104 STAT. 1388-32 PUBLIC LAW 101-508—NOV. 5, 1990 (B) in subclause (VI)— (i) by striking "1991" and inserting "1994", and (ii) by redesignating such subclause as subclause (IX); and (C) by inserting after subclause (V) the following new subclauses: "(VI) for fiscal year 1991, the market basket percentage increase minus 2.0 percentage points for hospitals in all areas, "(VII) for fiscal year 1992, the market basket percentage increase minus 1.6 percentage points for hospitals in all areas, "(VIII) for fiscal year 1993, the market basket percentage increase minus 1.55 percentage point for hospitals in all areas, and". 42 USC 1395ww (2) EFFECTIVE DATE.—The amendments made by paragraph (1) °°*®- shall apply to payments for discharges occurring on or after January 1, 1991. (b) CHANGES IN DISPROPORTIONATE SHARE PAYMENTS.— (1) INCREASE FOR URBAN HOSPITALS WITH MORE THAN lOO BEDS. —Section 1886(d)(5)(F)(vii) (42 U.S.C. 1395ww(d)(5)(F)(vii)) is amended— (A) in subclause (I), by striking "greater than 20.2," and all that follows and inserting the following: "greater than 20.2 — "(a) for discharges occurring on or after April 1, 1990, and on or before December 31, 1990, (P-20.2)(.65) + 5.62, "(b) for discharges occurring on or after January 1, 1991, and on or before September 30, 1993, (P-20.2)(.7) + 5.62, "(c) for discharges occurring on or after October 1, 1993, and on or before September 30, 1994, (P-20.2)(.8) + 5.88, and "(d) for discharges occurring on or after October 1, 1994, (P-20.2)(.825) + 5.88; or"; and (B) in subclause (II), by striking "hospital, (P-15)(.6) + 2.5," and inserting the following: "hospital— "(a) for discharges occurring on or after April 1, 1990, and on or before December 31, 1990, (P-15)(.6) + 2.5, "(b) for discharges occurring on or after January 1, 1991, and on or before September 30, 1993, (P-15)(.6) + 2.5, "(c) for discharges occurring on or after October 1, 1993, (P-15)(.65) + 2.5,". (2) INCREASE FOR HOSPITALS WITH DISPROPORTIONATE INDIGENT CARE REVENUES.— Section 1886(d)(5)(F)(iii) (42 U.S.C. 1395ww(d)(5)(F)(iii)) is amended by striking "30 percent" and inserting "35 percent". (3) REPEAL OF SUNSET.— (A) IN GENERAL.— Section 1886(d) (42 U.S.C. 1395ww(d)) is amended by striking "and before October 1, 1995," each place it appears in paragraph (2)(C)(iv) and paragraph (5)(F)(i). (B) CONFORMING AMENDMENTS.—(A) Section 1886(d)(5)(B)(ii) (42 U.S.C. 1395ww(d)(5)(B)) is amended to read as follows: "(ii) For purposes of clause (i)(II), the indirect teaching adjustment factor for discharges occurring on or after May 1, 1986, is equal to 1.89 X (((1 + r) to the nth power) — 1), where 'r' is the ratio of the hospital's full-time equivalent interns and residents to beds and 'n' equals.405.".
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