § 1000(a)(6) [title I, § 111(c)], inserted “or any additional payments under such paragraph resulting from the application of section 111 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999” after “Balanced Budget Act of 1997”.
Subsec. (d)(5)(B)(ii)(V), (VI). , § 1000(a)(6) [title I, § 111(a)], added subcl. (V), redesignated former subcl. (V) as (VI), and substituted “2001” for “2000” in subcl. (VI).
Subsec. (d)(5)(B)(v). , § 1000(a)(6) [title IV, § 407(b)(2)], inserted “(or, 130 percent of such number in the case of a hospital located in a rural area)” after “may not exceed the number”.
, § 1000(a)(6) [title IV, § 407(a)(2)], inserted at end “Rules similar to the rules of subsection (h)(4)(F)(ii) of this section shall apply for purposes of this clause.”
Subsec. (d)(5)(F)(i). , § 1000(a)(6) [title III, § 321(k)(16)], inserted a comma after “1986” in introductory provisions.
Subsec. (d)(5)(F)(ix)(III). , § 1000(a)(6) [title I, § 112(a)(1)], substituted “during each of fiscal years 2000 and 2001” for “during fiscal year 2000”.
Subsec. (d)(5)(F)(ix)(IV). , § 1000(a)(6) [title I, § 112(a)(2)–(4)], redesignated subcl. (V) as (IV), substituted “reduced by 4 percent” for “reduced by 5 percent”, and struck out former subcl. (IV) which read as follows: “during fiscal year 2001, such additional payment amount shall be reduced by 4 percent;”.
Subsec. (d)(5)(F)(ix)(V), (VI). , § 1000(a)(6) [title I, § 112(a)(3)], redesignated subcl. (VI) as (V). Former subcl. (V) redesignated (IV).
Subsec. (d)(5)(G)(i). , § 1000(a)(6) [title IV, § 404(a)(1)], substituted “October 1, 2006,” for “October 1, 2001,”.
, § 1000(a)(6) [title III, § 321(b)(1)(A)], substituted “or discharges occurring on or after October 1, 1997, and before October 1, 2001,” for “or beginning on or after October 1, 1997, and before October 1, 2001,”.
Subsec. (d)(5)(G)(ii)(II). , § 1000(a)(6) [title IV, § 404(a)(2)], substituted “October 1, 2006,” for “October 1, 2001,”.
, § 1000(a)(6) [title III, § 321(b)(1)(B)], substituted “or discharges occurring on or after October 1, 1997, and before October 1, 2001,” for “or beginning on or after October 1, 1997, and before October 1, 2001,”.
Subsec. (d)(8)(B). , § 1000(a)(6) [title IV, § 402(a)], designated existing provisions as cl. (i), substituted “described in clause (ii)” for “published in the Federal Register on January 3, 1980”, and added cl. (ii).
Subsec. (d)(8)(E). , § 1000(a)(6) [title IV, § 401(a)], added subpar. (E).
Subsec. (d)(9)(A)(ii). , § 1000(a)(6) [title III, § 321(k)(17)], inserted a comma after “1987” in introductory provisions.
Subsec. (g)(1)(A). , § 1000(a)(6) [title III, § 321(e)], substituted “October 1, 2002,” for “September 30, 2002,” in last sentence.
Subsec. (h)(2)(D)(i). , § 1000(a)(6) [title III, § 311(a)(1), (b)(1)], inserted heading and substituted “a subsequent clause” for “clause (ii)” and “the approved FTE resident amount determined” for “the amount determined”.
Subsec. (h)(2)(D)(ii). , § 1000(a)(6) [title III, § 311(b)(2)], inserted heading and realigned margins.
Subsec. (h)(2)(D)(iii), (iv). , § 1000(a)(6) [title III, § 311(a)(2)], added cls. (iii) and (iv).
Subsec. (h)(2)(E), (F). , § 1000(a)(6) [title III, § 311(a)(3), (4)], added subpar. (E) and redesignated former subpar. (E) as (F).
Subsec. (h)(3)(D)(i). , § 1000(a)(6) [title V, § 541(b)(1)], inserted “, subject to clause (iii),” after “shall equal” in introductory provisions.
Subsec. (h)(3)(D)(iii), (iv). , § 1000(a)(6) [title V, § 541(b)(2), (3)], added cl. (iii) and redesignated former cl. (iii) as (iv).
Subsec. (h)(4)(F). , § 1000(a)(6) [title IV, § 407(a)(1)], designated existing provisions as cl. (i), inserted heading, realigned margins, and added cl. (ii).
Subsec. (h)(4)(F)(i). , § 1000(a)(6) [title IV, § 407(b)(1)], inserted “(or, 130 percent of such number in the case of a hospital located in a rural area)” after “may not exceed the number”.
Subsec. (h)(4)(H)(iv). , § 1000(a)(6) [title IV, § 407(c)(1)], added cl. (iv).
Subsec. (h)(5)(F). , § 1000(a)(6) [title III, § 312(a)(1)], substituted “Subject to subparagraph (G)(v), the initial residency period” for “The initial residency period” in concluding provisions.
Subsec. (h)(5)(G)(i). , § 1000(a)(6) [title III, § 312(a)(2)(A)], substituted “(iv), and (v)” for “and (iv)”.
Subsec. (h)(5)(G)(v). , § 1000(a)(6) [title III, § 312(a)(2)(B)], added cl. (v).
Subsec. (j)(1)(D). , § 1000(a)(6) [title I, § 125(a)(1)], struck out “, day of inpatient hospital services, or other unit of payment defined by the Secretary” before period at end.
Subsec. (j)(1)(E). , § 1000(a)(6) [title I, § 125(a)(3)], added subpar. (E).
Subsec. (j)(2)(A)(i). , § 1000(a)(6) [title I, § 125(a)(2)], amended cl. (i) generally. Prior to amendment, cl. (i) read as follows: “classes of patients of rehabilitation facilities (each in this subsection referred to as a ‘case mix group’), based on such factors as the Secretary deems appropriate, which may include impairment, age, related prior hospitalization, comorbidities, and functional capability of the patient; and”.
Subsec. (l). , § 1000(a)(6) [title V, § 541(a)], added subsec. (l).
1997—Subsec. (b)(1). , § 4421(b)(1), inserted “and other than a rehabilitation facility described in subsection (j)(1) of this section” after “subsection (d)(1)(B) of this section” in introductory provisions.
, § 4415(b)(1), inserted “plus the amount, if any, provided under paragraph (2)” before “except that in no case” in concluding provisions.
Subsec. (b)(1)(A). , § 4415(a), added cls. (i) and (ii) and concluding provisions and struck out former cls. (i) and (ii) and former concluding provisions which read as follows:
“(i) 50 percent of the amount by which the target amount exceeds the amount of the operating costs, or
“(ii) 5 percent of the target amount,
whichever is less; or”.
Subsec. (b)(1)(B). , § 4415(c)(3), added subpar. (B). Former subpar. (B) redesignated (C).
Subsec. (b)(1)(C). , § 4415(c)(1), (2), redesignated subpar. (B) as (C) and substituted “greater than 110 percent of the target amount” for “greater than the target amount” and “exceed 110 percent of the target amount” for “exceed the target amount”.
Subsec. (b)(2). , § 4415(b)(2), added par. (2).
Subsec. (b)(3)(A). , §§ 4413(a)(1),
, in introductory provisions, substituted “subparagraph (C) and succeeding subparagraph,” for “subparagraphs (C), (D), and (E),” and inserted “and in paragraph (7)(A)(ii),” before “for purposes of this subsection”.
Subsec. (b)(3)(B)(i). , § 4421(b)(2), inserted “and subsection (j) of this section” after “For purposes of subsection (d) of this section” in introductory provisions.
Subsec. (b)(3)(B)(i)(XIII) to (XVII). , § 4401(a), added subcls. (XIII) to (XVII) and struck out former subcl. (XIII) which read as follows: “for fiscal year 1998 and each subsequent fiscal year, the market basket percentage increase for hospitals in all areas.”
Subsec. (b)(3)(B)(ii)(VI) to (VIII). , § 4411(a)(1), added subcls. (VI) and (VII) and redesignated former subcl. (VI) as (VIII).
Subsec. (b)(3)(B)(vi). , § 4411(a)(2), added cl. (vi).
Subsec. (b)(3)(D). , § 4204(a)(2)(A), substituted “September 30, 1994, and for cost reporting periods beginning on or after October 1, 1997, and before October 1, 2001,” for “September 30, 1994,” in introductory provisions.
Subsec. (b)(3)(D)(iv). , § 4204(a)(2)(B)–(D), added cl. (iv).
Subsec. (b)(3)(F), (G). , § 4413(a)(2), (b), added subpars. (F) and (G).
Subsec. (b)(3)(H). , § 4414, added subpar. (H).
Subsec. (b)(4)(A)(i). , § 4419(a)(1), in first sentence, substituted “The Secretary shall provide for an exception and adjustment to (and in the case of a hospital or unit described in subsection (d)(1)(B)(iii) of this section, may provide an exemption from)” for “The Secretary shall provide for an exemption from, or an exception and adjustment to,”.
Subsec. (b)(4)(A)(ii). , § 4411(b), inserted at end “In making such reductions, the Secretary shall treat the applicable update factor described in paragraph (3)(B)(vi) for a fiscal year as being equal to the market basket percentage for that year.”
Subsec. (b)(7). , § 4416(1), added par. (7).
Subsec. (d)(1)(B). , § 4417(a)(1), inserted at end “A hospital that was classified by the Secretary on or before September 30, 1995, as a hospital described in clause (iv) shall continue to be so classified notwithstanding that it is located in the same building as, or on the same campus as, another hospital.”
Subsec. (d)(1)(B)(iv). , § 4417(b)(1), designated existing provisions as subcl. (I) and added subcl. (II).
Subsec. (d)(1)(B)(v). , § 4418(a)(1), designated existing provisions as subcl. (I), substituted “, or” for semicolon at end, and added subcl. (II).
Subsec. (d)(1)(E). , § 4418(a)(2), added subpar. (E).
Subsec. (d)(2)(C)(i). , § 4621(a)(2), inserted at end “except that the Secretary shall not take into account any reduction in the amount of additional payments under paragraph (5)(B)(ii) resulting from the amendment made by section 4621(a)(1) of the Balanced Budget Act of 1997,”.
Subsec. (d)(5)(A)(ii). , § 4405(c), substituted “exceed the sum of the applicable DRG prospective payment rate plus any amounts payable under subparagraphs (B) and (F)” for “exceed the applicable DRG prospective payment rate”.
Subsec. (d)(5)(B)(i)(I). , § 4405(a), inserted “, for cases qualifying for additional payment under subparagraph (A)(i),” before “the amount paid to the hospital”.
Subsec. (d)(5)(B)(ii). , § 4621(a)(1), amended cl. (ii) generally. Prior to amendment, cl. (ii) read as follows: “For purposes of clause (i)(II), the indirect teaching adjustment factor for discharges occurring on or after October 1, 1988, is equal to 1.89 (((1 + r) to the nth power) 1), where ‘r’ is the ratio of the hospital’s full-time equivalent interns and residents to beds and ‘n’ equals .405.”
