103 STAT. 2220 PUBLIC LAW 101-239—DEC. 19, 1989 (C) in paragraph (5), by striking the period at the end an'd .,,, inserting "; and", and
(D) by inserting after paragraph (5) the following new paragraph: "(6) in the case of outpatient rural primary care hospital services, the amounts described in section 1834(g).". (2) Section 1834 of such Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: "(g) PAYMENT FOR OUTPATIENT RURAL PRIMARY CARE HOSPITAL SERVICES.— "(1) IN GENERAL.—The amount of payment for outpatient rural primary care hospital services provided during a year before 1993 in a rural primary care hospital under this part shall be determined by one of the 2 following methods, as elected by the rural primary care hospital: "(A) COST-BASED FACILITY FEE PLUS PROFESSIONAL CHARGES.— "(i) FACILITY FEE. — With respect to facility services, not including any services for which payment may be made under clause (ii), there shall be paid amounts equal to the amounts described in section 1833(a)(2)(B) (describing amounts paid for hospital outpatient serv- ices). "(ii) REASONABLE CHARGES FOR PROFESSIONAL SERV- ICES.—In electing treatment under this subparagraph, payment for professional medical services otherwise _ included within outpatient rural primary care hospital services shall be made under such other provisions of this part as would apply to payment for such services if they were not included in outpatient rural primary care hospital services. "(B) ALL-INCLUSIVE RATE. —With respect to both facility services and professional medical services, there shall be paid amounts equal to the costs which are reasonable and J related to the cost of furnishing such services or which are based on such other tests of reasonableness as the Secretary may prescribe in regulations, less the amount the hospital may charge as described in clause (i) of section 1866(a)(2)(A), but in no case may the payment for such services (other than for items and services described in section 1861(s)(10XA) and for items and services furnished in connection with obtaining a second opinion required under section 1164(c)(2), or a third opinion, if the second opinion was in disagreement with the first opinion) exceed 80 per- cent of such costs. "(2) DEVELOPMENT AND IMPLEMENTATION OF ALL INCLUSIVE, PROSPECTIVE PAYMENT SYSTEM.— Not later than January 1, 1993, the Secretary shall develop and implement a prospective pay- ment system for determining pa3mients under this part for outpatient rural primary care hospital services using a meth- odology that includes all costs in providing all such services (including related professional medical services) and that deter- mines the payment amount for such services on a prospective basis.".
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