103 STAT. 2142 PUBLIC LAW 101-239—DEC. 19, 1989 42 USC 1395WW note. 42 USC 1395WW note. (ii) by redesignating subclauses (II) and (III) as ,.:^ subclauses (III) and (IV), and (iii) by inserting after subclause (I) the following new subclause: "(II) 30 percent, if the hospital is located in a rural area and has more than 100 beds, or is located in a rural area and is classified as a sole community hospital under subparagraph (D),", and (C) by adding at the end the following new clause: "(viii) The formula used to determine the disproportionate share adjustment percentage for a cost reporting period for a hospital described in clause (ivXIV) or (ivXV) is the percentage determined in accordance with the following formula: (P-30X.6)+4,0, where 'P' is the hospital's disproportionate patient percentage (as defined in clause (vi)).". (3) INCREASE FOR HOSPITALS WITH DISPROPORTIONATE INDIGENT CARE REVENUES.— Section 1886(d)(5)(F)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(F)(iii)) is amended by striking "25 percent" and inserting "30 percent". (4) EFFECTIVE DATE. — The amendments made by this subsec- tion shall apply with respect to discharges occurring on or after April 1, 1990. (d) EXTENSION OF REGIONAL REFERRAL CENTER CLASSIFICATION.— Any hospital that is classified as a regional referral center under section 1886(d)(5)(C) of the Social Security Act as of September 30, 1989, including a hospital so classified as a result of section 9302(d)(2) of the Omnibus Budget Reconciliation Act of 1986, shall continue to be classified as a regional referral center for cost reporting periods beginning on or after October 1, 1989, and before October 1, 1992. (e) CRITERIA AND PAYMENT FOR SOLE (DOMMUNITY HOSPITALS. — (1) IN GENERAL. —(A) Section 1886(d)(5) of the Social Security Act (42 U.S.C. 1395ww(d)(5)) is amended— (i) by transferring clause (iv) of subparagraph (C) to the end and by redesignating it as subparagraph (H), (ii) by transferring clause (iii) of subparagraph (C) to the end and by redesignating it as subparagraph (I), (iii) in subparagraph (D), by striking "(D)(i)" and inserting "(E)(i)",and (iv) by amending clause (ii) of subparagraph (C) to read as follows: "(D)(i) For any cost reporting period beginning on or after April 1, 1990, with respect to a subsection (d) hospital which is a sole community hospital, payment under paragraph (I)(A) shall be— "(I) an amount based on 100 percent of the hospital's target amount for the cost reporting period, as defined in subsection ^t" a)X3XC),or "(II) the amount determined under paragraph (IXAXiii), whichever results in greater payment to the hospital. "(ii) In the case of a sole community hospital that experiences, in a cost reporting period compared to the previous cost reporting period, a decrease of more than 5 percent in its total number of inpatient cases due to circumstances beyond its control, the Secretary shall provide for such adjustment to the payment amounts under this subsection (other than under paragraph (9)) as may be necessary to fully compensate the hospital for the fixed costs it incurs in the
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