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PUBLIC LAW 99-509—OCT. 21, 1986 I-. * "
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100 STAT. 1983
(A) the proportions under paragraph (3)(B) for hospitals located in urban and rural areas shall be established at such levels as produce the same total dollar reduction under such paragraph as if this section had not been enacted; and (B) the thresholds and standards used for making additional payments under paragraph (5) of such section shall be the same as those in effect as of October 1, 1986.
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(c) COMPUTING URBAN AND RURAL AVERAGES.—Section 42 USC I395ww 1886(d)(3)(A) of such Act is amended by adding at the end the p..^,.,^.. following: "With respect to discharges occurring on or after Octo"^ "^'^ "' " ber 1, 1987, the Secretary shall compute urban and rural averages on the basis of discharge weighting rather than hospital weighting, -,,,. ^.j making appropriate adjustments to ensure that computation on such basis does not result in total payments under this section that are greater or less than the total payments that would have been made under this section but for this sentence, and making appropriate changes in the manner of determining the reductions under subparagraph (C)(ii),". (d) REGIONAL REFERRAL CENTERS.— (1) CRITERIA.—
(A) IN GENERAL.—Section 1886(d)(5)(C)(i) of such Act is \.,. amended— (i) by inserting "(I)" after "(C)(i)", and (ii) by adding at the end the following new subclause: "(II) The Secretary shall provide, under subclause (I), for the classification of a rural hospital as a regional referral center if the hospital has a case mix equal to or greater than the median case mix for hospitals (other than hospitals with approved teaching,, j.- ? programs) located in an urban area in the same region (as defined in paragraph (2)(D)), has at least 5,000 discharges a year or, if less, the median number of discharges in urban hospitals in the region in which the hospital is located (or, in the case of a rural osteopathic >y'>M hospital, meets the criterion established by the Secretary under subclause (I) with respect to the annual number of discharges for such hospitals), and meets any other criteria established by the Secretary under subclause (I).". -. * (B) EFFECTIVE DATE.—(i) Subject to clause (ii), the amend- 42 USC 1395WW ments made by subparagraph (A) shall apply to payments note. '11 for discharges occurring on or after October 1, 1986. (ii) An appeal for classification of a rural hospital as a regional referral center, pursuant to the amendments made by subparagraph (A), which is filed before January 1, 1987, and which is approved shall be effective with respect to discharges occurring on or after October 1, 1986. '[
(2) EXTENSION OF REGIONAL REFERRAL CENTER CLASSIFICA- 42 USC 1395WW TiON.—Any hospital that is classified as a regional referral note.
center under section 1886(d)(5)(C)(i) of the Social Security Act on the date of the enactment of this Act shall continue to be classified as a regional referral center for cost reporting periods beginning on or after October 1, 1986, and before October 1, 1989. f
(3) BUDGET-NEUTRAL IMPLEMENTATION.—Paragraph (2) and
the 42 USC 1395WW in note.
amendment made by paragraph (I)(A) shall be implemented a manner that ensures that total payments under section 1886 of the Social Security Act are not increased or decreased by
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