Subsec. (d)(5)(B)(iv). , § 4621(b)(2), amended cl. (iv) generally. Prior to amendment, cl. (iv) read as follows: “In determining such adjustment, the Secretary shall continue to count interns and residents assigned to outpatient services of the hospital or providing services at any entity receiving a grant under section
of this title that is under the ownership or control of the hospital (if the hospital incurs all, or substantially all, of the costs of the services furnished by such interns and residents) as part of the calculation of the full-time-equivalent number of interns and residents.”
Subsec. (d)(5)(B)(v) to (viii). , § 4621(b)(1), added cls. (v) to (viii).
Subsec. (d)(5)(D)(iii)(III). , § 4201(c)(4)(A), inserted “as in effect on September 30, 1997” before period at end.
Subsec. (d)(5)(D)(v). , § 4201(c)(4)(B), inserted “as in effect on September 30, 1997” after “section
of this title” and substituted “(as defined in section
of this title)” for “(as defined in section
of this title)”.
Subsec. (d)(5)(F)(i). , § 4403(a)(1), inserted “and before October 1, 1997” after “May 1, 1986” in introductory provisions.
Subsec. (d)(5)(F)(ii). , § 4403(a)(2), substituted “Subject to clause (ix), the amount” for “The amount”.
Subsec. (d)(5)(F)(ii)(I). , § 4405(b), inserted “, for cases qualifying for additional payment under subparagraph (A)(i),” before “the amount paid to the hospital”.
Subsec. (d)(5)(F)(ix). , § 4403(a)(3), added cl. (ix).
Subsec. (d)(5)(G)(i), (ii)(II). , § 4204(a)(1), substituted “October 1, 1994, or beginning on or after October 1, 1997, and before October 1, 2001,” for “October 1, 1994,”.
Subsec. (d)(5)(I)(ii). , § 4407(1), inserted “not taking in account the effect of subparagraph (J),” after “in a fiscal year,”.
Subsec. (d)(5)(J). , § 4407(2), added subpar. (J).
Subsec. (d)(6). , § 4644(a)(1), substituted “August 1” for “September 1”.
Subsec. (d)(9)(A). , § 4406(1), struck out “in a fiscal year beginning on or after October 1, 1987,” after “inpatient hospital discharges” in introductory provisions.
Subsec. (d)(9)(A)(i). , § 4406(2), substituted “for discharges beginning on or after October 1, 1997, 50 percent (and for discharges between October 1, 1987, and September 30, 1997, 75 percent)” for “75 percent”.
Subsec. (d)(9)(A)(ii). , § 4406(3), substituted “for discharges beginning in a fiscal year beginning on or after October 1, 1997, 50 percent (and for discharges between October 1, 1987 and September 30, 1997, 25 percent)” for “25 percent”.
Subsec. (d)(10)(C)(ii). , § 4644(c)(1), substituted “the first day of the 13-month period ending on September 30 of the preceding fiscal year.” for “the first day of the preceding fiscal year.”
Subsec. (d)(10)(D)(iii), (iv). , § 4202(a), added cl. (iii) and redesignated former cl. (iii) as (iv).
Subsec. (d)(11). , § 4622, added par. (11).
Subsec. (e)(2). , § 4022(b)(1)(A)(i), struck out par. (2) which related to appointment, composition, and responsibilities of the Prospective Payment Assessment Commission.
Subsec. (e)(3). , § 4022(b)(1)(A)(ii), redesignated subpar. (B) as par. (3) and struck out subpar. (A) which read as follows: “The Commission, not later than the March 1 before the beginning of each fiscal year (beginning with fiscal year 1986), shall report its recommendations to Congress on an appropriate change factor which should be used for inpatient hospital services for discharges in that fiscal year, together with its general recommendations under paragraph (2)(B) regarding the effectiveness and quality of health care delivery systems in the United States.”
Subsec. (e)(5)(A). , § 4644(b)(1)(A), substituted “April 1” for “May 1”.
Subsec. (e)(5)(B). , § 4644(b)(1)(B), substituted “August 1” for “September 1”.
Subsec. (e)(6). , § 4022(b)(1)(A)(i), struck out par. (6) which related to appointments, membership, responsibilities, compensation, access to records and information, audits, and appropriations concerning the Prospective Payment Assessment Commission.
Subsec. (g)(1)(A). , § 4402, inserted at end “In addition to the reduction described in the preceding sentence, for discharges occurring on or after October 1, 1997, the Secretary shall apply the budget neutrality adjustment factor used to determine the Federal capital payment rate in effect on September 30, 1995 (as described in section
.352 of title 42 of the Code of Federal Regulations), to (i) the unadjusted standard Federal capital payment rate (as described in section 412.308(c) of that title, as in effect on September 30, 1997), and (ii) the unadjusted hospital-specific rate (as described in section 412.328(e)(1) of that title, as in effect on September 30, 1997), and, for discharges occurring on or after October 1, 1997, and before September 30, 2002, reduce the rates described in clauses (i) and (ii) by 2.1 percent.”
Subsec. (g)(3)(B). , § 4201(c)(1), substituted “critical access” for “rural primary care”.
Subsec. (g)(4). , § 4412, added par. (4).
Subsec. (h)(3)(B). , § 4625(b), inserted concluding provisions.
Subsec. (h)(3)(D). , § 4624, added subpar. (D).
Subsec. (h)(4)(F) to (H). , § 4623, added subpars. (F) to (H).
Subsec. (h)(5)(G). , § 4627(a), substituted “Subject to clauses (ii), (iii), and (iv)” for “Subject to clauses (ii) and (iii)” in cl. (i) and added cl. (iv).
Subsec. (h)(6). , § 4626(a), added par. (6).
Subsec. (j). , § 4421(a), added subsec. (j).
Subsec. (k). , § 4625(a), added subsec. (k).
1994—Subsec. (a)(4). , § 110(a), inserted “(or, in the case of a hospital that is not a subsection (d) hospital, during the 1 day)” after “3 days”.
Subsec. (b)(3)(B)(iv)(II). , § 105(b), substituted “(adjusted to exclude any portion of a cost reporting period beginning during fiscal year 1993 for which the applicable percentage increase is determined under subparagraph (I))” for “(taking into account any portion of the 12-month cost reporting period beginning during fiscal year 1993 that occurred during fiscal year 1994)”.
Subsec. (b)(3)(D). , § 105(a)(2), substituted “September 30, 1994” for “March 31, 1993” in introductory provisions.
Subsec. (d)(3)(A)(iii). , § 101(c), inserted at end “For discharges occurring on or after October 1, 1994, the Secretary shall adjust the ratio of the labor portion to non-labor portion of each average standardized amount to equal such ratio for the national average of all standardized amounts.”
Subsec. (d)(5)(B)(ii). , § 110(c), substituted “October 1, 1988” for “May 1, 1986”.
Subsec. (d)(5)(D)(iii)(III). , § 102(b)(1)(B)(i), substituted “that is located in a rural area and designated” for “that is designated”.
Subsec. (d)(5)(D)(v). , § 102(b)(1)(B)(ii), substituted “in the case of a hospital located in a rural area and designated” for “in the case of a hospital designated”.
Subsec. (d)(5)(G)(ii)(I). , § 105(a)(1), substituted “the 36-month period beginning with the first day of the cost reporting period that begins” for “the first 3 12-month cost reporting periods that begin”.
Subsec. (d)(5)(I). , § 109, designated existing provisions as cl. (i) and added cl. (ii).
Subsec. (d)(8)(C)(iv). , § 101(b)(1)(A), substituted “paragraph (10)” for “paragraph (1)”.
Subsec. (d)(8)(C)(v). , § 101(b)(1)(B), added cl. (v).
Subsec. (d)(10)(C)(i)(II). , § 101(b)(2)(A), substituted “the factor used to adjust the DRG prospective payment rate for area differences in hospital wage levels that applies” for “the area wage index applicable”.
Subsec. (d)(10)(D)(i)(I). , § 101(a)(1), inserted “(to the extent the Secretary determines appropriate)” after “taking into account”.
Subsec. (d)(10)(D)(ii), (iii). , § 101(b)(2)(B), added cl. (ii) and redesignated former cl. (ii) as (iii).
Subsec. (e)(6)(B). , § 108, substituted “health facility management, reimbursement of health facilities or other providers of services which reflect the scope of the Commission’s responsibilities” for “hospital reimbursement, hospital financial management”.
Subsec. (h)(5)(E). , § 153(a), inserted “or any successor examination” after “Medical Sciences”.
1993—Subsec. (b)(3)(B)(i)(IX). , § 13501(a)(1)(A), substituted “percentage increase minus 2.5 percentage points for hospitals” for “percentage increase for hospitals” and “percentage increase minus 1.0 percentage point” for “percentage increase plus 1.5 percentage points”.
Subsec. (b)(3)(B)(i)(X). , § 13501(a)(1)(B), substituted “percentage increase minus 2.5 percentage points for hospitals” for “percentage increase for hospitals” and struck out “and” at end.
Subsec. (b)(3)(B)(i)(XI). , § 13501(a)(1)(C), struck out “and each subsequent fiscal year” after “1996”, inserted “minus 2.0 percentage points” after “percentage increase”, and substituted a comma for period at end.
Subsec. (b)(3)(B)(i)(XII), (XIII). , § 13501(a)(1)(D), added subcls. (XII) and (XIII).
Subsec. (b)(3)(B)(ii). , § 13501(a)(2)(B)(i), struck out “, (C), (D),” after “subparagraphs (A)”.
Subsec. (b)(3)(B)(ii)(III) to (VI). , § 13502(a)(1), struck out “and” at end of subcl. (III), in subcl. (IV), substituted “a subsequent fiscal year ending on or before September 30, 1993,” for “subsequent fiscal years” and a comma for the period at end, and added subcls. (V) and (VI).
Subsec. (b)(3)(B)(iv). , § 13501(a)(2)(A), added cl. (iv).
Subsec. (b)(3)(B)(v). , § 13502(a)(2), added cl. (v).
Subsec. (b)(3)(C)(i)(II). , § 13501(a)(2)(B)(ii), struck out “or” at end.
Subsec. (b)(3)(C)(ii). , § 13501(a)(2)(B)(iii), substituted “period beginning before fiscal year 1994, the target” for “period, the target”, “subparagraph (B)(iv)” for “subparagraph (B)(ii)”, and a comma for period at end.
Subsec. (b)(3)(C)(iii), (iv). , § 13501(a)(2)(B)(iv), added cls. (iii) and (iv).
Subsec. (b)(3)(D)(ii). , § 13501(a)(2)(B)(v), substituted “period beginning before fiscal year 1994, the target” for “period, the target”, “subparagraph (B)(iv)” for “subparagraph (B)(ii)”, and “, and” for period at end.
Subsec. (b)(3)(D)(iii). , § 13501(a)(2)(B)(vi), added cl. (iii).
Subsec. (b)(4)(A). , § 13502(b), designated existing provisions as cl. (i) and added cl. (ii).
Subsec. (d)(1)(A)(iii). , § 13501(f), amended cl. (iii) generally. Prior to amendment, cl. (iii) read as follows: “beginning on or after April 1, 1988, and ending on September 30, 1993,, the sum of (I) 85 percent of the national adjusted DRG prospective payment rate determined under paragraph (3) for such discharges, and (II) 15 percent of the regional adjusted DRG prospective payment rate determined under such paragraph.”
Subsec. (d)(5)(A)(i). , § 13501(c)(1), substituted “For discharges occurring during fiscal years ending on or before September 30, 1997, the Secretary” for “The Secretary”.
