•.*g^^ PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-37 (ii) by striking the period at the end and inserting the following: ", together with its general recommendations under paragraph (2)(B) regarding the effectiveness and quality of health care delivery systems in the United States."; (D) in subsection (e)(4)— (i) by striking "(4)" and inserting "(4)(A)", and (ii) by adding at the end the following new subparagraph: "(B) In addition to the recommendation made under subparagraph (A), the Secretary shall, taking into consideration the recommendations of the Commission under paragraph (2)(B), recommend for each fiscal year (beginning with fiscal year 1992) other appropriate changes in each existing reimbursement policy under this title under which payments to an institution are based upon prospectively determined rates."; (E) in subsection (e)(5)— (i) by striking "recommendation" each place it appears and inserting "recommendations", and (ii) by adding at the end the following new sentence: "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."; and (F) in subsection (e)(6)(G)— (i) by striking clause (i), and (ii) by redesignating clauses (ii) and (iii) as clauses (i) and (ii). (3) CONFORMING AMENDMENT.—Section 1845(c)(l)(D) (42 U.S.C. 1395w-l(c)(l)(D)) is amended by striking "reports and". (4) PROP AC STUDY OF MEDICAID PAYMENTS TO HOSPITALS. — (A) STUDY.— The Prospective Payment Assessment Commission shall conduct a study of hospital payment rates under State plans for medical assistance under title XIX of the Social Security Act, and shall specifically examine in such study the relationship between payments under such plans and payments made to hospitals under title XVIII of such Act, and the financial condition of hospitals receiving payments under such plans, with particular attention to hospitals in urban areas which treat large numbers of individuals eligible for medical assistance under title XIX of such Act and other low-income individuals. (B) REPORT. —By not later than October 1, 1991, the Commission shall submit a report to Congress on the study conducted under subparagraph (A) and shall include in such report such recommendations relating to requirements for payments to hospitals under title XIX of such Act as the Commission deems appropriate. (5) EFFECTIVE DATE. — The amendments made by this subsec- 42 USC 1395ww tion shall take effect on the date of the enactment of this Act. note. (h) PROVISIONS RELATING TO GEOGRAPHIC CLASSIFICATION OF HOS- PITALS.— (1) PAYMENTS TO RECLASSIFIED HOSPITALS. — (A) IN GENERAL.—Section 1886(d)(8)(C) (42 U.S.C. 1395ww(d)(8)(C)) is amended—
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