104 STAT. 1388-52 PUBLIC LAW 101-508—NOV. 5, 1990 42 USC I395tt (3) SWING BEDS CERTIFIED PRIOR TO MAY 1, 1987.—Notwithnote. standing the requirement of section 1883(b)(l) of the Social Security Act that the Secretary may not enter into an sigreement under such section with a hospital that is not located in a rural area, any agreement entered into under such section on or before May 1, 1987, between the Secretary of Health and Human Services and a hospital located in an urban area shall remain in effect. 42 USC 1395tt (4) EFFECTIVE DATE. — The amendment made by paragraph (1) "°^- shall apply to services furnished on or after October 1, 1990. 42 USC 1395yy (k) PROSPECTIVE PAYMENT SYSTEM FOR SKILLED NuRSING FACILITY "°*«- SERVICES. — (1) DEVELOPMENT OF PROPOSAL. — The Secretary of Health and Human Services shall develop a proposal to modify the current system under which skilled nursing facilities receive payment for extended care services under part A of the medicare program or a proposal to replace such system with a system under which such payments would be made on the basis of prospectively determined rates. In developing any proposal under this paragraph to replace the current system with a prospective payment system, the Secretary shall— (A) take into consideration the need to provide for appropriate limits on increases in expenditures under the medicare program without jeopardizing access to extended care services for individuals unable to care for themselves; (B) provide for adjustments to prospectively determined rates to account for changes in a facility's case mix, volume of cases, and the development of new technologies and standards of medical practice; (C) take into consideration the need to increase the pay- ment otherwise made under such system in the case of services provided to patients whose length of stay or costs of treatment greatly exceed the length of stay or cost of treatment provided for under the applicable prospectively determined payment rate; (D) take into consideration the need to adjust payments under the system to take into account factors such as a disproportionate share of low-income patients, differences in wages and wage-related costs among facilities located in various geographic areas, and other factors the Secretary considers appropriate; and (E) take into consideration the appropriateness of classifying patients and payments upon functional disability, cognitive impairment, and other patient characteristics. (2) REPORTS. — (A) By not later than April 1, 1991, the Secretary (acting through the Administrator of the Health Care Financing Administration) shall submit any research studies to be used in developing the proposal under paragraph (1) to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. (B) By not later than September 1, 1991, the Secretary shall suljmit the proposal developed under paragraph (1) to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. (C) By not later than March 1, 1992, the Prospective Payment Assessment Commission shall submit an analysis of and comments on the proposal developed under paragraph (1) to the
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