Subsec. (d)(5)(A)(ii). , § 13501(c)(2), substituted “, or, for discharges in fiscal years beginning on or after October 1, 1994, exceed the applicable DRG prospective payment rate plus a fixed dollar amount determined by the Secretary.” for period at end.
Subsec. (d)(5)(A)(iii). , § 13501(c)(3), substituted “shall (except as payments under clause (i) are required to be reduced to take into account the requirements of clause (v)) approximate” for “shall approximate”.
Subsec. (d)(5)(A)(v), (vi). , § 13501(c)(4), added cls. (v) and (vi).
Subsec. (d)(5)(B)(iv). , § 13506, inserted “or providing services at any entity receiving a grant under section
of this title that is under the ownership or control of the hospital (if the hospital incurs all, or substantially all, of the costs of the services furnished by such interns and residents)” after “the hospital”.
Subsec. (d)(5)(G)(i). , § 13501(e)(1)(A), which directed amendment of subsec. (d)(5)(G) in clause (i) in the matter preceding subclause (I), by striking “ending on or before March 31, 1993,” and all that follows and inserting “before October 1, 1994, in the case of a subsection (d) hospital which is a medicare-dependent, small rural hospital, payment under paragraph (1)(A) shall be equal to the sum of the amount determined under clause (ii) and the amount determined under paragraph (1)(A)(iii).”, was executed by substituting the new language for “ending on or before March 31, 1993, with respect to a subsection (d) hospital which is a medicare-dependent, small rural hospital, payment under paragraph (1)(A) shall be—
“(I) an amount based on 100 percent of the hospital’s target amount for the cost reporting period, as defined in subsection (b)(3)(D) of this section, or
“(II) the amount determined under paragraph (1)(A)(iii),
whichever results in the greater payment to the hospital.” to reflect the probable intent of Congress.
Subsec. (d)(5)(G)(ii) to (iv). , § 13501(e)(1)(B), (C), added cl. (ii) and redesignated former cls. (ii) and (iii) as (iii) and (iv), respectively.
Subsec. (d)(8)(C)(iv). , § 13501(b)(1), added cl. (iv).
Subsec. (g)(1)(A). , § 13501(a)(3), inserted at end “For discharges occurring after September 30, 1993, the Secretary shall reduce by 7.4 percent the unadjusted standard Federal capital payment rate (as described in 42 CFR 412.308(c), as in effect on August 10, 1993) and shall (for hospital cost reporting periods beginning on or after October 1, 1993) redetermine which payment methodology is applied to the hospital under such system to take into account such reduction.”
Subsec. (h)(2)(D). , § 13563(a)(1), designated existing provisions as cl. (i), substituted “Except as provided in clause (ii), for each” for “For each”, and added cl. (ii).
Subsec. (h)(5)(F). , § 13563(b)(1)(A), struck out “plus one year” after “board eligibility” in introductory provisions.
Subsec. (h)(5)(F)(ii). , § 13563(b)(1)(B), inserted “or a preventive medicine residency or fellowship program” after “fellowship program”.
Subsec. (h)(5)(H), (I). , § 13563(a)(2), added subpar. (H) and redesignated former subpar. (H) as (I).
Subsec. (h)(5)(J). , § 13563(c)(1), added subpar. (J).
1990—Subsec. (a)(4). , § 4003(a), struck out period at end of first sentence and inserted “, and includes the costs of all services for which payment may be made under this subchapter that are provided by the hospital (or by an entity wholly owned or operated by the hospital) to the patient during the 3 days immediately preceding the date of the patient’s admission if such services are diagnostic services (including clinical diagnostic laboratory tests) or are other services related to the admission (as defined by the Secretary).”
Subsec. (b)(1)(B)(ii). , § 4005(a)(1), added cl. (ii) and struck out former cl. (ii) which read as follows: “in the case of cost reporting periods beginning on or after October 1, 1982, and before October 1, 1984, 25 percent of the amount by which the amount of the operating costs exceeds the target amount;”.
Subsec. (b)(3)(B)(i)(V). , § 4002(a)(1)(A), struck out “and” after semicolon at end.
Subsec. (b)(3)(B)(i)(VI). , § 4002(c)(1)(A), substituted “in a large urban or other urban area, and the market basket percentage increase minus 0.7 percentage point for hospitals located in a rural area” for “in all areas”.
, § 4002(a)(1)(C), added subcl. (VI). Former subcl. (VI) redesignated (IX).
, § 4002(a)(1)(B)(i), substituted “1994” for “1991”.
Subsec. (b)(3)(B)(i)(VII). , § 4002(c)(1)(B), substituted “in a large urban or other urban area, and the market basket percentage increase minus 0.6 percentage point for hospitals located in a rural area” for “in all areas”.
, § 4002(a)(1)(C), added subcl. (VII).
Subsec. (b)(3)(B)(i)(VIII). , § 4002(c)(1)(C), substituted “in a large urban or other urban area, and the market basket percentage increase minus 0.55 for hospitals located in a rural area,” for “in all areas, and”.
, § 4002(a)(1)(C), added subcl. (VIII).
Subsec. (b)(3)(B)(i)(IX). , § 4002(c)(1)(E), added subcl. (IX). Former subcl. (IX) redesignated (XI).
, § 4002(c)(1)(D)(i), substituted “1996” for “1994”.
, § 4002(a)(1)(B)(ii), redesignated subcl. (VI) as (IX).
Subsec. (b)(3)(B)(i)(X). , § 4002(c)(1)(E), added subcl. (X).
Subsec. (b)(3)(B)(i)(XI). , § 4002(c)(1)(D)(ii), redesignated subcl. (IX) as (XI).
Subsec. (b)(3)(B)(ii). , § 4002(c)(2)(A)(i), substituted “(A), (C), (D), and (E),” for “(A) and (E),” in introductory provisions.
Subsec. (b)(3)(C)(ii), (D)(ii). , § 4002(c)(2)(A)(ii), substituted “subparagraph (B)(ii)” for “subparagraph (B)(i)”.
Subsec. (b)(4)(A). , § 4005(c)(1)(B), inserted at end “The Secretary shall announce a decision on any request for an exemption, exception, or adjustment under this paragraph not later than 180 days after receiving a completed application from the intermediary for such exemption, exception, or adjustment, and shall include in such decision a detailed explanation of the grounds on which such request was approved or denied.”
Subsec. (b)(4)(B), (C). , § 4005(c)(2), added subpar. (B) and redesignated former subpar. (B) as (C).
Subsec. (c)(4). , § 4008(f)(1), substituted “payments under the State system as compared to aggregate payments which would have been made under the national system since” for “rate of increase from” in last sentence.
Subsec. (d)(1)(A)(iii). , § 4002(e)(1), substituted “beginning on or after April 1, 1988, and ending on September 30, 1993,” for “beginning on or after October 1, 1987, is equal to the national adjusted DRG prospective payment rate determined under paragraph (3) for such discharges, or, if the average standardized amount (described in clause (i)(I) or clause (ii)(I) of paragraph (3)(D)) for hospitals within the region of, and in the same rural, large urban, or other urban area as, the hospital is greater than the average standardized amount (described in the respective clause) for hospitals within the United States in that type of area for discharges occurring during the period beginning on April 1, 1988, and ending on October 20, 1990”.
, § 4002(c)(2)(B)(i), substituted “large urban or other area” for “rural, large urban, or other urban area” in text of cl. (iii)(II) as amended by , § 13501(f). See 1993 Amendment note above.
substituted “October 20, 1990” for “September 30, 1990”.
Subsec. (d)(2)(C)(iv). , § 4002(b)(4)(B), substituted “1989 or the enactment of section 4002(b) of the Omnibus Budget Reconciliation Act of 1990.” for “1989.”
, § 4002(b)(4)(A), struck out period at end and inserted “, except that the Secretary shall not exclude additional payments under such paragraph made as a result of the enactment of section 6003(c) of the Omnibus Budget Reconciliation Act of 1989.”
, § 4002(b)(3)(A), struck out “and before October 1, 1995,” after “October 1, 1986,”.
Subsec. (d)(3)(A)(ii). , § 4002(c)(2)(B)(ii)(I), substituted “and ending on or before September 30, 1994, the Secretary” for “the Secretary”.
Subsec. (d)(3)(A)(iii) to (v). , § 4002(c)(2)(B)(ii)(II), (III), added cls. (iii) and (iv) and redesignated former cl. (iii) as (v).
Subsec. (d)(3)(B). , § 4002(c)(2)(B)(iii), substituted “by a factor equal to the proportion of payments under this subsection (as estimated by the Secretary) based on DRG prospective payment amounts which are additional payments described in paragraph (5)(A) (relating to outlier payments).” for “for hospitals located in an urban area and for hospitals located in a rural area by a proportion equal to the proportion (estimated by the Secretary) of the amount of payments under this subsection based on DRG prospective payment amounts which are additional payments described in paragraph (5)(A) (relating to outlier payments) for hospitals located in such respective area.”
Subsec. (d)(3)(C)(ii). , § 4002(b)(3)(B)(B), substituted “occurring on or after October 1, 1986,” through the end of cl. (ii) for “occurring—” and subcls. (I) and (II) which read as follows:
“(I) on or after October 1, 1986, and before October 1, 1995, of an amount equal to the estimated reduction in the payment amounts under paragraph (5)(B) that would have resulted from the enactment of the amendments made by section 9104 of the Medicare and Medicaid Budget Reconciliation Amendments of 1985 and by section 4003(a)(1) of the Omnibus Budget Reconciliation Act of 1987 if the factor described in clause (ii)(II) of paragraph (5)(B) were applied for discharges occurring during such period instead of the factor described in clause (ii)(I) of that paragraph, and
“(II) on or after October 1, 1995, of an amount equal to the estimated reduction in the payment amounts under paragraph (5)(B) for those discharges that has resulted from the enactment of the amendments made by section 9104 of the Medicare and Medicaid Budget Reconciliation Amendments of 1985 and by section 4003(a)(1) of the Omnibus Budget Reconciliation Act of 1987.”
Subsec. (d)(3)(D)(i). , § 4002(c)(2)(B)(iv)(I), which directed amendment of cl. (i) by substituting “a large urban area” for “an urban area (or,” and all that follows through “area),” was executed by making the substitution for “an urban area (or, for discharges occurring on or after April 1, 1988, in a large urban area or other urban area)” to reflect the probable intent of Congress.
Subsec. (d)(3)(D)(i)(I). , § 4002(c)(2)(B)(iv)(II), substituted “a large urban area” for “an urban area”.
Subsec. (d)(3)(D)(ii). , § 4002(c)(2)(B)(v), substituted “other areas” for “a rural area” in introductory provisions and in subcl. (I).
Subsec. (d)(4)(D). , § 4002(g)(2)(A), struck out subpar. (D) which read as follows: “The Commission (established under subsection (e)(2) of this section) shall consult with and make recommendations to the Secretary with respect to the need for adjustments under subparagraph (C), based upon its evaluation of scientific evidence with respect to new practices, including the use of new technologies and treatment modalities. The Commission shall report to the Congress with respect to its evaluation of any adjustments made by the Secretary under subparagraph (C).”
Subsec. (d)(5)(B)(ii). , § 4002(b)(3)(B)(A), amended cl. (ii) generally. Prior to amendment, cl. (ii) read as follows: “For purposes of clause (i)(II), the indirect teaching adjustment factor for discharges occurring—
“(I) on or after May 1, 1986, and before October 1, 1995, is equal to 1.89((1+r).4051), or
“(II) on or after October 1, 1995, is equal to 1.43((1+r).57951),
where ‘r’ is the ratio of the hospital’s full-time equivalent interns and residents to beds.”
