PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2159 0*) PROPAC STUDY OF PAYMENTS TO RURAL SOLE COMMUNITY HOSPITALS AND SMALL RURAL HOSPITALS.— (1) STUDY.—The Prospective Payment Assessment Commis- sion (hereinafter referred to as the "Commission") shall conduct a study of the feasibility and desirability of— (A) using a cost-based reimbursement system to deter- mine the amount of payments to be made under the medi- care program to small rural hospitals and rural sole community hospitals for the operating costs of inpatient hospital services; (B) developing and applying alternative definitions of market share for use in determining the eligibility of hos- pitals for classification as sole community hospitals under section 1886(d)(5) of the Social Security Act; and (C) developing and applying a method for accounting for decreases in the number of inpatients served in determin- ing payment to small rural hospitals under section 1886(d) of the Social Security Act for the operating costs of in- patient hospital services. (2) REPORT.—By not later than May 1, 1990, the Commission shall submit a report to (Congress on the study conducted under paragraph (1). SEC. 6004. PPS-EXEMPT HOSPITALS. (a) EXEMPTION OF CANCER HOSPITALS FROM PROSPECTIVE PAYMENT CyQmyfcJT ^^m, (i) IN GENERAL.— Section 1886(d)(l)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(l)(B)) is amended— (A) in clause (iii), by striking "or"; , (B) in clause (iv), by striking the semicolon at the end and inserting ", or"; and (C) by inserting after clause (iv) the following new clause: "(v) a hospital that the Secretary has classified, at any time on or before December 31, 1990, (or, in the case of a hospital that, as of the date of the enactment of this clause, is located in a State operating a demonstration project under section 1814(b), on or before December 31, 1991) for purposes of applying excep- tions and adjustments to payment amounts under this subsec- tion, as a hospital involved extensively in treatment for or research on cancer;". (2) CONFORMING AMENDMENT.— Section 1886(d)(5)(I) of such - Act (as redesignated by section 6003(e)(l)(A)) is amended by striking "(including" and all that follows through "cancer)'. (3) EFFECTIVE DATE.— The amendments made by this subsec- 42 USC I395ww tion shall apply with respect to cost reporting periods beginning ^°^- on or after October 1, 1989, except that— (A) in the case of a hospital classified by the Secretary of Health and Human Services as a hospital involved exten- ->•- sively in treatment for or research on cancer under section 1886(d)(5)(I) of the Social Security Act (as redesignated by section 6003(e)(l)(A)) after the date of the enactment of this Act, such amendments shall apply with respect to cost reporting periods beginning on or after the date of such classification, (B) in the case of a hospital that is not described in subparagraph (A), such amendments shall apply with re- spect to portions of cost reporting periods or discharges
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