PUBLIC LAW 101-508 —NOV. 5, 1990 104 STAT. 1388-33 (B) Section 1886(d)(3)(C)(ii) (42 U.S.C. 1395ww(d)(3)(C)(ii)) is amended by striking "occurring—" and all that follows and inserting the following: "occurring on or after October 1, 1986, of an amount equal to the estimated reduction in the payment amounts under paragraph (5)(B) that would have resulted from the enactment of the amendments made by section 9104 of the Medicare and Medicaid Budget Reconciliation Amendments of 1985 and by section 4003(a)(l) of the Omnibus Budget Reconciliation Act of 1987 if the factor described in clause (iiXH) of paragraph (5)(B) (determined without regard to amendments made by the Omnibus Budget Reconciliation Act of 1990) were applied for discharges occurring on or after such date instead of the factor described in clause (ii) of that paragraph.". (4) No RESTANDARDIZING FOR RECENT ADJUSTMENTS.— (A) ADJUSTMENTS UNDER OBRA 1989. — Section 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)) is amended by striking the period at the end and inserting the following: ", except that the Secretary shall not exclude additional payments under such paragraph made as a result of the enactment of section 6003(c) of the Omnibus Budget Reconciliation Act of 1989.". (B) ADJUSTMENTS UNDER OBRA 1990.— Section 1886(d)(2)(C)(iv), as amended by subparagraph (A), is further amended by striking "1989." and inserting "1989 or the enactment of section 4002(b) of the Omnibus Budget Reconciliation Act of 1990.". (5) EFFECTIVE DATE. —The amendments made by paragraphs f^^Y^ 1395ww (1), (3), and (4)(B) shall apply to discharges occurring on or after January 1, 1991, the amendment made by paragraph (2) shall apply to discharges occurring on or after October 1, 1991, and the amendment made by paragraph (4)(A) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989. (c) PAYMENTS TO RURAL HOSPITALS. — (1) PHASE-OUT OF SEPARATE AVERAGE STANDARDIZED AMOUNTS.— Section 1886(b)(3)(B)(i) (42 U.S.C. 1395ww(b)(3)(B)(i)), as amended by subsection (a)(1), is further amended— (A) in subclause (VI), by striking "in all areas," and inserting "in a large urban or other urban area, and the market basket percentage increase minus 0.7 percentage point for hospitsds located in a rural area,"; (B) in subclause (VII), by striking "in all areas," and inserting "in a large urban or other urban area, and the market basket percentage increase minus 0.6 percentage point for hospitals located in a rural area,"; (C) in subclause (VIII), by striking "in all aregis, and" and inserting "in a large urban or other urban area, and the market basket percentage incresise minus 0.55 for hospitals located in a rural area,"; (D) in subclause (IX)— (i) by striking "1994" and inserting "1996", and (ii) by redesignating such subclause as subclause (XI); and (E) by inserting after subclause (VIII) the following new subclauses: note.
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