Subsec. (d)(5)(D)(iii). , § 4008(m)(2)(A), substituted “For purposes of this subchapter, the term” for “The term” at beginning.
Subsec. (d)(5)(F)(i). , § 4002(b)(3)(A), struck out “and before October 1, 1995,” after “May 1, 1986,”.
Subsec. (d)(5)(F)(iii). , § 4002(b)(2), substituted “35 percent” for “30 percent”.
Subsec. (d)(5)(F)(vii)(I). , § 4002(b)(1)(A), substituted “greater than 20.2—” and subdivs. (a) to (d) for “greater than 20.2, (P20.2)(.65)+5.62, or”.
Subsec. (d)(5)(F)(vii)(II). , § 4002(b)(1)(B), substituted “hospital—” and subdivs. (a) to (c) for “hospital, (P15)(.6)+2.5,”.
Subsec. (d)(8)(C)(i). , § 4002(h)(1)(A)(i), substituted “area, or by treating hospitals located in one urban area as being located in another urban area—” for “area—”.
Subsec. (d)(8)(C)(i)(II). , § 4002(h)(1)(A)(ii), amended subcl. (II) generally. Prior to amendment, subcl. (II) read as follows: “reduces the wage index for that urban area by more than 1 percentage point (as applied under this subsection), the Secretary shall calculate and apply such wage index under this subsection separately to hospitals located in such urban area (excluding all the hospitals so treated) and to the hospitals so treated (as if each affected rural county were a separate urban area).”
Subsec. (d)(8)(C)(ii) to (iv). , § 4002(h)(1)(A)(iii), (iv), redesignated cls. (iii) and (iv) as (ii) and (iii), respectively, and struck out former cl. (ii) which read as follows: “If the application of subparagraph (B) or a decision of the Medicare Geographic Classification Review Board or the Secretary under paragraph (10), by reclassifying a county from a rural to an urban area or by reclassifying an urban county from one urban area to another urban area—
“(I) reduces the wage index for the urban area within which the county or counties is reclassified by 1 percentage point or less (as applied under this subsection), the Secretary, in calculating such wage index under this subsection, shall exclude those counties so reclassified, or
“(II) reduces the wage index for the urban area within which the county or counties is reclassified by more than 1 percentage point (as applied under this subsection), the Secretary shall calculate and apply such wage index under this subsection separately to hospitals located in such urban area (excluding all the hospitals so reclassified) and to hospitals located in the counties so reclassified (as if each affected county were a separate area).”
Subsec. (d)(8)(D). , § 4002(c)(2)(B)(vi), struck out “for hospitals located in an urban area” after “determined under paragraph (3)” and struck out at end “The Secretary shall make such adjustment in payments under this section to hospitals located in rural areas as are necessary to assure that the aggregate of payments to rural hospitals not affected by subparagraphs (B) and (C) or a decision of the Medicare Geographic Classification Review Board or the Secretary under paragraph (10) are not changed as a result of the application of subparagraphs (B) and (C) or a decision of the Medicare Geographic Classification Review Board or the Secretary under paragraph (10).”
Subsec. (d)(10)(A). , § 4002(h)(2)(B)(i), substituted “Geographic” for “Geographical”.
Subsec. (d)(10)(B)(i). , § 4002(h)(2)(B)(ii), substituted “representative” for “representatives” and struck out “1 member shall be a member of the Prospective Payment Assessment Commission, and at least” after “At least”.
Subsec. (d)(10)(B)(ii). , § 4002(h)(2)(B)(iii), substituted “initial” for “all”.
Subsec. (d)(10)(C)(iii)(II). , § 4002(h)(2)(B)(iv), substituted “Appeal of decisions of the Board shall be subject to the provisions of section
557b of title
” for “A decision of the Board shall be final unless the unsuccessful applicant appeals such decision to the Secretary by not later than 15 days after the Board renders its decision. The Secretary in considering the appeal of an applicant shall receive no new evidence but shall consider the record as a whole as such record appeared before the Board” and substituted “after the date on which” for “after”.
Subsec. (e)(2). , § 4002(g)(1), designated existing provisions as subpar. (A) and added subpars. (B) and (C).
Subsec. (e)(2)(A). , § 4002(g)(2)(B), substituted “The Commission” for “In addition to carrying out its functions under subsection (d)(4)(D) of this section, the Commission”.
Subsec. (e)(3)(A). , § 4002(g)(2)(C), substituted “Congress” for “the Secretary” and inserted before period at end “, together with its general recommendations under paragraph (2)(B) regarding the effectiveness and quality of health care delivery systems in the United States”.
Subsec. (e)(4). , § 4002(g)(2)(D), designated existing provisions as subpar. (A) and added subpar. (B).
Subsec. (e)(5). , § 4002(g)(2)(E), substituted “recommendations” for “recommendation” in subpars. (A) and (B) and inserted at end “To the extent that the Secretary’s recommendations under paragraph (4) differ from the Commission’s recommendations for that fiscal year, the Secretary shall include in the publication referred to in subparagraph (A) an explanation of the Secretary’s grounds for not following the Commission’s recommendations.”
Subsec. (e)(6)(G). , § 4002(g)(2)(F), redesignated cls. (ii) and (iii) as (i) and (ii), respectively, and struck out former cl. (i) which read as follows: “The Office shall report annually to the Congress on the functioning and progress of the Commission and on the status of the assessment of medical procedures and services by the Commission.”
Subsec. (g)(1)(A). , § 4001(b), inserted at end “Aggregate payments made under subsection (d) of this section and this subsection during fiscal years 1992 through 1995 shall be reduced in a manner that results in a reduction (as estimated by the Secretary) in the amount of such payments equal to a 10 percent reduction in the amount of payments attributable to capital-related costs that would otherwise have been made during such fiscal year had the amount of such payments been based on reasonable costs (as defined in section
of this title).”
Subsec. (g)(3)(A)(v). , § 4001(a), substituted “September 30, 1991” for “September 30, 1990”.
Subsec. (g)(3)(B). , § 4001(c), substituted “subsection (d)(5)(D)(iii) of this section or a rural primary care hospital (as defined in section
of this title)” for “subsection (d)(5)(D)(iii) of this section)”.
1989—Subsec. (a)(4). , § 6011(a), struck out “or,” after “equity capital,” and substituted “October 1, 1987), or costs with respect to administering blood clotting factors to individuals with hemophilia” for “October 1, 1987)”.
Subsec. (b)(3)(A). , § 6004(b)(1)(A), substituted “(C), (D), and (E)” for “(C) and (D)” in introductory provisions.
, § 6003(f)(2)(i), substituted “subparagraphs (C) and (D)” for “subparagraph (C)” in introductory provisions.
, § 6003(e)(1)(B)(i), substituted “(A) Except as provided in subparagraph (C), for purposes of this subsection” for “(A) For purposes of this subsection” in introductory provisions.
Subsec. (b)(3)(B)(i)(V), (VI). , § 6003(a)(1), added subcl. (V), redesignated former subcl. (V) as (VI), and substituted “fiscal year 1991” for “fiscal year 1990” in subcl. (VI).
Subsec. (b)(3)(B)(ii). , § 6004(b)(1)(B), substituted “For purposes of subparagraphs (A) and (E)” for “For purposes of subparagraph (A)” in introductory provisions.
Subsec. (b)(3)(C). , § 6003(e)(1)(B)(ii), added subpar. (C).
Subsec. (b)(3)(D). , § 6003(f)(2)(ii), added subpar. (D).
Subsec. (b)(3)(E). , § 6004(b)(1)(C), added subpar. (E).
Subsec. (b)(4)(A). , § 6015(a), substituted “deems appropriate, including the assignment of a new base period which is more representative, as determined by the Secretary, of the reasonable and necessary cost of inpatient services and” for “deems appropriate,”.
Subsec. (c)(4). , § 6022, substituted “the aggregate rate of increase from October 1, 1984, to the most recent date for which annual data are available” for “the aggregate payment or payments per inpatient admission or discharge during the three cost reporting periods beginning on or after October 1, 1983, after which such test, at the option of the Secretary, shall no longer apply, and such State systems shall be treated in the same manner as under other waivers” in second sentence.
Subsec. (d)(1)(B)(v). , § 6004(a)(1), added cl. (v).
Subsec. (d)(3)(E). , § 6003(h)(6), substituted “October 1, 1990, and October 1, 1993 (and at least every 12 months thereafter)” for “October 1, 1990 (and at least every 36 months thereafter)” and inserted at end “Any adjustments or updates made under this subparagraph for a fiscal year (beginning with fiscal year 1991) shall be made in a manner that assures that the aggregate payments under this subsection in the fiscal year are not greater or less than those that would have been made in the year without such adjustment.”
Subsec. (d)(4)(C). , § 6003(b), designated existing provisions as cl. (i) and added cls. (ii) to (iv).
Subsec. (d)(5)(C). , § 6003(e)(1)(A)(i), (ii), (iv), (2)(B), redesignated former cl. (i)(I) as cl. (i), redesignated former cl. (i)(II) as cl. (ii) and substituted “clause (i)” for “subclause (I)” in three places, and redesignated former cls. (ii), (iii), and (iv) as subpars. (D), (I), and (H), respectively.
Subsec. (d)(5)(D). , § 6003(e)(1)(A)(iv), amended former subpar. (C)(ii) generally, redesignating it as subpar. (D) and substituting cls. (i) to (iv) relating to payments to sole community hospitals for cost reporting periods beginning on or after Apr. 1, 1990, for former single paragraph relating to payments to such hospitals for cost reporting periods beginning on or after Oct. 1, 1984.
Subsec. (d)(5)(D)(iii)(III). , § 6003(g)(2)(A), added subcl. (III).
Subsec. (d)(5)(D)(v). , § 6003(g)(2)(B), added cl. (v).
Subsec. (d)(5)(E). , § 6003(e)(1)(A)(iii), redesignated subpar. (D) as (E).
Subsec. (d)(5)(F)(iii). , § 6003(c)(3), substituted “30 percent” for “25 percent”.
Subsec. (d)(5)(F)(iv)(I). , § 6003(c)(1)(A), substituted “the applicable formula described in clause (vii)” for “the following formula: (P15)(.5)+2.5, where ‘P’ is the hospital’s disproportionate patient percentage (as defined in clause (vi))”.
Subsec. (d)(5)(F)(iv)(III). , § 6003(c)(2)(A)(ii), inserted “in subclause (IV) or (V) or” after “described”.
Subsec. (d)(5)(F)(iv)(IV) to (VI). , § 6003(c)(2)(A)(i), (iii), (iv), added subcls. (IV) to (VI).
Subsec. (d)(5)(F)(v)(II) to (IV). , § 6003(c)(2)(B), added subcl. (II), redesignated former subcls. (II) and (III) as (III) and (IV), respectively, and substituted “area and is not described in subclause (II)” for “area” in subcl. (IV).
Subsec. (d)(5)(F)(vii). , § 6003(c)(1)(B), added cl. (vii).
Subsec. (d)(5)(F)(viii). , § 6003(c)(2)(C), added cl. (viii).
Subsec. (d)(5)(G). , § 6003(f)(1), added subpar. (G).
