101 STAT. 1330-48
PUBLIC LAW 100-203—DEC. 22, 1987
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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 /f 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 ,1 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. "(C) The Secretary shall make a proportional adjustment in the standardized amount determined under paragraph (3) for hospitals located in an urban area to assure that the provisions of subparagraph (B) do not result in aggregate payments under this section that are greater or less than those that would otherwise be made. 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 subparagraph (B) are not changed as a result of the application of subparagraph (B).". (2) LOCATION OF HOSPITAL.—For purposes of section 1886 of the Social Security Act, Watertown Memorial Hospital in Watertown, Wisconsin is deemed to be located in Jefferson County, Wisconsin. 42 USC 1395WW (3) EFFECTIVE DATE.—This section, and the amendments made note. by paragraph (1), shall apply to discharges occurring on or after October 1, 1988. (b) EXPANSION OF SWING-BED PROGRAM.— (1) EXPANSION TO HOSPITALS WITH FEWER THAN lOO BEDS.—
Section 1883(b)(1) of the Social Security Act (42 U.S.C. 1395tt(b)(l)) is amended by striking "50 beds" and inserting "100 beds". (2) REQUIREMENTS FOR HOSPITALS WITH MORE THAN 49 BEDS.—
42 USC 1395tt.
Regulations.
Section 1883(d) of such Act (42 U.S.C. 1395dd(d)) is amended— (A) by inserting "(1)" after "(d)", and (B) by adding at the end the following new paragraphs: "(2)(A) Any agreement under this section with a hospital with more than 49 beds shall provide that no payment may be made for extended care services which are furnished to an extended care patient after the end of the 5-day period (excluding weekends and holidays) beginning on an availability date for a skilled nursing facility, unless the patient's physician certifies, within such 5-day period, that the transfer of that patient to that facility is not medically appropriate on the availability date. The Secretary shall prescribe regulations to provide for notice by skilled nursing facilities of availability dates to hospitals which have agreements under this section and which are located within the same geographic region (as defined by the Secretary). "(B) In this paragraph: "(i) The term 'availability date' means, with respect to an extended care patient at a hospital, any date on which a bed is available for the patient in a skilled nursing facility located ,.!; within the geographic region in which the hospital is located.
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