103 STAT. 2152 PUBLIC LAW 101-239—DEC. 19, 1989 hospital services if furnished to an inpatient of a hospital by a hospital.". (B) COVERAGE AND PAYMENT.— (i) Section 1812(a)(l) of such Act (42 U.S.C. 1395d(a)(l)), as restored by the Medicare Catastrophic Coverage Repeal Act of 1989, is amended by inserting "and inpatient rural primary care hospital serv- ices" before the semicolon. (ii) Section 1814(a) of such Act (42 U.S.C. 1395f(a)) is amended— (I) by striking "and" at the end of paragraph (6), (II) by striking the period at the end of paragraph (7) and inserting "; and", and 'V (III) by inserting after paragraph (7) the following new paragraph: "(8) in the case of inpatient rural primary care hospital services, a physician certifies that such services were required to be immediately furnished on a temporary, inpatient basis.". - (iii) Section 1814 of such Act is further amended— (I) in subsection (b), by inserting ", other than a rural primary care hospital providing inpatient rural pri- mary care hospital services," after "providing hospice ^ care", and (II) by adding at the end the following new subsection: "Payment for Inpatient Rural Primary Care Hospital Services "(IXD The amount of payment under this part for inpatient rural primary care hospital services— "(A) in the case of the first 12-month cost reporting period for which the facility operates as such a hospital, is the reasonable costs of the facility in providing inpatient rural primary care hospital services during such period, as such costs are deter- mined on a per diem basis, and "(B) in the case of a later reporting period, is the per diem payment amount established under this paragraph for the preceding 12-month cost reporting period, increased by the applicable percentage increase under section 1886(b)(3)(B)(i) for that particular cost reporting period applicable to hospitals located in a rural area. The payment amounts otherwise determined under this paragraph shall be reduced, to the extent necessary, to avoid duplication of any payment made under section 1820(a)(2) (or under section 4005(e) of the Omnibus Budget Reconciliation Act of 1987) to cover the provi- sion of inpatient rural primary care hospital services. "(2) The Secretary shall develop a prospective payment system for determining payment amounts for inpatient rural primary care hospital services under this part furnished on or after January 1, 1993.". (C) TREATMENT OF RURAL PRIMARY CARE HOSPITALS AS ^ ', PROVIDERS OF SERVICES.^i) Section 1861(u) of such Act (42 U.S.C. 1395x(u)) is amended by inserting "rural primary care hospital," after "hospital,". ^^ (ii) Section 1863 of such Act (42 U.S.C. 1395z) is amended by striking "and (jjX3)" and inserting "(ijX3), and (mmXD". (iii) The first sentence of section 1864(a) of such Act (42 U.S.C. 1395aa(a)) is amended by inserting ", a rural primary
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