Subsec. (d)(5)(H). , § 6003(e)(1)(A)(i), redesignated subpar. (C)(iv) as subpar. (H).
Subsec. (d)(5)(I). , § 6004(a)(2), struck out “(including exceptions and adjustments that may be appropriate with respect to hospitals involved extensively in treatment for and research on cancer)” after “deems appropriate”.
, § 6003(e)(1)(A)(ii), redesignated subpar. (C)(iii) as subpar. (I).
Subsec. (d)(8)(C). , § 6003(h)(3), amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows:
“(i) If the application of subparagraph (B) or a decision of the Medicare Geographic Classification Review Board or the Secretary under paragraph (10),, [sic] by treating hospitals located in a rural county or counties as being located in an urban area, reduces the wage index for that urban area (as applied under this subsection), the Secretary shall calculate and apply such wage index under this subsection separately to hospitals located in such urban area (excluding all the hospitals so treated) and to the hospitals so treated (as if each affected rural county were a separate urban area). If the application of subparagraph (B) or a decision of the Medicare Geographic Classification Review Board or the Secretary under paragraph (10),, [sic] by treating the hospitals located in a rural county or counties as not being located in the rural area in a State, reduces the wage index for that rural area (as applied under this subsection), the Secretary shall calculate and apply such wage index under this subsection as if the hospitals so treated had not been excluded from calculation of the wage index for that rural area.
“(ii) Clause (i) shall only apply to discharges occurring on or after October 1, 1989, and before October 1, 1991.”
Subsec. (d)(8)(C)(i). , § 6003(h)(2), substituted “subparagraph (B) or a decision of the Medicare Geographic Classification Review Board or the Secretary under paragraph (10),” for “subparagraph (B)” in two places.
Subsec. (d)(8)(C)(iv). , § 6003(h)(4), added cl. (iv).
Subsec. (d)(8)(D). , § 6003(h)(2)(B), substituted “(B) and (C) or a decision of the Medicare Geographic Classification Review Board or the Secretary under paragraph (10)” for “(B) and (C)” in three places.
Subsec. (d)(9)(B)(ii)(IV). , § 6003(e)(2)(C), substituted “subparagraph (D)(iii)” for “subparagraph (D)(v)”.
Subsec. (d)(9)(D)(iii). , § 6003(e)(2)(D)(ii), redesignated cl. (v) as (iii). Former cl. (iii) redesignated (iv).
Subsec. (d)(9)(D)(iv). , § 6003(e)(2)(D)(i), (ii), redesignated former cl. (iii) as (iv), substituted “Subparagraph (H)” for “Subparagraph (C)(iii)”, and struck out former cl. (iv) which read as follows: “Subparagraph (E) (relating to payments for costs of certified registered nurse anesthetists).”
Subsec. (d)(9)(D)(v). , § 6003(e)(2)(D)(iii), redesignated cl. (v) as (iii).
Subsec. (d)(10). , § 6003(h)(1), added par. (10).
Subsec. (g)(3)(A)(iv). , § 301(b)(3), (c)(3), amended cl. (iv) identically, substituting “(as the case may be)” for “(as the case may) be”.
Subsec. (g)(3)(A)(v). , § 6002, added cl. (v).
Subsec. (g)(3)(B). , § 6003(e)(2)(E), substituted “subsection (d)(5)(D)(iii)” for “subsection (d)(5)(C)(ii)”.
Subsec. (i). , § 6003(g)(4), added subsec. (i).
1988—Subsec. (b)(3)(B)(i)(III). , § 608(d)(18)(A), substituted “for hospitals” for “for for hospitals” before “located in other urban areas”.
, § 411(b)(1)(A), substituted “for hospitals located in other urban areas” for “other hospitals”.
Subsec. (b)(3)(B)(i)(IV). , § 608(d)(18)(A), substituted “for hospitals” for “for for hospitals” before “located in other urban areas”.
, § 411(b)(1)(A), (B), substituted “percentage points” for “percent” in three places and “for hospitals located in other urban areas” for “other hospitals”.
Subsec. (b)(3)(B)(i)(V). , § 411(b)(1)(C), inserted “increase” after “market basket percentage”.
Subsec. (d)(1)(A)(iii). , § 411(b)(1)(G), substituted “if the average standardized amount (described in clause (i)(I) or clause (ii)(I) of paragraph (3)(D)) for hospitals within the region of, and in the same rural, large urban, or other urban area as, the hospital is greater than the average standardized amount (described in the respective clause) for hospitals within the United States in that type of area” for “if greater”.
Subsec. (d)(2)(C)(i). , § 1018(r)(1), struck out , § 1895(b)(1), (2). Previously, , § 9307(c)(1)(A), struck out , § 1895(b)(1)(A). See 1986 Amendment note below.
Subsec. (d)(2)(C)(iv). , § 8401, substituted “1995” for “1990”.
, § 1018(r)(1), struck out , § 1895(b)(1), (2). Previously, , § 9307(c)(1)(B)(i), as amended by , § 4009(j)(6)(A), struck out , § 1895(b)(2)(A). See 1986 Amendment note below.
Subsec. (d)(2)(D). , § 411(b)(1)(D), substituted “the publications described in subsection (e)(5) of this section” for “the publication described in subsection (e)(5)(B) of this section” in second sentence.
, § 411(b)(1)(H)(i), struck out at end “For purposes of payment under this subsection, a hospital is considered to be located in an urban area or large urban area, respectively, if the hospital is paid under this subsection at the rate for hospitals located in such an area.”
Subsec. (d)(3)(A). , § 1018(r)(1), struck out , § 1895(b)(1), (2). Previously, , § 9307(c)(1)(A), struck out , § 1895(b)(1)(B). See 1986 Amendment note below.
Subsec. (d)(3)(A)(i). , § 411(b)(1)(E)(i), as added by , § 608(d)(18)(B), substituted “occurring” for “occuring” in first sentence.
, § 411(b)(1)(E)(ii), formerly § 411(b)(1)(E), as redesignated by , § 608(d)(18)(B), made technical correction to , § 4002(c)(1)(B)(iii), see 1987 Amendment note below.
Subsec. (d)(3)(A)(ii). , § 411(b)(1)(F), substituted “in other urban areas” for “in urban areas”.
Subsec. (d)(3)(C)(ii). , § 1018(r)(1), struck out , § 1895(b)(1), (2). Previously, , § 9307(c)(1)(A), struck out , § 1895(b)(1)(C). See 1986 Amendment note below.
Subsec. (d)(3)(C)(ii)(I), (II). , § 8401, substituted “1995” for “1990”.
Subsec. (d)(3)(C)(iii). , § 1018(r)(1), struck out , § 1895(b)(1), (2). Previously, , § 9307(c)(1)(B)(i), as amended by , § 4009(j)(6)(A), struck out , § 1895(b)(2)(B). See 1986 Amendment note below.
Subsec. (d)(5)(B)(ii)(I), (II). , § 8401, substituted “1995” for “1990”.
Subsec. (d)(5)(F)(i). , § 8401, substituted “1995” for “1990”.
Subsec. (d)(5)(F)(vi)(I). , § 1018(r)(1), struck out , § 1895(b)(1), (2). See 1986 Amendment note below.
Subsec. (d)(8). , § 411(b)(4)(C)(i), made technical correction to directory language of , § 4005(a)(1)(D), see 1987 Amendment note below.
Subsec. (d)(8)(B). , § 411(b)(4)(A)(i), substituted “For purposes of this subsection, the Secretary” for “The Secretary”.
, § 411(b)(4)(A)(ii), substituted “the rural county would otherwise be considered part of an urban area, under the standards for designating Metropolitan Statistical Areas (and for designating New England County Metropolitan Areas) published in the Federal Register on January 3, 1980, if the commuting rates used in determining outlying counties (or, for New England, similar recognized areas) were determined on the basis of the aggregate number of resident workers who commute to (and, if applicable under the standards, from) the central county or counties of all contiguous Metropolitan Statistical Areas (or New England County Metropolitan Areas).” for “—
“(i) the rural county would otherwise be considered part of an urban area but for the fact that the rural county does not meet the standard relating to the rate of commutation between the rural county and the central county or counties of any adjacent urban area; and
“(ii) either (I) the number of residents of the rural county who commute for employment to the central county or counties of any adjacent urban area is equal to at least 15 percent of the number of residents of the rural county who are employed, or (II) the sum of the number of residents of the rural county who commute for employment to the central county or counties of any adjacent urban area and the number of residents of any adjacent urban area who commute for employment to the rural county is at least equal to 20 percent of the number of residents of the rural county who are employed.”
Subsec. (d)(8)(C). , § 8403(a)(2), added subpar. (C). Former subpar. (C) redesignated (D).
, § 411(b)(4)(B), substituted “standardized amounts” for “standardized amount”.
Subsec. (d)(8)(D). , § 8403(a)(1), redesignated former subpar. (C) as (D) and substituted “subparagraphs (B) and (C)” for “subparagraph (B)” wherever appearing.
Subsec. (d)(9)(C)(iv). , § 411(b)(3), added , § 4004(a)(2), see 1987 Amendment note below.
Subsec. (e)(6)(B). , § 411(b)(8)(B), amended , § 4009(d)(1), see 1987 Amendment note below.
Subsec. (f)(1)(A). , § 411(b)(6)(B), added , § 4007(b)(1)(A), (B), see 1987 Amendment note below.
Subsec. (f)(1)(B). , § 411(b)(6)(B), added , § 4007(b)(1)(C), see 1987 Amendment note below.
Subsec. (g)(3)(A)(ii) to (iv). , § 411(b)(5)(B), made technical amendment to , § 4006(a), see 1987 Amendment note below.
Subsec. (g)(3)(A)(iv). , § 411(b)(5)(A), inserted “for payments attributable” after “15 percent”.
1987—Subsec. (a)(4). , § 4009(j)(1), inserted a comma after “educational activities”.
, § 4006(b)(2)(A), substituted “other capital-related costs (as defined by the Secretary for periods before October 1, 1987)” for “with respect to costs incurred in cost reporting periods beginning prior to October 1 of 1987 (or of such later year as the Secretary may, in his discretion, select), other capital-related costs, as defined by the Secretary”.
Subsec. (b)(3)(B)(i). , § 4002(e)(1), struck out “subparagraph (A) for 12-month cost reporting periods beginning during a fiscal year and for purposes of” after “For purposes of”.
Subsec. (b)(3)(B)(i)(II). , § 4002(a), struck out “and for fiscal year 1988, the market basket percentage increase (as defined in clause (ii)) minus 2.0 percentage points, and” after “1.15 percent,”.
Subsec. (b)(3)(B)(i)(III) to (V). , § 4002(a), added subcls. (III) to (V) and struck out former subcl. (III) which read “for fiscal year 1989 and subsequent fiscal years, the percentage determined by the Secretary pursuant to subsection (e)(4) of this section.”
Subsec. (b)(3)(B)(ii), (iii). , § 4002(e)(2), (3), added cl. (ii), redesignated former cl. (ii) as (iii), and substituted “For purposes of this subparagraph” for “For purposes of clause (i)”.
Subsec. (d)(1)(A)(iii). , § 4002(d), inserted before period at end “, or, if greater for discharges occurring during the period beginning on April 1, 1988, and ending on September 30, 1990, the sum of (I) 85 percent of the national adjusted DRG prospective payment rate determined under paragraph (3) for such discharges, and (II) 15 percent of the regional adjusted DRG prospective payment rate determined under such paragraph”.
