103 STAT. 2144 PUBLIC LAW 101-239—DEC. 19, 1989 42 USC 1395WW. 42 USC 1395WW note. f. (ii) by redesignating subclause (II) as clause (ii) and by striking "subclause (I)" each place it appears in such Clause and inserting "clause (i)"; (C) in section 1886(d)(9)(B)(iiXIV), by striking "(D)(v)" and inserting "(D)(iii)"; (D) in section 1886(d)(9)(D)— zrC (i) by striking clause (iv), (ii) by transferring clause (iii) to the end and re- designating it as clause (iv), and by striking "(C)(iii)" and inserting "(H)", and (iii) by redesignating clause (v) as clause (iii); and (E) in section 1886(g)(3)(B), by striking "(d)(5)(C)(ii)" and inserting "(d)(SXDXiii). (3) CONTINUATION OF SOLE COMMUNITY HOSPITAL DESIGNATION FOR CURRENT SOLE COMMUNITY HOSPITALS.— Any hospital classi- fied as a sole community hospital under section 1886(d)(5)(C)(ii) of the Social Security Act on the date of the enactment of this Act that will no longer be classified as a sole community hospital after such date as a result of the amendments made by paragraph (1) shall continue to be classified as a sole community hospital for purposes of section 1886(d)(5)(D) of such Act. (f) CRITERIA AND PAYMENT FOR MEDICARE-DEPENDENT, SMALL RURAL HOSPITALS. — (1) CRITERIA.— Section 1886(d)(5) of the Social Security Act (42 U.S.C. 1395ww(d)(5)), as amended by subsection (e)(l)(A), is fur- ther amended by inserting after subparagraph (F) the following new subparagraph: "(G)(i) For any cost reporting period beginning on or after April 1, 1990, and ending on or before March 31, 1993, with respect to a subsection (d) hospital which is a medicare-dependent, small rural 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 (b)(3)(D), or "(II) the amount determined under paragraph (IXAXiii), whichever results in the greater payment to the hospital. "(ii) In the case of a m^icare dependent, small rural 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 period in providing inpatient hospital services, including the reasonable cost of maintaining necessary core staff and services. "(iii) The term 'medicare-dependent, small rural hospital' means, with respect to any cost reporting period to which clause (i) applies, any hospital— "(I) located in a rural area, ' "(II) that has not more than 100 beds, "(III) that is not classified as a sole community hospital under subparagraph (D), and "(IV) for which not less than 60 percent of its inpatient days or discharges during the cost reporting period beginning in fiscal year 1987 were attributable to inpatients entitled to bene- fits under part A.".
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