Subsec. (d)(2)(C)(iv). , § 4009(j)(6)(A), made technical amendment to , § 9307(c)(1)(B). See 1986 Amendment note below.
, § 4003(c), substituted “1990” for “1989”.
Subsec. (d)(2)(D). , § 4002(f)(1)(A), inserted sentence at end providing that hospital is considered located in urban area or large urban area, respectively, if it is paid under this subsection at rate for hospitals located in such area.
, § 4002(b), in second sentence inserted definition of “large urban area”.
Subsec. (d)(3). , § 4002(c)(1)(A), substituted “large urban, other urban, or rural areas” for “urban or rural areas” in second sentence.
Subsec. (d)(3)(A)(i). , § 4002(c)(1)(B), (C), as amended by , § 411(b)(1)(E)(ii), designated existing provisions as cl. (i), substituted “For discharges occuring [sic] in a fiscal year beginning before October 1, 1987, the Secretary” for “The Secretary” and “the fiscal year involved” for “each of fiscal years 1985, 1986, 1987, and 1988”, struck out “, and adjusted for subsequent fiscal years in accordance with the final determination of the Secretary under subsection (e)(4) of this section, and adjusted to reflect the most recent case-mix data available”, and added cls. (ii) and (iii).
Subsec. (d)(3)(C)(ii). , § 4003(c), substituted “1990” for “1989” in subcls. (I) and (II).
, § 4003(a)(2), inserted “and by section 4003(a)(1) of the Omnibus Budget Reconciliation Act of 1987” after “Amendments of 1985” in subcls. (I) and (II).
Subsec. (d)(3)(C)(iii). , § 4009(j)(6)(A), made technical amendment to , § 9307(c)(1)(B). See 1986 Amendment note below.
Subsec. (d)(3)(D)(i). , § 4002(c)(1)(D), inserted “(or, for discharges occurring on or after April 1, 1988, in a large urban area or other urban area)” after first reference to “urban area”, and in subcl. (I) inserted “such” before “an urban area”.
Subsec. (d)(3)(E). , § 4004(a)(1), formerly § 4004(a), as redesignated by , § 411(b)(3), inserted at end “Not later than October 1, 1990 (and at least every 36 months thereafter), the Secretary shall update the factor under the preceding sentence on the basis of a survey conducted by the Secretary (and updated as appropriate) of the wages and wage-related costs of subsection (d) hospitals in the United States. To the extent determined feasible by the Secretary, such survey shall measure the earnings and paid hours of employment by occupational category and shall exclude data with respect to the wages and wage-related costs incurred in furnishing skilled nursing facility services.”
Subsec. (d)(5)(B)(ii). , § 4003(c), substituted “1990” for “1989” in subcls. (I) and (II).
, § 4003(a)(1), substituted “1.89” for “2” in subcl. (I) and “1.43” for “1.5” in subcl. (II).
Subsec. (d)(5)(C)(i)(I). , § 4005(d)(1)(A), substituted “275” for “500”.
Subsec. (d)(5)(C)(i)(II). , § 4009(j)(2), inserted “index” after “case mix” in two places.
Subsec. (d)(5)(C)(ii). , § 4005(c)(1), substituted “1990” for “1988” in second sentence and inserted after second sentence “A subsection (d) hospital that meets the criteria for classification as a sole community hospital and otherwise qualifies for the adjustment authorized by the preceding sentence may qualify for such an adjustment without regard to the formula by which payments are determined for the hospital under paragraph (1)(A).”
Subsec. (d)(5)(F)(i). , § 4003(c), substituted “1990” for “1989”.
Subsec. (d)(5)(F)(i)(II). , § 4009(j)(3)(A), substituted “such net inpatient care revenues” for second reference to “such revenues”.
Subsec. (d)(5)(F)(iii). , § 4003(b)(1), substituted “25 percent” for “15 percent”.
Subsec. (d)(5)(F)(iv)(I). , § 4009(j)(3)(B), substituted “clause (v)” for “subclause (III)”.
, § 4003(b)(2), struck out “the lesser of 15 percent, or” after “is equal to”.
Subsec. (d)(5)(F)(vi)(I). , § 4009(j)(6)(A), made technical amendment to , § 9307(c)(1)(B)(ii). See 1986 Amendment note below.
Subsec. (d)(8). , § 4005(a)(1), as amended by , § 411(b)(4)(C)(i), designated existing provisions as subpar. (A), redesignated former subpar. (A) and cls. (i) and (ii) as cl. (i) and subcls. (I) and (II), respectively, redesignated former subpar. (B) and cls. (i) and (ii) as cl. (ii) and subcl. (I) and (II), respectively, and added subpars. (B) and (C).
Subsec. (d)(9)(A)(ii). , § 4002(c)(2), substituted “a large urban area,” for “an urban area, and” in subcl. (I), added subcl. (II), and redesignated former subcl. (II) as (III).
Subsec. (d)(9)(B). , § 4009(j)(4), realigned margin of introductory provisions.
Subsec. (d)(9)(C)(iv). , § 4004(a)(2), as added by , § 411(b)(3), inserted at end “The second and third sentences of paragraph (3)(E) shall apply to subsection (d) Puerto Rico hospitals under this clause in the same manner as they apply to subsection (d) hospitals under such paragraph and, for purposes of this clause, any reference in such paragraph to a subsection (d) hospital is deemed a reference to a subsection (d) Puerto Rico hospital.”
Subsec. (e)(3)(B). , § 4002(f)(1)(B), struck out “or determine” after “recommend”.
Subsec. (e)(4). , § 4002(f)(1)(C), substituted “for each fiscal year (beginning with fiscal year 1988)” for “for fiscal year 1988”, struck out “and shall determine for each subsequent fiscal year the percentage change which will apply for purposes of this section as the applicable percentage increase (otherwise described in subsection (b)(3)(B) of this section) for discharges in that fiscal year, and” after “in that fiscal year”, and amended last sentence generally. Prior to amendment, last sentence read as follows: “The percentage change shall be the same for all subsection (d) hospitals and subsection (d) Puerto Rico hospitals, but may be different from that for other hospitals (and units not included as such hospitals) and may vary among such other hospitals and units.”
Subsec. (e)(5). , § 4009(j)(6)(B), amended , § 9302(a)(2)(C). See 1986 Amendment note below.
, § 4002(f)(1)(D), struck out “or determination” after “recommendation” in subpars. (A) and (B).
Subsec. (e)(6)(B). , § 4009(d)(1), as amended by , § 411(b)(8)(B), substituted “include individuals with national recognition for their expertise in health economics, hospital reimbursement, hospital financial management, and other related fields, who provide a mix of different professionals, broad geographic representation, and a balance between urban and rural representatives” for “provide expertise and experience in the provision and financing of health care”, and struck out last sentence which required Director to seek nominations from wide range of groups, including specified types of national organizations.
Subsec. (e)(6)(D). , § 4083(b)(1), inserted at end “For purposes of pay (other than pay of members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the United States Senate.”
Subsec. (f)(1)(A). , § 4007(b)(1)(A), (B), as added by , § 411(b)(6)(B), inserted subpar. (A) designation and struck out “, for a period ending not earlier than September 30, 1988,” after “shall maintain”.
Subsec. (f)(1)(B). , § 4007(b)(1)(C), as added by , § 411(b)(6)(B), added subpar. (B).
Subsec. (f)(3). amended par. (3) generally. Prior to amendment, par. (3) read as follows: “The provisions of paragraphs (2), (3), and (4) of section
of this title shall apply to determinations under paragraph (2) of this subsection in the same manner as they apply to determinations made under section
of this title.”
Subsec. (g)(1). , § 4006(b)(1), amended par. (1) generally. Prior to amendment, par. (1) read as follows: “If the Congress does not enact legislation, after April 20, 1983, and before October 1, 1987, respecting the payment under this subchapter for capital-related costs for inpatient hospital services, no payment may be made under this subchapter for capital-related costs of capital expenditures (as defined in section
of this title and except as provided in section
of this title) for inpatient hospital services in a State, which expenditures are obligated after September 30, 1987, unless the State has an agreement with the Secretary under section
of this title and under the agreement the State has recommended approval of the capital expenditures.”
Subsec. (g)(3)(A)(ii) to (iv). , § 4006(a), as amended by , § 411(b)(5)(B), substituted “on or after October 1, 1987, and before January 1, 1988,” for “, and”, at end of cl. (ii), added cls. (iii) and (iv), and struck out former cl. (iii) which read as follows: “10 percent for payments attributable to portions of cost reporting periods or discharges (as the case may be) occurring during fiscal year 1989.”
Subsec. (g)(3)(C). , § 4006(b)(2)(B), struck out subpar. (C) which read as follows: “If the Secretary provides, under subsection (a)(4) of this section, for the inclusion of other capital-related costs in operating costs of inpatient hospital services, the Secretary shall provide—
“(i) notwithstanding any other provision of this subchapter, for the continuation of payment under the reasonable cost methodology described in section
of this title with respect to capital-related costs of any hospital that is such a sole community hospital for cost reporting periods beginning before October 1, 1990, and
“(ii) in the design of such payment system that the aggregate payment amounts under this subchapter for such other capital-related costs for payments attributable to portions of cost reporting periods occurring during fiscal year 1988 and fiscal year 1989 shall approximate the aggregate payment amount under this subchapter that would have been made (taking into account the provisions of subparagraphs (A) and (B)) during that fiscal year but for the inclusion of such costs by the Secretary.”
Subsec. (h)(4)(C). , § 4009(j)(5), substituted “subparagraph (D)” for “subparagraph (E)”.
1986—Subsec. (a)(4). , § 9320(g)(1), struck out “, costs of anesthesia services provided by a certified registered nurse anesthetist,” after “approved educational activities”.
, § 9303(c), substituted “October 1 of 1987 (or of such later year as the Secretary may, in his discretion, select)” for “October 1, 1987”.
substituted “1987” for “1986”.
, § 9107(a)(2), inserted “a return on equity capital,” after “anesthetist,” and “other” before “capital-related costs”.
Subsec. (b)(3)(B). , § 9101(b), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “For purposes of subparagraph (A) and subsection (d) of this section and except as provided in subsection (e) of this section, the ‘applicable percentage increase’ for any 12-month cost reporting period or fiscal year shall be equal to one-quarter of 1 percentage point plus the percentage, estimated by the Secretary before the beginning of the period or year, by which the cost of the mix of goods and services (including personnel costs but excluding non-operating costs) comprising routine, ancillary, and special care unit inpatient hospital services, based on an index of appropriately weighted indicators of changes in wages and prices which are representative of the mix of goods and services included in such inpatient hospital services, for such cost reporting period or fiscal year will exceed the cost of such mix of goods and services for the preceding 12-month cost reporting period or fiscal year. In determining a percentage change under subsection (e)(4) of this section with respect to discharges occurring in any cost reporting period or fiscal year beginning on or after October 1, 1985, and before October 1, 1986, the Secretary may not establish a percentage increase which exceeds the applicable percentage increase otherwise determined for that period or fiscal year under the preceding sentence.”
Subsec. (b)(3)(B)(i)(II). , § 9302(a)(1), amended subcl. (II) generally. Prior to amendment, subcl. (II) read as follows: “for fiscal years 1987 and 1988, a percentage determined by the Secretary pursuant to subsection (e)(4) of this section, but not to exceed the market basket percentage increase (as defined in clause (ii)), and”.
Subsec. (b)(6). , § 2, substituted “Internal Revenue Code of 1986” for “Internal Revenue Code of 1954”.
Subsec. (c)(7). , § 9109(a), added par. (7).
Subsec. (d)(1)(A). , § 9102(a), substituted “1987” for “1986” in cls. (ii) and (iii).
Subsec. (d)(1)(C). , § 9102(b), struck out “, or discharges occurring” after “periods beginning” in introductory provision, and “and” after “percent;” in cl. (ii), added cl. (iii), redesignated former cl. (iii) as (iv), and in cl. (iv) substituted “on or after October 1, 1986, and before October 1, 1987” for “on or after October 1, 1985, and before October 1, 1986”.
Subsec. (d)(1)(D). , § 9102(c), struck out “cost reporting periods beginning, or” before “discharges occurring” in introductory provision, in cl. (i) substituted “1986” for “1985”, and in cl. (ii) substituted “1986” and “1987” for “1985” and “1986”, respectively.
Subsec. (d)(2)(C)(i). , § 9307(c)(1)(A), struck out , § 1895(b)(1)(A), which had directed the striking out of “(taking into account, for discharges occurring after September 30, 1986, the amendments made by section 9104(a) of the Medicare and Medicaid Budget Reconciliation Amendments of 1985)” after “medical education costs”.
, § 9104(b)(1), inserted “(taking into account, for discharges occurring after September 30, 1986, the amendments made by section 9104(a) of the Medicare and Medicaid Budget Reconciliation Amendments of 1985)” after “medical education costs”.
Subsec. (d)(2)(C)(iv). , § 9306(c), substituted “1989” for “1988”.
, § 9307(c)(1)(B)(i), as amended by , § 4009(j)(6)(A), struck out , § 1895(b)(2)(A), which had directed that cl. (iv) was to be struck out.
, § 9105(b), added cl. (iv).
Subsec. (d)(3)(A). , § 9302(a)(2)(A), (c), substituted “1986, 1987, and 1988” for “and 1986” and inserted provisions relating to the computation of urban and rural averages with respect to discharges occurring on or after October 1, 1987.
, § 9307(c)(1)(A), struck out , § 1895(b)(1)(B), which had directed insertion of “If the formula under paragraph (5)(B) for determining payments for the indirect costs of medical education is changed for any fiscal year, the Secretary shall readjust the standardized amounts previously determined for each hospital to take into account the changes in that formula.”
, § 9101(c)(1), substituted “for each of fiscal years 1985 and 1986” for “for fiscal year 1985”.
Subsec. (d)(3)(B). , § 9302(b)(1), inserted “for hospitals located in an urban area and for hospitals located in a rural area” after “subparagraph (A)”, and inserted before the period “for hospitals located in such respective area”.
Subsec. (d)(3)(C). , § 9104(b)(2), designated existing provision as cl. (i), substituted “For discharges occurring in fiscal year 1985, the Secretary” for “The Secretary”, and added cl. (ii).
Subsec. (d)(3)(C)(ii). , § 9306(c), substituted “1989” for “1988” in subcls. (I) and (II).
, § 9307(c)(1)(A), struck out , § 1895(b)(1)(C), which had directed a general amendment of cl. (ii) to read as follows: “The Secretary shall further reduce each of the average standardized amounts by a proportion equal to the proportion (estimated by the Secretary) of the amount of payments under this subsection based on DRG prospective payment amounts which is the difference between—
“(I) the sum of the additional payment amounts under paragraph (5)(B) (relating to indirect costs of medical education) if the indirect teaching adjustment factor were equal to 1.159r (as ‘r’ is defined in paragraph (5)(B)(ii)), and
“(II) that sum using the factor specified in paragraph (5)(B)(ii)(II).”
Subsec. (d)(3)(C)(iii). , § 9307(c)(1)(B)(i), as amended by , § 4009(j)(6)(A), struck out , § 1895(b)(2)(B), which had added cl. (iii) reading as follows: “The Secretary shall further reduce each of the average standardized amounts by reducing the standardized amount for each hospital (as previously determined without regard to this clause) by a proportion equal to the proportion (established by the Secretary) of the amount of payments under this subsection based on DRG prospective payment amounts which are additional payments described in paragraph (5)(F) (relating to disproportionate share payments) for subsection (d) hospitals.”
Subsec. (d)(3)(D)(i)(I), (ii)(I). , § 9104(b)(3), inserted “or reduced” after “(B), and adjusted”.
Subsec. (d)(4)(C). , § 9302(e)(1), substituted “in fiscal year 1988 and at least annually” for “in fiscal year 1986 and at least every four fiscal years”.
Subsec. (d)(5)(B). , § 9104(a), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “The Secretary shall provide for an additional payment amount for subsection (d) hospitals with indirect costs of medical education, in an amount computed in the same manner as the adjustment for such costs under regulations (in effect as of January 1, 1983) under subsection (a)(2) of this section, except that in the computation under this subparagraph the Secretary shall use an educational adjustment factor equal to twice the factor provided under such regulations. In determining such adjustment the Secretary shall not distinguish between those interns and residents who are employees of a hospital and those interns and residents who furnish services to a hospital but are not employees of such hospital.”
Subsec. (d)(5)(B)(ii). , § 9306(c), substituted “1989” for “1988” in subcls. (I) and (II).
Subsec. (d)(5)(C)(i). , § 9302(d)(1)(A), designated existing provisions as subcl. (I) and added subcl. (II).
, § 9106(a), inserted “and which shall not require a rural osteopathic hospital to have more than 3,000 discharges in a year in order to be classified as a rural referral center” before the period in second sentence.
, § 9105(c), struck out “, and of public or other hospitals that serve a significantly disproportionate number of patients who have low income or are entitled to benefits under part A of this subchapter” after “in rural areas)”.
Subsec. (d)(5)(C)(i)(I). , § 9304(b)(1), inserted “(other than under paragraph (9))” after “established under this subsection” in first sentence.
Subsec. (d)(5)(C)(ii). , § 9304(b)(2), inserted “(other than under paragraph (9))” after “this subsection” in second and third sentences.
, § 9302(e)(4), substituted “1988” for “1986”.
, § 9111(a), inserted provision authorizing the Secretary to adjust amount of payments to sole community hospitals that realize a significant increase in operating costs in a cost reporting period attributable to addition of new inpatient facilities or services.
Subsec. (d)(5)(E). , § 9320(g)(2), struck out subpar. (E) which read as follows: “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.”
Subsec. (d)(5)(F). , § 9105(a), added subpar. (F).
Subsec. (d)(5)(F)(i). , § 9306(c), substituted “1989” for “1988”.
Subsec. (d)(5)(F)(iv)(I). , § 9306(b)(1), inserted “or is described in the second sentence of subclause (III)” after “100 or more beds”.
Subsec. (d)(5)(F)(iv)(III). , § 9306(b)(2), inserted “and is not described in the second sentence of clause (v)” after “rural area”.
Subsec. (d)(5)(F)(v). , § 9306(a), inserted at end “A hospital located in a rural area and with 500 or more beds also ‘serves a significantly disproportionate number of low income patients’ for a cost reporting period if the hospital has a disproportionate patient percentage (as defined in clause (vi)) for that period which equals or exceeds a percentage specified by the Secretary.”
Subsec. (d)(5)(F)(vi)(I). , § 1895(b)(2)(A), formerly § 1895(b)(2)(C), as amended by , § 9307(c)(1)(B)(ii), as amended by , § 4009(j)(6)(A), which directed the substitution of “supplemental” for “supplementary” and “period” for “fiscal year”, was repealed by , § 1018(r)(1).
Subsec. (d)(9). , § 9304(a), added par. (9).
Subsec. (e)(1)(C). , § 9304(c), added subpar. (C).
Subsec. (e)(3). , § 9302(e)(3), designated existing provisions as subpar. (A) and added subpar. (B).
, § 9101(c)(2), struck out “(instead of the applicable percentage increase described in subsection (b)(3)(B) of this section)” after “should be used”.
Subsec. (e)(3)(A). , § 9321(e)(2)(A), substituted “March” for “April”.
Subsec. (e)(4). , § 9302(a)(2)(B), (e)(2), substituted “recommend for fiscal year 1988 an appropriate change factor for inpatient hospital services for discharges in that fiscal year and shall determine for each subsequent fiscal year” for “determine for each fiscal year (beginning with fiscal year 1987) and inserted at end “The percentage change shall be the same for all subsection (d) hospitals and subsection (d) Puerto Rico hospitals, but may be different from that for other hospitals (and units not included as such hospitals) and may vary among such other hospitals and units.”
, § 9101(c)(3), substituted “fiscal year 1987” for “fiscal year 1986”.
Subsec. (e)(5). , § 9302(a)(2)(C), as amended by , § 4009(j)(6)(B), inserted “recommendation or” before “determination” in subpars. (A) and (B).
Subsec. (e)(5)(A). , § 9321(e)(2)(B), substituted “May” for “June”.
Subsec. (e)(6)(A). , § 9127(a), substituted “17 individuals” for “15 individuals”.
Subsec. (g)(1). substituted “1987” for “1986” in two places.
Subsec. (g)(2). , § 9107(a)(1), designated existing provision as subpar. (A), inserted “the applicable percentage (described in subparagraph (B)) of”, and added subpar. (B).
Subsec. (g)(2)(B). , § 1895(b)(3), realigned margins of subpar. (B).
Subsec. (g)(3). , § 9303(a), added par. (3).
Subsec. (g)(3)(A). , § 9303(b), inserted “and a subsection (d) Puerto Rico hospital” after “subsection (d) hospital”.
Subsec. (h). , § 9202(a), added subsec. (h).
Subsec. (h)(2)(C). , § 1895(b)(9)(A), substituted “subparagraph (B)” for “paragraph (B)”.
Subsec. (h)(4)(D). , § 1895(b)(9)(B), (C), redesignated subpar. (E) as (D) and in cl. (ii) inserted “but before July 1, 1987,”.
Subsec. (h)(4)(E). , § 9314(a), added subpar. (E).
, § 1895(b)(9)(C), redesignated former subpar. (E) as (D).
Subsec. (h)(5)(B). , § 1895(b)(9)(D), substituted “The” for “As used in this paragraph, the”.
1984—Subsec. (a)(2)(B). , § 2354(b)(42), substituted “disproportionate” for “disportionate”.
Subsec. (a)(4). , § 2312(b), temporarily inserted “, costs of anesthesia services provided by a certified registered nurse anesthetist” after “approved educational activities”. See Effective and Termination Dates of 1984 Amendments note below.
Subsec. (b)(3)(A)(ii). , § 2354(b)(43), inserted “of” after “in the case”.
Subsec. (b)(3)(B). , § 2310(a), substituted “one-quarter of 1 percentage point” for “1 percentage point” and inserted provision that in determining the percentage change under subsec. (e) of this section with respect to discharges occurring in any cost reporting period or fiscal year beginning on or after Oct. 1, 1985, and before Oct. 1, 1986, the Secretary may not establish a percentage increase which exceeds the applicable percentage increase otherwise determined for that period or fiscal year under the preceding sentence.
Subsec. (c)(4)(A). , § 2315(a), substituted “(D), and (E)” for “and (D)”.
Subsec. (d)(2)(D). , § 2315(b), struck out “Standard” before “Metropolitan” in provision following cl. (ii).
, § 2311(b), inserted provision for determining the region a hospital located in a Metropolitan Statistical Area would be deemed to be located.
Subsec. (d)(3)(D)(i)(I). , § 2354(b)(44), substituted “(C))” for “(C),”.
Subsec. (d)(5)(B). , § 2307(b)(1), inserted provision that in determining such adjustment the Secretary not distinguish between those interns and residents who are employees of a hospital and those who furnish services to a hospital but are not employees of such hospital.
Subsec. (d)(5)(C)(i). substituted “August 17, 1984” for “30 days after July 18, 1984” before “for implementation by”.
, § 2311(a), inserted provisions permitting a hospital classified as a rural hospital to appeal to the Secretary for reclassification as a rural referral center on the basis of criteria established and published by the Secretary and requiring the Secretary to make a final determination with respect to such appeal within 60 days after the date the appeal was submitted.
Subsec. (d)(5)(E). , § 2312(a), temporarily added subpar. (E). See Effective and Termination Dates of 1984 Amendments note below.
Subsec. (d)(8). , § 2311(c), added par. (8).
Subsec. (e)(2). , § 2313(a), inserted “(without regard to the provisions of title 5 governing appointments in the competitive service)” after “appointed by the Director”.
Subsec. (e)(5). , § 2315(c)(1), struck out “for public comment” after “have published” in provisions preceding subpar. (A).
Subsec. (e)(5)(A). , § 2315(c)(2), inserted “for public comment” after “that fiscal year”.
Subsec. (e)(6)(C). , § 2313(b)(3), inserted provision that section 10(a)(1) of the Federal Advisory Committee Act not apply to any portion of a Commission meeting if the Commission, by majority vote, determines such portion of such meeting should be closed.
Subsec. (e)(6)(C)(i). , § 2313(b)(1), amended cl. (i) generally, substituting provision authorizing the Commission to employ and fix the compensation of an Executive Director, subject to the approval of the Director of the Office, and such other personnel, not to exceed 25, as necessary, without regard to the provisions of title 5 governing appointment in the competitive service, for provision authorizing the Commission to employ and fix the compensation of such personnel, not to exceed 25, as may be necessary to carry out its duties.
Subsec. (e)(6)(C)(iii). , § 2313(b)(2), inserted “(without regard to section
of title
)” after “Commission”.
Subsec. (e)(6)(D). , § 2313(b)(4), inserted provision relating to payment of physician comparability allowance in the same manner as provided under section
of title
and providing that for such purpose subsec. (i) of such section apply to the Commission in the same manner as it applies to the Tennessee Valley Authority.
Subsec. (e)(6)(J). , § 2313(d), added subpar. (J).
1983—Subsec. (a)(1)(D). , § 601(a)(1), added subpar. (D).
Subsec. (a)(4). , § 601(a)(2), inserted provision that term “operating costs of inpatient hospital services” does not include costs of approved educational activities, or, with respect to costs incurred in cost reporting periods beginning prior to Oct. 1, 1986, capital-related costs, as defined by the Secretary.
, § 309(b)(13), substituted “as such costs are determined” for “and such costs are determined”.
Subsec. (b)(1). , § 601(b)(1), (2), in provisions preceding subpar. (A), substituted “Notwithstanding section
of this title but subject to the provisions of section
of this title” for “Notwithstanding sections
of this title, but subject to the provisions of sections
of this title” and inserted “(other than a subsection (d) hospital, as defined in subsection (d)(1)(B) of this section)”.
, § 601(b)(3), inserted “(other than on the basis of a DRG prospective payment rate determined under subsection (d) of this section)” in provisions following subpar. (B).
, § 309(b)(14), substituted “section
” for “sections
” in provisions preceding subpar. (A).
Subsec. (b)(2). , § 601(b)(4), struck out par. (2) which provided that par. (1) would not apply to cost reporting periods of hospitals beginning on or after Oct. 1, 1985.
Subsec. (b)(3)(B). , § 601(b)(5)–(8), inserted “and subsection (d) of this section and except as provided in subsection (e) of this section” after “subparagraph (A)”, inserted “or fiscal year” after “cost reporting period” each place it appears, inserted “before the beginning of the period or year” after “estimated by the Secretary”, and substituted “will exceed” for “exceeds”.
Subsec. (b)(6). , § 601(b)(9), added par. (6) and repealed a prior par. (6) which directed the Secretary to provide for an adjustment under this paragraph in the amount of payment otherwise provided a hospital under this subsection in the case of a hospital which, as of Aug. 15, 1982, was subject to FICA taxes and which was not subject to such taxes for part or all of a cost reporting period beginning on or after Oct. 1, 1982, that in making such adjustment for a cost reporting period the Secretary was to estimate the amount of the operating costs of inpatient hospital services that would have resulted if the hospital was subject to the FICA taxes during that period, that in making such estimate the Secretary was to reduce the amount of such FICA taxes that would have been paid (but not below zero) by the amount of costs which the hospital demonstrated to the satisfaction of the Secretary were incurred in the period for pensions, health, and other fringe benefits for employees (and former employees and family members) comparable to, and in lieu of, the benefits provided under subchapter II of this chapter and this subchapter, that if a hospital’s operating costs of inpatient hospital services estimated under subparagraph (B) was greater than the hospital’s operating costs of inpatient hospital services determined without regard to this paragraph for a cost reporting period, then the Secretary was to reduce the amount otherwise paid the hospital (respecting operating costs of inpatient hospital services) under this title (taking into account any limitation under subsection (a) of this section) for the period by the amount by which (i) the amount that would have been paid the hospital if (I) the amount of the operating costs of inpatient hospital services estimated under subparagraph (B) were treated as the amount of the operating costs of inpatient hospital services and (II) subsection (a) of this section did not apply to the determination, exceeded (ii) the amount that would otherwise have been paid the hospital if subsection (a) of this section (and this paragraph) did not apply, except that, in making such determination for cost reporting periods beginning on or after Oct. 1, 1984, clause (ii) of paragraph (1)(B) was to continue to apply.
Subsec. (b)(6)(C). , § 309(b)(15), substituted “under this subchapter (taking into account any limitation under subsection (a) of this section)” for “under this subsection” in provisions preceding cl. (i).
Subsec. (c)(1). , § 601(c)(1), added subpars. (D) and (E) and provisions following subpar. (E).
Subsec. (c)(3)(A). , § 601(c)(2)(A), substituted “meets the requirements of subparagraphs (A), (D), and (E) of paragraph (1) and, if applicable, the requirements of paragraph (5),” for “meets the requirement of paragraph (1)(A)”.
Subsec. (c)(3)(B). , § 601(c)(2)(B), inserted “(or, if applicable, in paragraph (5))”.
Subsec. (c)(4) to (6). , § 601(c)(3), added pars. (4) to (6).
Subsec. (d). , § 601(d)(2), (e), added subsec. (d) and redesignated former subsec. (d), relating to the elimination of lesser-of-cost-or-charges provisions, as subsec. (j) of section
of act Aug. 14, 1935, which is classified to subsec. (j) of section
of this title.
Subsecs. (e) to (g). , § 601(e), added subsecs. (e) to (g).
1982—Subsec. (d). , § 110, added subsec. (d).
Effective Date of 2000 Amendment
, § 1(a)(6) [title II, § 212(b)], Dec. 21, 2000, , 2763A–485, provided that: “The amendment made by this section [amending this section] shall apply with respect to cost reporting periods beginning on or after April 1, 2001.”
, § 1(a)(6) [title II, § 213(b)], Dec. 21, 2000, , 2763A–486, provided that: “The amendments made by this section [amending this section] shall take effect as if included in the enactment of section 405 of BBRA [, § 1000(a)(6) [title IV, § 405]] (A–372).”
, § 1(a)(6) [title III, § 301(e)(2)], Dec. 21, 2000, , 2763A–492, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to discharges occurring on or after October 1, 2001.”
, § 1(a)(6) [title III, § 303(d)(2)], Dec. 21, 2000, , 2763A–494, provided that: “The amendment made by paragraph (1) [amending this section] is effective as if included in the enactment of BBA [].”
, § 1(a)(6) [title III, § 305(c)], Dec. 21, 2000, , 2763A–496, provided that: “The amendments made by this section [amending this section] take effect as if included in the enactment of BBA [].”
, § 1(a)(6) [title V, § 512(b)], Dec. 21, 2000, , 2763A–534, provided that: “The amendment made by subsection (a) [amending this section] shall apply to portions of cost reporting periods occurring on or after January 1, 2001.”
Effective Date of 1999 Amendment
, div. B, § 1000(a)(6) [title I, § 121(b)], Nov. 29, 1999, , 1501A–330, provided that: “The amendments made by subsection (a) [amending this section] apply to cost reporting periods beginning on or after October 1, 1999.”
, div. B, § 1000(a)(6) [title I, § 125(c)], Nov. 29, 1999, , 1501A–333, provided that: “The amendments made by subsection (a) [amending this section] are effective as if included in the enactment of section 4421(a) of BBA [the Balanced Budget Act of 1997, ].”
, div. B, § 1000(a)(6) [title III, § 312(b)], Nov. 29, 1999, , 1501A–365, provided that: “The amendments made by subsection (a) [amending this section] apply on and after July 1, 2000, to residency programs that began before, on, or after the date of the enactment of this Act [Nov. 29, 1999].”
Amendment by section
1000
(a)(6) [title III, § 321(b), (e), (f), (h), (k)(15)–(17)] of effective as if included in the enactment of the Balanced Budget Act of 1997, , except as otherwise provided, see section
1000
(a)(6) [title III, § 321(m)] of , set out as a note under section
of this title.
Amendment by section
1000
(a)(6) [title IV, § 401(a)] of effective Jan. 1, 2000, see section
1000
(a)(6) [title IV, § 401(c)] of , set out as a note under section
of this title.
, div. B, § 1000(a)(6) [title IV, § 402(b)], Nov. 29, 1999, , 1501A–370, provided that: “The amendments made by subsection (a) [amending this section] apply with respect to discharges occurring during cost reporting periods beginning on or after October 1, 1999.”
, div. B, § 1000(a)(6) [title IV, § 407(a)(3)], Nov. 29, 1999, , 1501A–373, provided that:
“(A) DGME.—The amendments made by paragraph (1) [amending this section] apply to cost reporting periods that begin on or after the date of the enactment of this Act [Nov. 29, 1999].
“(B) IME.—The amendment made by paragraph (2) [amending this section] applies to discharges occurring in cost reporting periods that begin on or after such date of enactment.”
, div. B, § 1000(a)(6) [title IV, § 407(b)(3)], Nov. 29, 1999, , 1501A–374, provided that:
“(A) DGME.—The amendment made by paragraph (1) [amending this section] applies to cost reporting periods beginning on or after April 1, 2000.
“(B) IME.—The amendment made by paragraph (2) [amending this section] applies to discharges occurring on or after April 1, 2000.”
, div. B, § 1000(a)(6) [title IV, § 407(c)(2)], Nov. 29, 1999, , 1501A–374, provided that: “The amendment made by paragraph (1) [amending this section] applies with respect to—
“(A) payments to hospitals under section 1886(h) of the Social Security Act ( U.S.C.
) for cost reporting periods beginning on or after April 1, 2000; and
“(B) payments to hospitals under section 1886(d)(5)(B)(v) of such Act ( U.S.C.
) for discharges occurring on or after April 1, 2000.”
Effective Date of 1997 Amendment
Amendment by se